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Generate impression based on findings. | Head CT: There is no acute intracranial hemorrhage, mass-effect, or midline shift. There is mild hypoattenuation of the white matter of the cerebral hemispheres most consistent with mild chronic small vessel ischemic disease. Gray-white differentiation is preserved. The ventricles and cisterns appear normal. The calvarium is unremarkable without fracture.Cervical spine CT: Alignment is within normal limits. Vertebral body heights and disk spaces are preserved without fracture. There are small anterior osteophytes and a small disk osteophyte complex at C6-7, without high grade central canal or neuroforaminal stenosis at any level. There is facet arthropathy at left C5-6 with mild fragmentation and is likely chronic. There are atherosclerotic calcifications of the carotid bifurcations. Otherwise, the paraspinal soft tissues appear unremarkable.Maxillofacial CT: There is no acute fracture or malalignment. There is deformity involving the medial left orbital wall likely related to remote medial orbital blowout fracture and unchanged since 5/12/2014. Septal perforation is noted similar to prior. Otherwise, the paranasal sinuses appear unremarkable. The orbits are unremarkable. | 1. No acute intracranial abnormalities. 2. No maxillofacial fracture. Chronic left medial orbital blowout fracture.3. No cervical spine or skull fracture. 4. Nasal septal perforation. 5. 1 cm right parotid nodule. Differentials include enlarged lymph node and primary parotid neoplasm. |
Generate impression based on findings. | 68-year-old male with squamous cell carcinoma base of tongue and new diagnosis prostate cancer. Evaluate for metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral benign cortical cyst. No other significant abnormality seenRETROPERITONEUM, LYMPH NODES: Paucity of intra-abdominal/intrapelvic fat makes delineation difficult, but no definite enlarged lymph nodes identified. No significant abnormality notedBOWEL, MESENTERY: Percutaneous gastrostomy tube with expected position and appearance. Gastrointestinal contrast material has exited stomach and progressed through the small bowel into colon without evidence of obstruction or visible intrinsic abnormalities. No free peritoneal fluid.BONES, SOFT TISSUES: Numerous sclerotic foci throughout the thoracic and lumbar vertebral bodies most consistent with prostate carcinoma metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Paucity of intra-abdominal/intrapelvic fat makes delineation difficult, but no definite enlarged lymph nodes identified. No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Numerous focal small sclerotic foci seen throughout the pelvic bony structures most consistent with prostate carcinoma metastases.OTHER: No significant abnormality noted | 1. Diffuse sclerotic foci throughout the abdominal/pelvic bony structures most consistent with prostate carcinoma metastases. Nuclear medicine bone scan is a more accurate indicator of skeletal metastatic disease activity. 2. No evidence for adenopathy although lack of intra-abdominal fat makes delineation of soft tissues difficult. |
Generate impression based on findings. | 65 years, Male, Reason: eval for progression History: metastatic RCC. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. Subcentimeter nodules along the minor fissure is likely represents intrapulmonary lymph nodes. No suspicious nodules or masses.MEDIASTINUM AND HILA: Mildly enlarged precarinal node measures 1.9 x 1.2 cm (3/44), previously 1.6 x 1.1 cm.. Enlarged subcarinal node. Moderate coronary artery calcifications. Mild right hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Peri-splenic nodule measures 2.2 x 1.7 cm (3/100), previously 1.9 x 1.5 cm.. This is hyperattenuating compared to the spleenPANCREAS: Prominent pancreatic duct is unchanged.ADRENAL GLANDS: Left adrenal nodule which does not fit criteria for an adenoma measures 4.6 x 2.6 cm, previously 4.1 x 2.0 cm. Status post resection of right adrenal gland.KIDNEYS, URETERS: Status post right nephrectomy with mild thickening of soft tissues in this region which may be postsurgical. Cortical hyperattenuating lesion left kidney lesion measures 9 mm (3/121), unchanged.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications aneurysmal dilatation of the or infrarenal abdominal aorta measuring 3.6 x 2.4 cm. areas of intramural thrombus is unchanged. Mildly enlarged left para-aortic node measuring 1.8 x 1.0 cm (3/143), previously 1.2 x 0.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below. Degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Right inguinal hernia containing a small portion of bladder.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large right sacral lytic lesion with soft tissue component measures 5.8 x 5.3 cm (3/162), previously 5.1 x 4.8 cm.OTHER: No significant abnormality noted. | 1.Large sacral lesion with a soft tissue component is increased in size and likely represents a metastases.2.Left adrenal lesion is increased in size well, suspicious for metastases.3.Mild mediastinal and retroperitoneal lymphadenopathy is increased.4.Perisplenic nodule is higher attenuation than the spleen, suspicious for a metastases and slightly increased in size.5.Infrarenal abdominal aortic aneurysm. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild rightward convexity of the lumbar spine. The vertebral body and disk heights are not significantly changed, although there is mild disk desiccation along the mid lumbar spine. No worrisome focal marrow signal abnormality is appreciated. There is a new Schmorl's along the inferior endplate of L1, with surrounding STIR hyperintensity suggestive of mild marrow edema which likely is reactive. Additional areas rounded STIR hyperintensity are noted along the inferior endplate of L2 and superior endplate of L3 which may indicate impending Schmorl's nodes. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.At T11-T12, sagittal images suggest a tiny central disk extrusion migrating minimally cranially with annular fissure, indenting the ventral thecal sac. There is mild bilateral facet arthropathy and ligamentum flavum thickening.At T12-L1, there is very minimal shallow right paracentral disk protrusion.At L1-L2, there is a stable mild disk bulge with left paracentral prominence. There is minimal left facet arthropathy.At L2-L3, there is a stable mild disk bulge with mild bilateral facet arthropathy. The disk approaches the descending left L3 nerve roots and results in mild to moderate left foraminal narrowing. At L3-L4, there is a stable mild disk bulge although with slight right for a lateral progression. There is moderate bilateral facet arthropathy and ligamentum flavum thickening. Overall there is mild to moderate central spinal stenosis with slight narrowing of the lateral recesses. The disk abuts the descending left L4 nerve roots. There is slight prominence of dorsal epidural fat. There is mild bilateral foraminal narrowing.At L5-S1, there is no significant disk pathology or stenosis. There is minimal facet arthropathy. | No significant interval change in mild scattered spondylotic changes except for recent Schmorl's node formation along the inferior endplate of L1 and possible impending Schmorl's formation at the L2-L3 level. A mild to moderate central spine canal stenosis at L3-L4 and mild to moderate left foraminal narrowing at L2-L3. |
Generate impression based on findings. | TachypneaVIEW: Chest AP Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the right upper lobe and left lower lobe. No pleural effusion or pneumothorax. Probable gallstones at the right upper quadrant. | Patchy atelectasis bilaterally without focal lung opacity. |
Generate impression based on findings. | There are atherosclerotic changes involving the bilateral cavernous internal carotid arteries. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is diffuse irregularity and mild narrowing involving the distal vertebral arteries without high-grade stenosis. There is more focal right vertebral artery stenosis proximal to the vertebrobasilar junction. The basilar artery and posterior cerebral arteries are patent with no significant stenosis. Patent left posterior communicating artery. Right posterior communicating artery not definitively seen. No evidence of aneurysms or vascular malformationsMRA NECK | Overall mild intracranial and extracranial atherosclerotic disease. There is at least moderate focal stenosis involving the right distal vertebral artery proximal to the vertebrobasilar junction, which is better seen on the postcontrast images. There is more diffuse mild narrowing of the bilateral distal vertebral arteries without evidence of flow-limiting stenosis. Basilar artery is patent. Otherwise, no significant stenosis involving the intracranial or extracranial vasculature in the neck. |
Generate impression based on findings. | 76-year-old male with hemorrhage of gastrointestinal tract.? Diverticulosis.? Diverticulitis.? Recurrent renal carcinoma. ABDOMEN:LUNG BASES: Calcified right base granulomas. No other significant abnormalities.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Calcified granulomas without other significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Prior right nephrectomy with no evidence of recurrent tumor in the surgery bed. Left kidney shows numerous benign-appearing cysts without other significant abnormality. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic changes seen in the aorta with diffuse calcifications and peripheral mural thrombus which significantly narrows the intraluminal diameter. No significant aneurysmal dilatation is seen. Aorta bifurcates into common iliac arteries with marked narrowing of intraluminal lumen with peripheral atherosclerotic plaques and calcification. Within limits of the venous phase CT, marked narrowing is seen throughout both common and external iliac arteries.No lymphadenopathy seen. BOWEL, MESENTERY: Orally administered gastrointestinal contrast rapidly progresses through the normal appearing stomach and small bowel the cecum without evidence of obstruction or intrinsic abnormality. The colon is filled with fecal material throughout. Diverticular changes are seen about the cecum and ascending colon and again in the descending colon and extensive and large diverticular changes are seen in the sigmoid colon. No evidence of acute inflammatory changes seen and no extracolonic fluid collections to suggest abscess are seen.No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Markedly enlarged nodular prostate without other abnormality.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered gastrointestinal contrast rapidly progresses through the normal appearing stomach and small bowel the cecum without evidence of obstruction or intrinsic abnormality. The colon is filled with fecal material throughout. Diverticular changes are seen about the cecum and ascending colon and again in the descending colon and extensive and large diverticular changes are seen in the sigmoid colon. No evidence of acute inflammatory changes seen and no extracolonic fluid collections to suggest abscess are seen.No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Right colon, descending colon and sigmoid diverticular changes as described above. No evidence complication seen. 2. Marked atherosclerotic changes of the aorta and iliac arteries. 3. Status post right nephrectomy without evidence for recurrent or metastatic tumor. 4. No other significant abnormalities seen. |
Generate impression based on findings. | Pain and swelling Moderate osteoarthritis affects the interphalangeal joint of the thumb. A small ossicle along the radial aspect of the IP joint is noted. | Osteoarthritis. |
Generate impression based on findings. | Female 71 years old Reason: diastasis vs. Hernia History: probably diastasis on CT chest. The exam is not sensitive for detecting lesions in the solid organs of vasculature due to lack of intravenous contrast. Given nodes limitation, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. No evidence of intrahepatic or extra right biliary dilatation. New small hypodense lesions in the liver not fully characterized to the lack of contrast but likely cysts or hemangiomas.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes aorta. No evidence of aneurysm.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: Broad-based protuberant abdomen with thinning of abdominal musculature. No evidence of diastases and no frank hernia sac. The hernia contains non-obstructed colon, stomach omentum and mesentery. Flowing syndesmophytes consistent with ankylosing spondylitis.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Finding to syndesmophytes consistent with ankylosing spondylitis. No evidence of fracture.OTHER: No significant abnormality noted | Cholelithiasis. Broad-based ventral hernia in the upper abdomen and generally protuberant abdomen with thinned (but not diastatic) musculature.Osseous changes in the lumbosacral spine suggestive of ankylosing spondylitis. |
Generate impression based on findings. | 65 year old woman with history of right breast cancer s/p mastectomy. Now with right supraclavicular lymphadenopathy, core biopsy for ER, PR, and HER2. Right ultrasound re-identified the target lymph node for biopsy. The lesion to be targeted is a large, predominantly hypoechoic mass measuring 3.5 x 2.6 cm in the right supraclavicular space with increased non-hilar vascularity. The target node was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right supraclavicular region was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (InRad) specimens were obtained of the lesion using open-trough technique. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent. Whitish tissue was noted throughout all specimens.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. Abe and Patel. Dr. Abe was present during the procedure at all times. | Successful ultrasound guided core biopsy of an abnormal right supraclavicular lymph node obtained for markers. Pathology is pending at this time.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female 75 years old Reason: pain History: pain. Severe osteoarthritis affects the right hip and mild osteoarthritis affects left hip. Chronic enthesopathic changes along the iliac wings may not be of any current clinical significance. Degenerative arthritic changes affect the lower lumbar spine. Mild osteoarthritis also affect the sacroiliac joints. | Osteoarthritis as above. |
Generate impression based on findings. | Female 49 years old Reason: prosthetic assess History: post-op. Two views of the left hip show hardware components of a left total hip arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. AP view of the pelvis shows the aforementioned left total hip arthroplasty. Degenerative arthritic changes affect the visualized lower lumbar spine. | Left total hip arthroplasty. |
Generate impression based on findings. | New squamous cell carcinoma of larynx, status post urgent tracheostomy and elevated PSA concerning for prostate malignancy. There are postoperative findings related to tracheostomy tube insertion with interval resolution of the extensive multicompartment emphysema in the neck. There is a heterogeneous, infiltrative mass centered in the right supraglottic region with extension into the hypopharynx and base of tongue that measures up to at least 4 cm, with extension across the midline. There is effacement of the laryngeal ventricles and infiltration of the right paraglottic space, but no evidence of tumor extension into the subglottic region. There is a heterogeneous appearance of the tracheal cartilages that may be due to tumor invasion, but the outer cortex appears to be intact, without discernible extension of tumor into strap muscles. There are bilateral air-filled laryngoceles, left larger than right. There is right level 3 lymphadenopathy that appears to measure up to approximatively 2 cm, although assessment is limited due to the lack of fat planes. There are numerous sclerotic bone lesions throughout the imaged axial skeleton. The airway inferior to the tracheostomy tube is clear. There is a midline thyroidotomy, but the thyroid tissue otherwise appears unremarkable. The major salivary glands are unremarkable. There is atherosclerotic plaque at the bilateral carotid bifurcations. There are multiple dental caries. The imaged intracranial structures are unremarkable. There are emphysematous changes in the partially imaged lungs. | 1. Postoperative findings related to tracheostomy tube insertion with interval resolution of extensive multicompartment emphysema in the neck. 2. A necrotic infiltrative mass centered in the supraglottic region with extension into the tongue base that measures up to at least 4 cm and extends across the midline is compatible with squamous cell carcinoma. Further characterization of the mass is limited and MRI or PET may be useful for additional evaluation.3. Right level 3 lymphadenopathy is compatible with metastatic disease, although assessment is limited due to the lack of fat planes related to cachexia. Further characterization of the mass is limited and MRI or PET may be useful for additional evaluation of this as well.4. Numerous sclerotic bone lesions throughout the imaged axial skeleton likely represent metastases, prehaprs related to prostate cancer.5. Multiple dental caries. |
Generate impression based on findings. | Left chest painVIEW: Chest AP Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax. No displaced rib fracture. | No displaced rib fracture. If there is continued clinical concern for rib injury, dedicated rib radiographs could be obtained for further evaluation. |
Generate impression based on findings. | Male 46 years old Reason: mass or stone? History: asymptomatic hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No nephroureteral calculus. No hydronephrosis. No filling defects within the ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel thickening or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is normal size.BLADDER: No filling defects within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No radiographic findings to explain patient's hematuria. |
Generate impression based on findings. | NG placementVIEW: Chest AP and abdomen AP ET tube tip below thoracic inlet and above the carina. Placement of a nasogastric tube with interval decompression of the stomach which is located in the right hemithorax. The liver is herniated into the right hemithorax with the tip of the umbilical vein within the left portal vein. Partially decompressed bowel loops in the right hemithorax. The umbilical arterial catheter is at T8. There is mediastinal shift from right to left. Disorganized nonobstructive bowel gas pattern. | Placement of a nasogastric tube with interval decompression of the stomach. Right-sided diaphragmatic hernia as described above. |
Generate impression based on findings. | Male 48 years old; Reason: Pre-op for L UKA History: same Moderate to severe degenerative changes are noted at the knee joint, with focal depression of the weight-bearing surface of the medial femoral condyle suggestive of an insufficiency fracture and similar to the prior MRI. The hip and ankle joints appear unremarkable. | Degenerative changes, as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Images are somewhat limited by patient motion. There is mild diffuse ill-defined diffusion restriction within the cerebral white matter bilaterally predominantly in the frontal lobes, involving the centrum semiovale and extending along the corona radiata into the posterior limb of the internal capsules. The pattern is very symmetrical with sparing of the subcortical U-fibers. There is additional diffusion restriction centrally within the pons with extension along the transverse fibers and into the bilateral brachium pontis, surrounding the dentate nuclei. Responding areas of T2/FLAIR hyperintensity, without corresponding T1 abnormality. There is additional patchy T2/FLAIR hyperintensity within the periventricular white matter especially along the posterior body and atria of the lateral ventricles. Assessment for abnormal signal in the periaqueductal gray is difficult due to motion artifact.The ventricles and sulci are prominent, consistent with moderate-severe volume loss, greater than expected for the patient's stated age. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Symmetric appearing abnormal mild diffusion restriction within the cerebral white matter bilaterally, predominantly anteriorly within the centrum semiovale extending into the posterior limb of the internal capsules. There is also symmetric involvement of the central pons and bilateral brachium pontis.Differential diagnosis would include a demyelinating process such as toxic demyelination or PRES from uremic encephalopathy, and viral encephalitis, with probable underlying component of HIV encephalopathy. PML is felt to be less likely given the very symmetric pattern of findings and lack of subcortical U-fiber involvement. MR spectroscopy could be considered for further evaluation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There is a focal asymmetry at upper inner quadrant in the right breast.Stable postsurgical volume loss and architectural distortion are present in the left breast. Stable benign calcifications are present. No suspicious microcalcifications or areas of architectural distortion are present. | A focal asymmetry at upper inner quadrant in the right breast. Spot compression views and possible ultrasound study are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Follow-up of metastatic nasopharyngeal carcinoma that progressed through carboplatin/cetuximab/5FU. Neck: There is no evidence of measurable mass lesions in the nasopahrynx. There is an unchanged mildly prominent right level 1A lymph node that measures up to 9 mm in short axis. Otherwise, there is no significant lymphadenopathy in the neck. However, there is partially imaged upper mediastinal lymphadenopathy. The thyroid and major salivary glands appear unchanged. The major cervical vessels are patent. There is a right internal jugular venous catheter. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable. Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is persistent partial opacification of the left sphenoid sinus. The skull and scalp soft tissues are unremarkable. | 1. No evidence of measurable mass lesions in the nasopharynx. 2. Unchanged nonspecific mildly prominent right level 1A lymph node.3. No evidence of intracranial metastases.4. Partially imaged upper mediastinal lymphadenopathy compatible with metastatic disease. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable circumscribed mass is present at upper inner quadrant in the right breast.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 66 years old Reason: Assess for metastatic cancer History: Iron def anemia; 50 # wt loss, CEA 17. CHEST:LUNGS AND PLEURA: Large right middle lobe mass adjacent to and just inferior to the minor fissure which measures 5.3 x 4.3 cm (series 4, image 63). There is an additional nonspecific micronodule in the right lower lobe (series 4, image 81).MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No biliary ductal dilatation or focal hepatic mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left lower pole focus which has intrinsically high-attenuation but is too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No definitive colonic mass visualized. No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Degenerative changes of thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymphadenopathy with reference right inguinal lymph node measuring 1.1 cm in the short axis (series 3, image 102).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1.Large right middle lobe lung mass as above.2.No definitive primary or metastatic lesion is visualized.3.Pelvic lymphadenopathy. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is mostly fatty replaced. Three benign circumscribed masses are present in the right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Male 56 years old Reason: prosthetic assess History: post-op. Two views of the right hip show hardware components of a right total hip arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. Two views of the left hip show hardware components of a left total hip arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. AP view of the pelvis shows the aforementioned bilateral total hip arthroplasties. Degenerative arthritic changes affect the visualized lower lumbar spine. | Bilateral total hip arthroplasties in near-anatomic alignment. |
Generate impression based on findings. | Deviated nasal septum; recurrent epistaxis. The paranasal sinuses are clear. The nasal cavity is also clear. There is a left concha bullosa. The nasal septum is slightly deviated towards the right. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | 1. Slight nasal septal deviation to the right with associated left concha bullosa. 2. No evidence of sinusitis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Male 65 years old Reason: pain History: pain. We have two views of the right hip and 3 views of the pelvis showing hardware components of a right total hip arthroplasty device situated in near anatomic alignment. Slightly eccentric positioning of the prosthetic femoral head in the acetabular cup may reflect minimal linear wear. There is lucency along the medial aspect of the acetabular component which is of uncertain significance and could conceivably reflect mild particle wear osteolysis, but this is equivocal. Additional lucency projecting over the superior acetabulum likely reflects overlying bowel gas. In addition to the acetabular cup screw, two additional screws overlie the acetabular cup component, presumably affixing the adjacent bony acetabulum.There is extensive heterotopic ossification extending superiorly from the femoral component. Overall, the bones appear demineralized. Moderate osteoarthritis affects the left hip and degenerative arthritic changes affect the visualized lower lumbar spine. The right sacroiliac joint is not visualized and may be ankylosed. | Right total hip arthroplasty and other findings as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign biopsy in 2006. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. There is a circumscribed oval shaped mass at upper outer quadrant in the left breast, with internal marker clip, indicating a previous biopsy. This could calcifications is seen at upper inner quadrant in the right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Clinical correlation is recommended for the previously biopsied mass in the left breast. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Mammogram works best when searching for changes. Submission of prior mammogram is, therefore, recommended for future reference. If the patient submits her old mammograms, we can compare them with the current study to establish stability.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | PICC placement. Perforated appendicitis.VIEW: Chest AP (one view) 02/25/15, 0839 Feeding tube tip is in gastric antrum. Left upper extremity PICC has its tip in right atrium.Bilateral pleural effusion with right larger is noted. Opacities are seen in medial bases. Cardiac silhouette size is normal. The aortic arch, cardiac apex, and stomach are left-sided. | Left upper extremity PICC tip in right atrium. |
Generate impression based on findings. | 4 year old female with cystic kidney. KIDNEYS Cortical Echogenicity: Normal echogenicity with multiple scattered cortical based cysts bilaterally which are unchanged, the largest measuring 0.6 cm x 0.6 cm x 0.7 cm on the right and 1.4 cm x 1.5 cm x 1.0 cm on the left. Nonspecific punctate echogenic focus with no shadowing measuring 1 mm in length. Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 7.8 cm Left: 7.5 cm Mean for age: 7.5 cm Range for age: 6.5 - 8.5 CmADDITIONAL OBSERVATIONS: Debris in the bladder | 1. Multiple renal cysts not significantly changed.2. Debris in the bladder. 3. Nonspecific punctate echogenic focus in the left kidney.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning.Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | 71-year-old male with breast cancer; surgery 2/25/15 Left SNBx left mastectomy possible CALND with reverse mapping.RADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.52 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. Three foci of increased activity were noted in the left axilla, representing the sentinel nodes. This regions were marked with an indelible marker. | Three sentinel nodes were identified in the left axilla and marked. |
Generate impression based on findings. | 77-year-old male with renal failure. Status post renal transplant. Within the limits of a non-IV contrast-enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: Chronic interstitial parenchymal disease at left lung base greater than right lung base. Dendriform ossification is seen in association with the interstitial parenchymal lung disease.LIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma severely limited evaluation due to lack of IV contrast. Large solitary gallstone without other biliary tract complication seen.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic renal parenchyma is seen with bilateral hydronephrosis with dilated ureters seen extending to a right lower quadrant ileal loop urinary diversion. Peripelvic stranding into the adjacent fat is seen which may reflect chronic edema or inflammatory change. Diffuse calcifications of varying size are seen in the renal parenchyma scattered bilaterally. Two of these calcifications are associated with mass lesions -- both are cystic lesions (in left kidney series 3, image 87 and the right kidney series 3, image 75 and coronal image 42)) which have peripheral rim calcification around a near water density cyst and presumably represent benign cysts although lack of IV contrast limits definitive characterization. Other small cysts are seen in the cortex bilaterally. One exophytic right renal lesion (series 3, image 54) measures 56HU and may represent a high density cyst, but without IV contrast, neoplasm cannot be excluded.Right renal transplant in right iliac fossa. Marked hydronephrosis is seen with cortical thinning. Ureter does not appear dilated to the ilial diversion.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes with calcification is seen about the aorta without aneurysmal dilatation. Scattered small but slightly prominent lymph nodes are seen throughout the retroperitoneum. Largest of these (series 3, image 78) measures 1.6 x 1.0 cm.BOWEL, MESENTERY: Lack of orally administered contrast limits evaluation of the gastrointestinal tract. Small hiatal hernia is seen with otherwise unremarkable stomach. Small bowel appears normal other than postoperative changes from urinary conduit diversion procedure. Colon is filled with fecal material with a descending left colostomy and a Hartmann's pouch. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior cystoprostatectomy.BLADDER: Prior cystectomy. Calcified and soft tissue density lesion is seen in the left cystectomy and bed (series 3, image 144) of uncertain significance but bladder cancer recurrence usually does not have calcifications in this most likely represents a benign abnormality, although comparison with outside prior imaging would be helpful to confirm this.LYMPH NODES: Scattered small but slightly prominent lymph nodes are seen scattered. Largest of these measures 1.2 x 1.0 cm (series 3, image 106) in the right common iliac chain. No lymphadenopathy is seen more distally..BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Prior cystoprostatectomy. Abnormal calcified density in surgical bed most likely represents postoperative benign process, but comparison with prior outside imaging if available would be helpful to confirm stability. 2. Atrophic native kidneys and hydronephrotic transplant right iliac fossa kidney. Numerous in right urinary conduit diversion. 3. Descending colostomy. 4. Scattered small but slightly prominent para-aortic and pelvic lymph nodes of uncertain significance. Comparison with any prior oral outside imaging would be helpful to confirm stability and exclude potential neoplastic disease. 5. Probable high density benign right renal cyst, but without IV contrast, neoplasm cannot be excluded. 6. Bilateral all near water density cysts with associated peripheral rim calcification -- calcification increases concern over neoplasm could appears to represent Bosniak two thin calcification without associated soft tissue mass, indicating benign nature. However lack of IV contrast limits definitive evaluation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Scattered benign calcifications seen in both breast.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 69 year old woman with history of right breast DCIS, on therapy. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy clips are noted in the right lower inner breast at anterior and middle depth. Pleomorphic calcifications spanning the area between the biopsy clips appear similar to the prior examination, as do other calcifications. There are no new dominant masses, suspicious microcalcifications, or areas of architectural distortion in the right breast. Resolving post biopsy hematoma is noted near the Trimark clip. | Stable appearing calcifications in the right breast without new mass or suspicious calcifications. Recommend followup with and clinical management as per breast surgery. Results and recommendations discussed with patient. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | 35 years, Female. Reason: constipation? History: constipation, abdominal bloating Cardiomediastinal silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax.Nonobstructive bowel gas pattern. No significant stool burden. No pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female; 65 years old. Reason: endometrial cancer compare to last CT and measure 1) retroperitoneal soft tissue attenuation, 2) left paraaortic lymph node 3) left external iliac lymph node. History: post 2 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Scattered punctate micronodules seen bilaterally are unchanged. No suspicious pulmonary nodules or masses. Mild subsegmental atelectasis/scarring. No pleural effusions or focal areas of consolidation.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 1.0 x 0.7 cm, previously 1.2 x 0.7 cm (series 3, image 35). This node does not meet CT size criteria for lymphadenopathy and is likely a normal finding, given that it is unchanged since the most remote comparison study from 10/22/2014. No new mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No coronary calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Unchanged subcentimeter segment 2 hepatic cyst. Cholelithiasis without evidence of acute cholecystitis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate hypodensities in left lower pole are too small to definitively characterize but likely benign. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic aortic calcification. IVC filter unchanged. Numerous small clustered aortocaval lymph nodes are noted, left greater than right, many of which do not meet size criteria for lymphadenopathy. Reference left para-aortic lymph node measures 1.6 x 0.9 cm, previously 1.8 x 0.9 cm (series 3, image 121). Poorly defined retroperitoneal soft tissue attenuation measures 1.7 x 1.2 cm, unchanged (series 3, image 127). Scattered mesenteric and gastrohepatic lymph nodes, also not meeting size criteria for lymphadenopathy.BOWEL, MESENTERY: Small hiatal hernia. Ventral abdominal hernia containing loops of small bowel is not significantly changed. No evidence of bowel obstruction, strangulation, or free air.BONES, SOFT TISSUES: Multilevel spinal degenerative changes. Soft tissue nodularity in the subcutaneous fat of the ventral abdominal wall likely secondary to prior injections.OTHER: No free fluid or drainable fluid collection.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac lymph node measures 1.3 x 1.0 cm, previously 1.3 x 0.8 cm (series 3, image 159). This lymph node is located adjacent to the left ureter but no associated ureteral dilatation is seen. Multiple additional external iliac and pelvic lymph nodes are seen bilaterally but are not enlarged. BOWEL, MESENTERY: See above discussion.BONES, SOFT TISSUES: See above discussion.OTHER: No significant abnormality noted. | 1.No significant interval change in retroperitoneal and pelvic lymph nodes. Please see reference measurements above. 2.No new sites of disease identified. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered benign calcifications and mild arterial calcifications are again seen in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present. Pacemaker obscures the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 63 years, Male. Reason: eval for sbo History: abdominal pain Dobbhoff tube projects over the proximal gastric body. Nonobstructive bowel gas pattern. Partially visualized central venous catheter tip is at the superior cavoatrial junction. | Dobbhoff tube projects over the proximal gastric body. |
Generate impression based on findings. | 9-year-old female, evaluate for pes planus deformityVIEW: Right foot, AP, oblique, and lateral (3 views), left foot, AP, oblique, and lateral (3 views) Right foot: Alignment is anatomic. No pes planus deformity. The osseous structures are normal for the patient's age.Left foot: Alignment is anatomic without pes planus deformity. The osseous structures appear normal for the patient's age. | Normal examination without pes planus deformity. |
Generate impression based on findings. | Female 51 years old; Reason: Patient with pain at wrist after pulling injury. Concern for microfracture. History: pain with movement of left thumb We see no fracture. The alignment is within normal limits. Mild osteoarthritis affects the basilar joint and interphalangeal joints. | Mild osteoarthritis without fracture.Findings were discussed with Dr. Alonso by telephone at 10:40 a.m. on 2/25/15 |
Generate impression based on findings. | 11-year-old male with knee pain while playing sports and tenderness over tibial tubercles VIEWS: Knees standing AP/notch, knees merchant, right knee lateral, left knee lateral (right knee - 4 views, left knee - 4 views) Alignment is anatomic. No fracture, joint effusion, or other specific finding to account for the patient's symptoms. | Normal examination. |
Generate impression based on findings. | Head and neck cancer/ pre protocol scans. CHEST:LUNGS AND PLEURA: The right upper lobe pulmonary nodule has decreased in size compared to the most recent study, which was post-biopsy, but is not significantly changed compared to a more remote study. The nodule measures approximately 26 x 20 mm (image 34, series 4), previously 26 x 31 mm. An additional left lower lobe lung nodule is similar in size measuring approximately 24 x 20 mm (image 72, series 4), previously 22 x 20 mm. Multiple non-reference pulmonary nodules in the superior right and left lower lobes have increased in size and become more confluent. For example, one of these nodules in the left upper lobe now measures approximately 16 x 15 mm, previously 10 x 10 mm (image 42, series 4). There is mild pleural reaction in this region as well. A new nodular opacity is also noted in the left upper lobe. A cyst or area of focal bronchiectasis within the right lower lobe appears to have a thicker wall (image 52, series 4). MEDIASTINUM AND HILA: Right hilar lymphadenopathy is again noted measuring 13 mm in the short axis (image 40, series 3), previously 15 mm. A left hilar lymph node measures 12 mm in the short axis (image 45, series 3), unchanged. There is new para-aortic and AP window confluent lymphadenopathy which appears slightly necrotic. This measures up to 18 mm in the short axis (image 33, series 3). There is no pericardial effusion. CHEST WALL: The right chest port catheter terminates in the SVC. There is no axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval enlargement of several non-reference pulmonary nodules and new mediastinal lymphadenopathy consistent with disease progression. The right upper lobe nodule is not significantly changed in size when compared to a more remote study on 11/17/2014. |
Generate impression based on findings. | 45-year-old recall from screening for a mass in the right breast. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Spot compression views show persistence of a circumscribed oval mass in the posterior depth of the right outer breast. The mammographic findings appear typically benign. No suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | Right breast cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Scoliosis. Pain. A posterior stabilization device extends from T5 to L2 affixing the spine via laminar hooks. We see no radiographic evidence of hardware complication. There is approximately 40 degrees of dextroscoliosis of the thoracic spine, as measured from the superior endplate of T4 to the inferior endplate of T11. There is mild (less than 2 cm) negative coronal balance. The sagittal balance is within normal limits. Mild degenerative disk disease affects the mid thoracic spine. Surgical clips are noted in the right upper abdominal quadrant, likely from a prior cholecystectomy. | Spinal fixation and scoliosis, as described above. |
Generate impression based on findings. | 42-day-old male with tachypnea and increased O2 requirements during feedsEXAMINATION: Oropharyngeal motility study 2/25/15:00 Julie Ecclestone (pager 8293), speech and language therapist, supervised the examination. 20 seconds of fluoroscopy was used.No penetration or aspiration was identified with thin liquids via slow flow. Increased suck to swallow ratio was noted as the feeding progressed. Nasopharyngeal regurgitation was seen with both thin liquids and nectar. Penetration without aspiration occurred with nectar. | Increased suck to swallow ratio as feeds progressed suggests fatigue. Nasopharyngeal reflux and mild penetration with nectar. No aspiration.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | 8-year-old male feels right shoulder not functioning well while playing basketballVIEWS: Right shoulder internal/external rotation (2 views) 2/25/15 9:48 The humeral head is well directed with respect to the glenoid fossa The osseous structures are normal for the patient's age. No fracture is evident. | Normal examination. |
Generate impression based on findings. | 36-year-old female with weight loss, abdominal pain with eating. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in the liver parenchyma. Low density gallstones are identified in the gallbladder without other biliary tract complication.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate distention is seen throughout the stomach, small bowel and the colon without intrinsic abnormality. No areas of obstruction, wall thickening, inflammation, are seen. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Essure tubes are seen in bilateral fallopian tubes. Small amount of endometrial cavity fluid is seen, presumably physiologic in a patient of this age. Physiologic cystic changes are seen in the left ovary. No other abnormalities.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Numerous intraluminal gallstones without other gallbladder complication seen. Numeral. No other significant abnormality seen. |
Generate impression based on findings. | Left breast pain and thickening for 6 years. Three standard views of both breasts and left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. This includes no suspicious mass at the areas of palpable concern in the left breast.ULTRASOUND | No mammographic evidence of malignancy. Clinical correlation is also recommended to ensure that these benign findings are concordant with physical exam. As long as the patient's physical examination remains benign, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | AORTOGRAM: The visualized portions of the thoracic aorta are without any significant disease. The brachia cephalic artery, visualized portions of the right subclavian artery, right common carotid artery, and right vertebral artery without significant disease. The visualized portions of the left common carotid artery without significant disease. The origin of the left subclavian artery is without disease. The left vertebral arteries without disease. With the arm at 90 degrees abduction, there is a small fixed defect in the distal subclavian artery as it crosses under the clavicle. This does not appear to be flow limiting. The constriction is exacerbated with the left arm in full abduction. In the military maneuver, the subclavian artery is totally obliterated suggesting external compression from either the first rib or pectoralis minor muscle.LEFT UPPER EXTREMITY: The axillary artery, brachial artery, radial ulnar and interosseous arteries are without significant disease. The palmar arch is incomplete. The visualized portions of the digital arteries of the first second third fourth and fifth digits are without evidence of obstruction or distal embolization.CONTRAST: 180 mLFLUOROSCOPY TIME: 4.9 MinutesAIR KERMA: 132.53 MGyESTIMATED BLOOD LOSS: Less than 5cc. | Occlusion of the left subclavian artery with provocative maneuvers suggestive of arterial thoracic outlet syndrome.PLAN: The patient will follow-up with vascular surgery to discuss thoracic outlet decompression. |
Generate impression based on findings. | HEAD: There is minimal motion degradation limiting evaluation. There is no gross intracranial hemorrhage, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CERVICAL: There is diffuse osteopenia. There is no acute fracture, subluxation or prevertebral soft tissue swelling. There is minimal 1 mm retrolisthesis of C4 on C5 and C5 on C6.There are small disk osteophyte complexes at C3-4, C4-5 and C5-6. At C5-6, there is bilateral uncovertebral hypertrophy, greater on the right, and right facet arthropathy causing mild to moderate right neural foraminal stenosis. There is scarring in the lung apices bilaterally. | 1.Motion degraded CT of the head with no evidence of acute intracranial hemorrhage or skull fracture.2.No acute cervical spine fracture or subluxation.3.Mild cervical spine degenerative changes. |
Generate impression based on findings. | 92 years, Female, Reason: evaluate for hydronephrosis History: hx of right hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.2 cm in length. Moderate to severe right-sided hydronephrosis, likely unchanged from prior CT. The distal right ureter is not dilated.LEFT KIDNEY: The left kidney measures 11.5 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.BLADDER: The bladder is unremarkable.OTHER: No significant abnormalities noted. | Moderate to severe right-sided hydronephrosis. |
Generate impression based on findings. | 69 year old presents with a new palpable mass in the right breast. Three standard views of both breasts and multiple right breast spot views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There are two masses in the right upper outer breast. The more posterior of these is only partially visualized. The more anterior mass measures about 1.3-cm. The more posterior mass measures at least 3.2-cm. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND | Two highly suspicious right breast masses. Surgical consultation is recommended. The patient will see Dr. Swati Kulkarni today. She will then return for image guided biopsy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | Ms. Thomas is a 61 year old female with a personal history of left breast lumpectomy in August 2008 for IDC/DCIS followed by chemotherapy and radiation. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, skin retraction and surgical clips present within the left lumpectomy site. Scattered benign calcifications, including arterial calcifications, are present in both breasts. Multiple lobulated masses in the right outer breast are stable when compared to multiple prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes project over the right axilla. | Stable postsurgical changes of the left breast. Stable masses of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: new diagnosis lung cancer History: lung cancer CHEST:LUNGS AND PLEURA: Severe apical predominant centrilobular and paraseptal emphysema.The large spiculated right upper lobe nodule measures 3.1 x 2.5 centimeters (series 6, image 37), unchanged accounting for differences in measurement technique, compatible with a known diagnosis of lung cancer, with surrounding reticulation suggestive of local interstitial tumor spread.A somewhat spiculated partially solid nodule in the superior segment of the left lower lobe (series 6, image 42) is unchanged.Additional scattered small pulmonary nodules are unchanged from the prior exam dated 12/2014.No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.Previously described prominent right hilar lymph node is not well evaluated on noncontrast imaging, but appears to measure approximately 1 cm (series 4, image 50), unchanged. No other mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Incompletely evaluated renal hypodensities are unchanged, likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | 1. A spiculated right upper lobe nodule, consistent with a known diagnosis of lung cancer, is not significantly changed from the prior exam dated 12/2014.2. Additional scattered small pulmonary nodules are unchanged, including a somewhat suspicious part-solid nodule in the superior segment of the left lower lobe. Stable borderline enlarged right hilar lymph node.3. No evidence of abdominal metastases on limited exam of the upper abdomen. |
Generate impression based on findings. | Frequent sinusitis; known allergic rhinitis and leftward deviated nasal septum. There are subcentimeter retention cysts in the bilateral maxillary sinuses. The other paranasal sinuses are clear. The nasal cavity is clear. The nasal septum is deviated slightly to the left. There is a partially paradoxical right middle turbinate. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There is partially-imaged periodontal lucency at tooth # 4. | 1. Subcentimeter retention cysts in the bilateral maxillary sinuses. The other paranasal sinuses and nasal cavity are clear. 2. The nasal septum is deviated slightly to the left.3. Partially-imaged periodontal disease at tooth # 4. |
Generate impression based on findings. | Male 57 years old Reason: s/p bilateral proximal femur replacements, complaining of left thigh pain and right groin pain History: above. We have two views of the left femur. The head of the femoral endoprosthesis device is dislocated slightly superolaterally from the acetabular component, which is new when compared to the prior study. Lucency along the distal end of the femoral component is unchanged when compared to the prior study. Additional post operative changes have been previously described and are similar to those seen on the prior study. Small sclerotic foci in the medial femoral condyle and proximal tibia likely represent chronic osteonecrosis.We have two views of the right femur. Again seen are components of the right total hip endoprosthesis device situated in near anatomic alignment, appearing similar to those seen on the prior study. Heterotopic ossification along the proximal aspect of the prosthesis is unchanged. Thin lucency along the cement bone interface distally is also unchanged and may not be of any clinical significance. Foci of chronic osteonecrosis are again seen in the medial femoral condyle and proximal tibia. | Postoperative changes of bilateral femoral reconstructions as described above with dislocation of the left femoral component relative to the acetabular component. |
Generate impression based on findings. | Male 50 years old Reason: Ileocolonic Crohn's disease; evaluate for inflammation vs structuring disease History: intermittent obstructions; nausea and vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No biliary ductal dilatation or focal hepatic mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the right lower quadrant from prior ileocecectomy. Ileocolonic anastomosis is widely patent measuring up to 2.0 cm, best seen on coronal images (series 80388, image 77). There is no fat stranding, free fluid, or discrete fluid collections. No evidence of fistulae or sinus tracts. No evidence of obstruction or intraperitoneal free air. No definitive signs of active disease.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical clips in the pelvis which may be secondary to prior partial colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of active Crohn's disease. Ileocolonic anastomosis is widely patent without evidence of stricturing. |
Generate impression based on findings. | 62 years, Male, Reason: Pleural/ peritoneal mesothelioma. Please compare to prior exam per recist criteria. History: Pleural/peritoneal mesothelioma. CHEST:LUNGS AND PLEURA: Small right pleural effusion is unchanged. No suspicious nodules or masses.MEDIASTINUM AND HILA: Right hilar lymph node measures 2.1I2 .6 cm (3/44), previously 2.5 x 2.2 cm. Precarinal node measures 2.5 x 1.5 cm (3/44), previously 2.1 x 1.0 cm. additional small mediastinal nodes are slightly increased in size. Right cardiophrenic node measures 1.4 x 1.4 cm (3/71), previously 1.5 x 1.2 cm. Postsurgical changes at the GE junction unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic hypodensities are unchanged with a right hepatic lobe lesion measuring 1.7 x 1.4 cm (3/100), previously 1.7 x 1.2 cm. Cholecystectomy clips.SPLEEN: Splenic hypodensity with associated calcification is unchanged.PANCREAS: Fatty atrophy of the pancreas.ADRENAL GLANDS: No hydronephrosis. Bilateral cysts are unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference gastrohepatic node measures 1.5 x 1.2 cm (3/93), previously 1.5 x 1.0 cm.BOWEL, MESENTERY: Omental disease is overall unchanged. Reference right upper quadrant omental haziness measures 1.1 cm in thickness (3/92), previously 1.1 cm. Moderate haziness/thickening of the greater omentum measures 2.5 cm (3/128), previously 2.4 cm.BONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Patchy sclerosis of the right ilium is unchanged.OTHER: Dropped surgical clip in the pelvis. | 1.No significant change of omental disease.2.Right hilar and mediastinal lymphadenopathy with minor increase in measurements. |
Generate impression based on findings. | 65 year old woman with history of left breast lesion noted on screening mammogram. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a circumscribed, oval, hypoechoic mass measuring 5 x 4 x 3 mm at the 8 o’clock position with increased central vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially and at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged very good. All specimens floated in the prefilled container of 10% formalin. Specimen quality was judged good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the anterior aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. Abe and Patel . Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | There are foci of susceptibility dependently in the occipital horns which likely relate to previous germinal matrix hemorrhage. There may be a small developmental venous anomaly extending towards left occipital horn, demonstrated as linear susceptibility. There are additional scattered foci along the margins of the lateral ventricles. There is diffuse prominence of the subarachnoid and dilatation especially of the lateral ventricles. In addition, there is suggestion of trace bilateral holohemispheric subdural collections best appreciated on the coronal images.The vermis is present, although the cerebellum diffusely diminutive in size, especially the hemispheres. There is focal prominence of extra axial space within the inferior posterior fossa with mild scalloping of the inner table. The posterior fossa is not enlarged and is more likely slightly developmentally diminutive in size. The tentorium is not elevated. The fourth ventricle is well formed, without direct communication to the retrocerebellar subarachnoid space. There are no definite septations identified.The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. Myelination appears appropriate for corrected age.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The cerebral aqueduct is not well delineated on the sagittal images but is visualized as a punctate focus of T2 hyperintensity on available axial imaging. | 1. Moderate symmetric predominantly lateral ventriculomegaly. Evidence of chronic hemosiderin deposition in the lateral ventricles likely related to previously identified germinal matrix hemorrhage, suggestive of grade 3.2. Cerebellar hypoplasia with prominent retrocerebellar subarachnoid space which may in part relate to the cerebellar hypoplasia, although there is also likely a retrocerebellar cyst or mega cisterna magna.3. Trace bilateral holohemispheric CSF signal intensity subdural collections which may represent evolved birth related collections. Also nonspecific mild prominence of the subarachnoid space diffusely. |
Generate impression based on findings. | Left hip pain The bones appear slightly demineralized. Moderate osteoarthritis affects the left hip.A right total hip arthroplasty device is situated in near-anatomic alignment as seen on the AP view, however the distal most aspect of this device is not included on the field of view.Degenerative disk disease affects the visualized lower lumbar spine. An aortobiiliac stent is noted. | Left hip osteoarthritis and other findings as described above. |
Generate impression based on findings. | NHL, re-evaluate and compare to previous. LUNGS AND PLEURA: There is redemonstration of a right lower lobe pulmonary nodule abutting the posterior cardiac border measuring 17 x 14 mm (image 64, series 6), unchanged. A 5 mm dense left lingular nodule is also unchanged (image 48, series 6). A dense, prominent peripheral inferior pulmonary vein branch in the right middle lobe is again seen and unchanged (image 61, series 6); this remains of uncertain clinical significance. A triangular shaped density abutting the major fissure in the right middle lobe appears more dense. Additionally, there is a adjacent new peri-fissural pulmonary micronodule. No pleural effusion or pneumothorax is seen. MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion is noted. There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Unchanged right lower lobe and lingular solid nodules remain highly suspicious for extranodal lymphoma.2. New and enlarging perifissural densities within the right middle lobe may be benign in etiology . Continued observation is recommended. |
Generate impression based on findings. | Male 65 years old; Reason: prosthetic assessment. History: post-op Two views of the right hip and one view the pelvis demonstrate hardware components of the right total hip arthroplasty device situated in near anatomic alignment, without radiographic evidence of hardware complication.Mild osteoarthritis affects the left hip as seen on the AP view of the pelvis.Surgical clips project beneath the inferior pubic rami. | Right total hip arthroplasty and other findings as described above. |
Generate impression based on findings. | Female 54 years old Reason: Evaluate for fracture 2-3-4 metatarsals left foot History: Pain, ecchymosis, and edema left foot after dropping a can of soup on it yesterday. We have 3 views of the left foot. There may be mild soft tissue swelling along the dorsal aspect of the midfoot, but we see no underlying fracture. Minimal osteoarthritic changes affect the foot. | Mild soft tissue swelling and osteoarthritic changes without fracture evident. |
Generate impression based on findings. | 6-year-old male with ALL with chest pain.VIEWS: Chest AP/lateral (two views) 2/25/2015 Left chest port catheter tip in the cavoatrial junction.Cardiothymic silhouette is normal. No focal pulmonary opacity. No pleural effusion or pneumothorax. | Normal examination. |
Generate impression based on findings. | Male 80 years old; Reason: hx of bladder cancer, evaluate for metastatic disease History: see above The exam is not sensitive for detecting lesions in the solid organs of vasculature due to lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNGS BASES: Emphysematous changes, bronchiectasis, atelectasis left base. No effusion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis and degenerative changes.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Cystoprostatectomy.BLADDER: Surgically absent.LYMPH NODES: Status post lymph node dissection. No pathologic size nodes.BOWEL, MESENTERY: Previous drainage catheter was removed. No free or loculated fluid. The bowel wall thickening or dilatation. Scattered colonic diverticula.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wall. The skin staples have been removed.Osteoporosis and degenerative changes lumbar spine. Scoliosis. Mild loss of height L2.OTHER: Heavy atherosclerotic disease. | 1.With the limitations of no IV contrast common no detectable metastatic disease.2.Expected postsurgical changes. Previously seen hematoma in the pelvis is resolved.3.Limitations of no IV contrast, punctate calcification left kidney and possible gallstones, unchanged. 4.Heavy Atherosclerotic changes.5.Chronic changes lung bases. |
Generate impression based on findings. | 48 year-old female with Murphy sign on exam, evaluate for gallstones. LIVER: Liver is normal in size measuring 15.3 cm in length. Coarse and echogenic liver parenchyma compatible with fatty infiltration. Hepatic contour is normal. No focal hepatic lesions are evident. Portal venous flow is hepatopetal with a peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. No evidence of cholelithiasis, gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.4 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 10.4 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.SPLEEN: The spleen measures 7.8 cm in length.OTHER: No evidence of ascites. | 1.No gallstones or sonographic evidence of cholecystitis as clinically questioned.2.Fatty liver infiltration. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A circumscribed mass is again seen in the right posterior upper inner quadrant. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a new cluster of calcifications at posterior 6 o'clock position in the right breast.No suspicious masses or areas of architectural distortion are present. | A new cluster of calcifications at posterior 6 o'clock position in the right breast. Spot magnification views are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There is a new cluster of calcifications at posterior upper outer quadrant in the right breast.No suspicious masses or areas of architectural distortion are present. | A new cluster of calcifications at posterior upper outer quadrant in the right breast. Spot magnification views are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Benign calcifications are again seen bilaterally.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 66 years old Reason: eval for fx History: s/p fall onto r shoulder now w r shoulder pain. We see no acute fracture. There is mild osteoarthritis of the glenohumeral and acromioclavicular joints. There is spurring of the anterior aspect of the acromion process. There are mild chronic appearing enthesopathic changes along the greater tuberosity at the expected site of insertion of the rotator cuff. A small ossicle is seen along the posterolateral aspect of the humerus, which may reside in the rotator cuff itself. | Degenerative arthritic changes as described above, without fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Benign arterial calcifications are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered bilateral benign calcifications are unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Metastatic lung cancer status post chemotherapy with disease progression. Status post RT to chest and left adrenal. LUNGS AND PLEURA: A left upper lobe mass which invades the mediastinum with internal areas of necrosis is decreased in size now measuring 30 x 30 mm (image 22, series 7), previously 33 x 38 mm. Contiguous tumor with the mass is still seen extending along the mediastinal pleural surface to the hilum. A right lower lobe pulmonary nodule (image 64, series 7) is unchanged along with a left lower lobe nodule (image 73, series 7). No new nodules are identified. MEDIASTINUM AND HILA: Ipsilateral mediastinal and hilar lymphadenopathy has decreased in size. A reference para-aortic lymph node measures 8 mm (image 33, series 5), previously 14 mm. A left hilar lymph node measures 15 mm (image 39, series 5), previously 16 mm. No pericardial effusion is noted. There are no coronary artery calcifications on this non-gated examination. CHEST WALL: There is no axillary lymphadenopathy. Tumor entering the left neural foramen of T1/T2 is less apparent (image 11, series 5). UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Please refer to dedicated CT abdomen and pelvis report for additional findings. | 1. Interval decrease in size of the left upper lobe mass and ipsilateral mediastinal and hilar lymphadenopathy.2. Please refer to separate dedicated CT abdomen and pelvis report for additional findings. |
Generate impression based on findings. | Osteosarcoma. 18 months off therapy.VIEWS: Chest PA/lateral (two views) 02/25/15 Left posterior sixth rib has been resected. Eventration of the posteromedial left hemidiaphragm is again seen.Cardiac silhouette size is normal. On the lateral view, a round opacity measuring approximately 2 cm in diameter overlies the posterior aspect of T7. No corresponding opacity is seen on the PA view. | Round opacity overlying T7 and lateral view. A metastatic lesion cannot be excluded and chest CT is recommended. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Multiple scattered benign appearing calcifications are seen in both breasts including arterial, secretory and dystrophic calcifications. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 14-month-old male, evaluate for obstruction.VIEW: Chest and Abdomen AP (two views) 2/25/2015 Tracheostomy tube unchanged. Gastrostomy tube unchanged. Cardiothymic silhouette is normal. No focal pulmonary opacity. Bibasilar atelectasis. No pleural effusion or pneumothorax.Nonobstructive bowel gas pattern. | Bibasilar atelectasis with no evidence of pneumonia. No evidence of obstruction. |
Generate impression based on findings. | Reason: follow lung nodule R costophrenic angle History: dyspnea Patient contractures, scoliosis and positioning limit evaluation on this exam.LUNGS AND PLEURA: Decreased left lung volume related to marked deformity of the spine.Scattered subsegmental atelectasis is unchanged.A well marginated pleural-based nodule in the right costophrenic angle measure 7 mm (series 5, image 151), unchanged. No new suspicious pulmonary nodules or masses.No new focal air space consolidation. Mild faint patchy diffuse groundglass is nonspecific, unchanged from the prior exam. No pleural effusions.MEDIASTINUM AND HILA: The heart is enlarged, with mild pericardial fluid/thickening, stable. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension.Calcified mediastinal and hilar lymph nodes from prior granulomatous disease. No lymphadenopathy. Moderate sized hiatal hernia.CHEST WALL: Marked deformity of the chest wall with severe scoliosis and accompanying degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Left nephroureteral stent is partially visualized. Renal calcifications appear similar to the prior exam. | Stable 7mm nodule in the right costophrenic angle. Continued monitoring as scheduled is advised. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 46 years old Reason: Assess Crohn's disease History: Epigastric abd pain, worsening diarrhea; Hx of small bowel Crohn's disease ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. No biliary dilatation. No focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post ileocecectomy. I believe the ileocolic anastomosis is likely in the subhepatic area seen on coronal image 49 measuring about 2.3 cm in diameter or greater. Marked dilatation of what appears to be ileum proximal to the anastomosis is markedly dilated but without a transition zone of obstruction. Ileal loops in the pelvis (>12 proximal to anastomosis) demonstrate homogeneous mild wall thickening over a long segment best seen on coronal images 46-57 compatible with chronic changes of Crohn's disease but without evidence of fat stranding, ulcers, sinus tracts or fistulae.Jejunal loops and colon appear normal.Extensive adenopathy in the mesenteric root. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The slightly thickened distal ileal loops described above extend into the pelvis. Please see detailed description above. No evidence of fibrofatty proliferation. No fat stranding or free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Patent ileocolic anastomosis. Wide-caliber of what is probably the distal ileum proximal to the anastomosis. Moderately long segment homogeneous mild wall thickening in the distal ileum without evidence of active disease or obstruction. No evidence of ascites.Cholelithiasis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left benign biopsy in 2013. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A marker clip is present at posterior central left breast. Benign calcifications are again seen in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 67 years, Female, Reason: HCV, Cirrhosis, eval for HCC History: HCV, Cirrhosis. LIVER: Liver is normal in size measuring 13.2 cm in length. Hepatic echotexture is coarse. No focal hepatic lesions are evident. Portal venous flow is hepatopetal with a peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 9.1 cm in length. No evidence of hydronephrosis or hydroureter. Left mid pole simple cyst measures 1.5 x 1.7 x 1.3 cm, previously 1.4 x 2.0 x 1.4 cmSPLEEN: The spleen measures 8.2 cm in length.OTHER: No evidence of ascites. | Coarse echotexture without suspicious lesion evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 77 year old woman with history of right IDC s/p lumpectomy in 2007. Also has history of bilateral mastopexy. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is architectural distortion bilaterally from prior mastopexy. Post-operative findings from right lumpectomy including local architectural distortion and surgical clips are stable. There are no new dominant masses or suspicious microcalcifications in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. An asymmetry at left axillary region is unchanged. No suspicious microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 49 years, Male, Reason: Hx of pancreatic pseudocyst History: Pseudocyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy with a trace amount of fluid in the gallbladder fossa, change.SPLEEN: Multiple coils from splenic artery embolization obscure visualization. Perisplenic collection seen on the prior CT which was inseparable from splenic tissue is decreased in size with a small amount of residual splenic tissue. There is been removal of a percutaneous drainage catheter with placement of a catheter extending from the gastric body to the collection. PANCREAS:Atrophy of the pancreatic tail without ductal dilatation. Small collections seen on the prior MRI are not visualized. No peripancreatic collections are seen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate lower pole stones bilaterally are unchanged. Subcentimeter renal hypodensities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: No significant abnormality noted | 1.Likely resolution of perisplenic collection with a small amount of residual splenic tissue which was inseparable from the collection on the prior CT.2.No peripancreatic collections are visualized, however the distal pancreas is partially obscured by embolization coils. |
Generate impression based on findings. | Male 60 years old Reason: h/o FL and large cell transformation History: Masses (pelvic) CHEST:LUNGS AND PLEURA: Small right middle lobe subpleural nodule measuring 8 mm (series 8, image 65), previously 8 mm.Stable scattered calcified and noncalcified micronodules. No new suspicious nodules or masses.Mosaic attenuation pattern is again seen with superimposed ground glass opacities which may suggest a component of edema.MEDIASTINUM AND HILA: Small lymph nodes are again seen throughout the mediastinum. Reference left paratracheal lymph node measures 1.5 x 0.9 cm (series 6, image 20), previously 1.2 x 1.0 cm.Incompletely imaged right chest wall port with catheter tip in the SVC.CHEST WALL: Interval development of a cluster of right axillary lymph nodes. Reference right axilla lymph node measures 1.9 x 1.2 cm (series 6, image 29).ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. Gallstones/sludge without evidence of cholecystitis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing ventral abdominal hernia, unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac lymph node measures 4.1 x 2.1 cm (series 6, image 198), previously 4.6 x 3.2 cm. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: New deep subcutaneous nodule in the right pelvis subcutaneous tissue measuring 2.6 x 2.0 cm (series 6, image 197). Skin thickening and superficial subcutaneous nodules within the superficial subcutaneous tissue in the right pelvis. These more superficial nodules appear grossly unchanged and may be secondary to prior injection site reaction. Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | New axillary lymphadenopathy and pelvic subcutaneous nodule consistent with progression of disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Prosthetic assessment. Postoperative. RIGHT HIP: Two views of the right hip demonstrate hardware components of a right total hip arthroplasty device situated in near anatomic alignment, without radiographic evidence of hardware complication. A small amount of heterotropic ossification is present lateral to the acetabulum.PELVIS: One view of the pelvis demonstrates the aforementioned right total hip arthroplasty. The left innominate bone is smaller than the right, likely reflecting sequelae of polio. Mild osteoarthritis affects the left hip and right sacroiliac joint, as seen on the single AP view. Degenerative changes affect the visualized lower lumbar spine.RIGHT KNEE: Three views of the right knee demonstrate hardware components of the right total knee arthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication. Findings compatible with sequelae of polio are present in the left knee, as seen on the frontal view. | Total right hip and knee arthroplasties and other findings as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and 2 implant displaced views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Bilateral retroglandular saline implants are unchanged in position and contour. Stable benign calcifications are present.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
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