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Generate impression based on findings. | History of base of tongue cancer, CRT. CHEST:LUNGS AND PLEURA: 5-mm scarlike nodular opacity in the posterior aspects of the right upper lobe (5/89) unchanged. Scarring in the lung apices unchanged. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Possible faint calcification at the left main coronary artery. Normal heart size. Physiologic volume of pericardial fluid. No lymphadenopathy.Left vertebral artery arises directly from the aortic arch, normal variant anatomy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Caudal tip of the liver extends into the pelvis and is beyond the scanning range.SPLEEN: Ectatic splenic artery.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta.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. | No evidence of metastatic disease. Stable right upper lobe nodule. |
Generate impression based on findings. | Female 42 years old; Reason: pain Mild osteoarthritis affects the first MTP joint. There is an equivocal soft tissue defect at the tip of the great toe. We see no specific features of osteomyelitis. Otherwise, we see no specific findings to account for the patient's pain. | Mild osteoarthritis and equivocal soft tissue defect. |
Generate impression based on findings. | Osteosarcoma. 18 months off therapy. VIEWS: Right knee AP/lateral/internal oblique/external oblique (4 views), right femur AP/lateral (two views) 02/25/15 A long stem total knee endoprosthesis reconstruction of the distal femur is again seen. Surgical clips are present posterior to the femoral component of the prosthesis. No loosening is identified. A fracture is not seen. No mass is present. | Postoperative changes with no evidence of disease recurrence or complication. |
Generate impression based on findings. | 2-year-old male with cystic fibrosis, intermittent cough, evaluate for interval changeVIEWS: Chest AP/lateral (two views) 2/25/1511:19 The cardiothymic silhouette is normal. Bronchial wall thickening without focal pulmonary opacity, bronchiectasis or pleural effusions. | Bronchial wall thickening without focal pulmonary opacity or bronchiectasis. |
Generate impression based on findings. | right side sensorineural hearing loss, right side pulsatile tinnitus. NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral Pcom arteries are patent and Acom artery is also patent.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | No evidence of acute ischemic or hemorrhagic lesion on this scan.Normal CT angiography of head and neckComment: Considering the patient's chief complaint was pulsatile tinnitus on the right, the patient might need to be evaluated at Neurointerventional Clinic (2-5004 or page 9287) for the necessity of performing diagnostic cerebral angiography to exclude possible diagnosis of dural arteriovenous fistula/shunts. |
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. Stable focal asymmetries and calcifications are present bilaterally. Two percutaneously placed clips are present in the right breast and one percutaneously placed clip is present in the left 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. | Clinical question: ICH. Signs and symptoms: Left forehead contusion. Unenhanced head CT:Examination demonstrates no detectable posttraumatic intracranial or calvarial findings. There is however a focus of soft tissue thickening in with high density in the right frontal supraorbital scalp may represent a focus of contusion. No underlying bony pathology.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. There is a tiny focus of low-attenuation in the periventricular white matter of left anterior frontal which is nonspecific and is new since prior exam. Although nonspecific the appearance is suggestive of age indeterminate small vessel territory ischemic stroke. Unremarkable images through the orbits with the exception of a chronic right lamina papyracea blow out fracture similar to prior exam. Unremarkable paranasal sinuses and mastoid air cells. | 1.No acute intracranial or calvarial posttraumatic findings.2.Right supraorbital soft tissue contusion.3.Tiny nonspecific focus of low attenuation in left periventricular frontal white matter which could represent an age indeterminate small vessel ischemic stroke. |
Generate impression based on findings. | 12-year-old male with blood tinged secretionsVIEW: Chest AP (one view) 2/21/15 10:36 Tracheostomy tube tip at the thoracic inlet. Elevation of the right hemidiaphragm with basilar atelectasis. The left lung is well aerated. The cardiothymic silhouette is unchanged. | Unchanged elevation of the right hemidiaphragm and basilar atelectasis. |
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. There are bilateral benign calcifications, some of which are oil cysts. 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. | 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. 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; 61 years old. Reason: RUQ Abdominal Pain. Evaluate for gallstones. LIVER: Liver is normal in size measuring 17.1 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 3 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.8 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 10 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.SPLEEN: The spleen measures 10.2 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 heterogeneously dense. 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 mostly fatty replaced, unchanged in pattern and distribution. Stable bilateral benign skin 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: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Female, 31 years old. Evaluation of fine detail is limited due to portable technique. We see no retained foreign object. | We see no retained foreign object.These findings were discussed by telephone with Dr. Haney, the attending surgeon, on 2/25/2015 at 1139am. |
Generate impression based on findings. | Right lower lung nodules surveillance PET negative. LUNGS AND PLEURA: The right apical ground glass nodule measures 22 mm, previously 21-mm when remeasured (5/17).When high-resolution series, the right lower lobe partially marginated nodule is unchanged, measuring 17 x 30 mm (series 6 image 169), previously 18 x 29 mm on prior series 5 image 189. This contains internal lipid and fluid density.Left basal tubular and nodular opacities associated with atelectasis or scar (5/61) are unchanged. Left upper lobe tubular opacity (5/29) not significantly changed. These are suggestive of bronchoceles..4-5 mm groundglass nodule right lower lobe (3/156) unchanged. Interval improvement in right paraspinal groundglass opacity seen previously, now with residual scarring.MEDIASTINUM AND HILA: Moderate cardiomegaly. Coronary artery stents on the left. No enlarged lymph nodes.CHEST WALL: Degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Left adrenal gland lesion measures less than 10 Hounsfield units, most likely a benign adenoma. Cysts and granulomas in the liver. | Indeterminate right lower lobe lesion is larger, the appearance and presence of probable bronchoceles elsewhere may indicate that this is also bronchogenic in origin (bronchogenic cyst, bronchocele), however no conclusive communication with an airway is identified. Suggest continued conservative imaging follow-up in 3 months as long as PET scan remains negative and unless there is a high level of clinical suspicion for malignancy. |
Generate impression based on findings. | Male; 60 years old. Reason: metastatic lung cancer, s/p chemo with disease progression and RT to chest and left adrenal. Recent PET scan showed left UPJ obstruction. Evaluate disease status. ABDOMEN:LUNG BASES: Please see separately dictated chest CT from same day for further details. LIVER, BILIARY TRACT: No suspicious hepatic lesions or biliary ductal dilatation. Nodularity of the gallbladder wall is unchanged and may represent adenomyomatosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland metastasis measures 2.3 x 1.3 cm, previously 2.8 x 2.0 cm (series 8, image 44). Normal right adrenal gland.KIDNEYS, URETERS: Left extrarenal pelvis and severely dilated collecting system is unchanged, suggestive of chronic UPJ obstruction. Scattered small renal cysts.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant pelvic adenopathy. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval decrease in size of left adrenal metastasis. No new metastatic lesions identified in the abdomen/pelvis. Please see separately dictated chest CT report from same day. 2.Unchanged severely dilated left proximal collecting system, suggestive of chronic UPJ obstruction. |
Generate impression based on findings. | There is slight prominence of the sulci diffusely, much more conspicuous along the frontal lobes bilaterally as well as the anterior temporal lobes. There is also mild nonspecific prominence of the ventricles.. The basal cisterns remain patent. There is no midline shift or mass effect. There are ill-defined areas of T2/FLAIR hyperintensity within the bifrontal deep and subcortical white matter. There is more conspicuous and well defined FLAIR hyperintensity within the periventricular white matter bilaterally. Additional FLAIR hyperintensity is seen in parietal periventricular white matter bilaterally. There is no diffusion abnormality. There may be focal prominence of the subarachnoid space versus a small cyst splaying the internal cerebral veins in the suprapineal region.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is moderate to severe right and moderate left mastoid air cell opacification. There may also be right middle ear fluid. | 1. No acute intracranial abnormality.2. Mild global volume loss suggested predominantly anteriorly with areas of well-defined as well as more conspicuous abnormal FLAIR hyperintensity in the frontal lobe white matter which are nonspecific but may relate to areas of gliosis or incomplete myelination. Additional patchy abnormal signal in the expected terminal zones of myelination, likely representing areas of incomplete myelination.3. Significant mastoid cell fluid bilaterally and possible right middle ear fluid. Please correlate clinically. |
Generate impression based on findings. | 31-year-old male with history of Wilms tumor 16 months off therapy LIVER: Normal echogenicity. The liver measures 14.7 cm. No focal hepatic lesion. No intra-or extrahepatic ductal dilatation.GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended without wall thickening or pericholecystic fluid. No biliary ductal dilatation.PANCREAS: The pancreas is obscured by bowel gas.SPLEEN: The spleen measures 9.5 cm.KIDNEYS: Multiple simple appearing right renal cysts, some of which are exophytic, are again identified, the largest measuring 2.6 cm in diameter and previously measuring 2.6 cm. No hydronephrosis. The left kidney is absent.ABDOMINAL AORTA: The proximal aorta measures 2.5 x 2.8 cm, the mid aorta measures 1.6 x 1.5 cm and the distal aorta measures 1.5 x 1.4 cm.INFERIOR VENA CAVA: Patent.OTHER: No significant abnormality noted. | No evidence of disease recurrence. Multiple unchanged right renal cyst as described above. |
Generate impression based on findings. | T2N2b squamous cell carcinoma of left tongue base treated with TFHX and radiation therapy completed in 2010. Much of the oral cavity is obscured by dental streak artifact. There is no significant interval change in the patchy focus of enhancement in the left tongue base, without definite evidence of measurable tumor. There is no significant cervical lymphadenopathy. For example, a right level 2 lymph node measures 4 mm in short axis, previously 4 mm. There is unchanged atrophy of the thyroid gland. The salivary glands are unchanged with of hyperemia of the submandibular glands. The airways are patent. There is mild plaque at the right carotid bifurcation. The osseous structures are unremarkable. The partially imaged intracranial structures are unremarkable. | 1. Stable post-treatment findings without definite evidence of oropharyngeal region tumor recurrence, within the limits of dental artifact. 2. No significant cervical lymphadenopathy. |
Generate impression based on findings. | 66 years, Male. Reason: r/o free air, eval dilation History: abd distention No pneumoperitoneum. Gas distended loops of predominantly large bowel measuring up to 6.3 cm in the ascending colon, previously 7.5 cm. Balloon type gastrostomy tube projects over the stomach. Residual contrast is noted within the descending and sigmoid colon. | Mild improvement in colonic ileus without evidence of pneumoperitoneum. |
Generate impression based on findings. | 59 years, Male, Reason: GE junction carcinoma please compare to most recent imaging and provide index lesions for RECIST as required per study History: As above. CHEST:LUNGS AND PLEURA: Moderate to large bilateral pleural effusions are increased in size from the prior exam with right upper lobe masslike consolidation.MEDIASTINUM AND HILA:Esophagus is dilated and filled with contrast proximal to the stents. There is soft tissue thickening around the stent which appears somewhat to the prior exam, likely corresponding to patient's known esophageal cancer. The stent itself appears patent. Right chest port tip terminates in SVC. Moderate coronary artery calcifications. Right paratracheal node measures 1.4 x 1.2 cm (701/33), previously 0.8 x 0.8 cm. Small pericardial effusion is unchanged.CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter hepatic hypodensities are stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing punctate right renal stone. Right renal cysts. Punctate nonobstructing left renal stone. Contrast in the adjacent colon obscures visualization of lower kidney. RETROPERITONEUM, LYMPH NODES: Gastrohepatic (paraesophageal) node measures 1.5 x 1.1 cm (701/90), previously 1.5 x 0.8 cm. Index left para-aortic node measures 0.7 x 0.5 cm (701/116), previously 0.7 x 0.5 cm.BOWEL, MESENTERY: Wall thickening of the cardia is unchanged. Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate abdominal ascites is increased.PELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: Index left external iliac node measures 1.0 x 0.7 centimeters (701/23), previously 1.2 x 0.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Soft tissue thickening around distal esophageal stent appears similar to the prior exam.2.Mediastinal lymphadenopathy is slightly increased. Additional lymphadenopathy is not significantly changed.3.Increased moderate to large bilateral pleural effusions with masslike consolidation in the right upper lobe.4.Increased moderate abdominal ascites. |
Generate impression based on findings. | 58 years, Male. Reason: eval for dilated bowel History: distended abd, elevated bilirubin There is improved, yet persistent ileus type pattern. Left lower extremity central venous catheter tip noted projecting over the pelvis. Additional large bore catheter projects over the abdomen. | Improved, yet persistent ileus. |
Generate impression based on findings. | Status post fall, hit head, pain and ecchymosis to left frontal area Head: No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent mild chronic small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Orbits are intact without evidence of hematoma. Calvarium is intact.Cervical:The cervical vertebral bodies are appropriate height. Alignment is maintained. No fractures are identified in the cervical spine. No suspicious bony lesions are identified in the cervical spine.Mild degenerative changes are seen without significant spinal canal or neural foramina stenosis. Paraspinous soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage or mass effect. No skull fracture. 2. No fracture or subluxation within the cervical spine. |
Generate impression based on findings. | Status post XLIF with spinal fusion, evaluate construct. Evaluation of the spine is slightly limited due to inability to optimally position the patient. There are intervertebral spacer devices at L1/2, L2/3, L3/4, and L4/5. The lumbar scoliosis seen on the prior study is perhaps slightly less pronounced on the current study. Loss of height of L3 associated with an underlying fracture is better seen on the recent CT scan. The bones appear slightly demineralized suggesting osteopenia/osteoporosis. Osteoarthritis affects both hip joints. There is calcification of the abdominal aorta and common iliac arteries. There is an IVC filter. Surgical clips in the right upper quadrant are presumably from prior cholecystectomy. | Postoperative changes of spinal fusion as described above. Loss of height of L3 with associated fracture is better visualized on prior CT scan. |
Generate impression based on findings. | Reason: Patient with SOB, cough and endocarditis w/ concern for septic emboli History: As above LUNGS AND PLEURA: Lingular subsegmental atelectasis.Bilateral basilar scarring/discoid atelectasis.No suspicious pulmonary nodules or masses.Mild left pleural thickening.No pleural effusions.MEDIASTINUM AND HILA: Left-sided ICD with lead wires and right atrial appendage and right ventricle and sinus.Scattered mildly prominent mediastinal lymph nodes without evidence of mediastinal lymphadenopathy.Patulous esophagus with luminal debris identified.Marked cardiac enlargement without evidence of a pericardial effusion. Marked coronary artery calcification.CHEST WALL: Moderate degenerative changes throughout the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered splenic and hepatic calcifications. | 1.Lingular and basilar subsegmental atelectasis with mild left pleural and parenchymal scarring.2.No suspicious point nodules or masses. No specific evidence of infection or edema. |
Generate impression based on findings. | Evaluate for osteoarthritis for upcoming orthopedic appointment and possible knee replacement. Four views of the left knee are provided. Moderate osteoarthritis affects the knee, particularly the patellofemoral and medial compartments. Ossicles posterior to the knee joint likely represent loose bodies in a Baker's cyst. I see no large joint effusion.Moderate osteoarthritis also affects the right knee as seen on the frontal views. | Osteoarthritis. |
Generate impression based on findings. | Postop prosthetic assessment Two views of the left hip show components of a total hip arthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication.The AP view of the pelvis reveals the aforementioned left total hip arthroplasty. The bones appear demineralized suggesting osteopenia. Avascular necrosis of the right femoral head appears similar to that seen on the prior study. Surgical clips are noted in the right lower quadrant. | Left total hip arthroplasty and other findings as above. |
Generate impression based on findings. | Patient has sickle cell of bilateral hip AVN status-post bilateral hip replacements, presented with 1.5 weeks of right hip pain. Evidence of fracture or cause of right hip pain? Two views of the right hip are provided. Again seen are components of a right total hip arthroplasty device appearing similar to those seen on the prior study, with relatively superomedial positioning of the acetabular cup. Lucency about the acetabular screws may reflect loosening, but appears similar to that seen on the prior study. Heterotopic ossification extends from the lateral aspect of the ilium toward the greater trochanter. Additional heterotopic ossification is seen along the medial aspect of the proximal femur. I see no acute fracture.AP view of the pelvis reveals the aforementioned right total hip arthroplasty device. The components of a left total hip arthroplasty device are incompletely imaged on this study; there is slight eccentric positioning of the head of the femoral component within acetabular cup, suggesting liner wear. This appears similar to the prior study. Overall, the bones appear demineralized, compatible with the stated history of sickle cell anemia, with loss of height of the lower lumbar vertebrae also appearing similar to the prior study. | Right total hip arthroplasty device as described above appearing similar to that seen on the prior study. I see no acute complications. |
Generate impression based on findings. | 57 year old woman with atypical chest pain referred to rule out CAD as cause. Cardiac risk factors include 20 year tobacco history. CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. There is a non-calcified, non-obstructive plaque resulting in 25% to 50% stenosis of mid LAD. The remainder of the LAD is without significant atherosclerosis. The first diagonal branch also a has a non-calcified, non-obstructive plaque at the proximal portion resulting in 25-50% stenosis.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery. There is a non-obstructive, non-calcified plaque in the mid RCA resulting in <25% stenosis. Left Ventricle: The left ventricle is normal in size (LVEDV 131ml) with mild left ventricular hypertrophy. Left ventricular systolic function is normal. Right Ventricle: Normal RV size. Left Atrium: Mild left atrial dilation. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to grossly normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. There are no severe coronary artery stenoses present. 2. Non-obstructive (<50% stenosis), non-calcified coronary atherosclerosis is noted in the mid LAD, proximal diagonal 1 artery, and the mid right coronary artery. 3. Normal LV size with normal systolic function. 4. Mild left ventricular hypertrophy with mild left atrial dilation. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Evaluate status-post left total hip arthroplasty The AP view of the left hip reveals components of a total hip arthroplasty device situated in near anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density within the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the left. Components of a right total hip arthroplasty device are situated in near-anatomic alignment appearing similar to the prior study. Mild osteoarthritis affects the sacroiliac joints. Severe degenerative disk disease affects the lower lumbar spine. | Left total hip arthroplasty and other findings as above. |
Generate impression based on findings. | Preop. Pain. Three views of the left knee are provided. Severe osteoarthritis affects the patellofemoral joint with near bone-on-bone apposition. There is also slight lateral translation of the patella relative to the femoral trochlea. Relatively mild osteoarthritis affects the tibiofemoral compartment. Overall, these findings are similar to those seen on the prior study. Mild to moderate osteoarthritis affects the tibiofemoral compartment of the right knee, as seen on the frontal view.The mechanical axis radiograph reveals the aforementioned left knee osteoarthritis. There is approximately 5 degrees of valgus alignment of the knee with respect to the neutral mechanical axis. | Osteoarthritis and mild valgus deformity as described above. |
Generate impression based on findings. | Shoulder pain Mild osteoarthritis affects the glenohumeral and acromioclavicular joints, appearing similar to the prior study. Alignment is within normal limits. | Mild osteoarthritis. |
Generate impression based on findings. | Pain status post left shoulder TSA Three views of the left shoulder and two views of the left humerus reveal components of a new total shoulder arthroplasty. There is slight anterior subluxation of the head of the humeral component with respect to the glenoid component. Discontinuity of the greater tuberosity likely represents interval osteotomy. A bone fragment along the medial aspect of the humeral neck also presumably represents prior osteotomy. Mineralization along the lateral aspect of the proximal humeral diaphysis may represent callus formation. Distally, the humerus appears intact. | Total shoulder arthroplasty as described above. |
Generate impression based on findings. | Left shoulder pain. Rule-out dislocation. Patient states that it feels like it is out of place. Painful range of motion. Glenohumeral and acromioclavicular joint alignment is within normal limits. Small acromioclavicular joint osteophytes indicate mild osteoarthritis. I see no fracture. | Mild osteoarthritis without fracture or dislocation. |
Generate impression based on findings. | Medial pain status post fall. Rule out fracture/dislocation. I see no fracture or dislocation. I see no findings to account for the patient's pain. | Normal-appearing knee without fracture, dislocation or other findings to account for the patient's pain. |
Generate impression based on findings. | Humerus fracture. Concern for pathologic fracture. Three views of the left shoulder, two views of left humerus and 4 views of the left elbow are provided. There is a transverse fracture through a geographic lucent lesion of the proximal humeral metadiaphysis. The lesion has well-defined thin sclerotic margins and results in mild expansile remodeling of the bone. It is approximately 9.5 cm in craniocaudal dimension. There are bony ridges within the lesion, in addition to a more vertically-oriented linear density that likely represents a "fallen fracture fragment". There is otherwise no displacement. The glenohumeral and acromioclavicular joints appear normal. The distal humerus appears normal. The elbow joint appears normal. | Nondisplaced fracture through simple bone cyst of the proximal humerus. |
Generate impression based on findings. | 69 year old woman with palpable right breast mass; two suspicious masses noted on mammogram and ultrasound. Right ultrasound re-identified the target lesions for biopsy. The first lesion to be targeted is a lobulated, hypoechoic mass measuring 12 x 12 x 10 mm at the 10 o’clock position with increased vascularity, 10 cm from the nipple. The second lesion to be targeted is a circumscribed, hypoechoic mass measuring 32 x 29 x 23 mm at the 9 o’clock position with increased vascularity, 10 cm from the nipple.The lesion was .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 right breast 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 single 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 10:00 lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen partially sank. Specimen quality was judged very good. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. Subsequently, using aseptic technique, continuous ultrasound guidance and a mediolateral approach, three 12-gauge core needle (Celero) specimens were obtained of the 9:00 lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Specimens were sent to Pathology with an accompanying history sheet. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed Wing clip to be in the expected location in the peripheral anterior aspect of the 10:00 lesion and the HydroMark clip to be in the expected location in the central 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 Dr. Patel. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesions and clip placement. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Malignant neoplasm of larynx, status post surgery and radiotherapy follow-up. There are post-treatment findings in the neck related to total laryngectomy and flap reconstruction, tracheostomy, as well as radiation therapy. There is no evidence of measurable tumor in the region of the treatment bed and no significant cervical lymphadenopathy based on size criteria. The airway inferior to the tracheostomy tube is patent. There are punctate right parotid calculi. The other salivary glands are unremarkable. The remaining portions of the thyroid appear unremarkable. The major cervical vessels are patent. There is a right subclavian venous catheter. There is multilevel degenerative spondylosis. There is a small left maxillary sinus retention cyst. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Post-treatment findings in the neck without definite evidence of tumor recurrence. |
Generate impression based on findings. | There is extensive encephalomalacia involving the left cerebral hemisphere, particularly in the frontal and parietal lobes and to a lesser degree in the temporal lobe, occipital lobe, and insular cortex similar to prior examination. There is ex vacuo dilatation of the left lateral ventricle which is unchanged. There is no significant midline shift. There is no acute intracranial hemorrhage or mass effect. There is stable mild periventricular white matter hypoattenuation adjacent to the right frontal horn which is nonspecific but likely representing chronic microvascular ischemic changes. There is persistent near complete opacification of the right mastoid air cells with well pneumatized right middle ear cavity. There is a small right sphenoid sinus air-fluid level with hyperdense secretions which may be related to inspissated secretions or chronic fungal colonization. Atherosclerotic calcifications noted. The calvarium is intact. | 1.No acute intracranial hemorrhage or mass-effect. However, please note that CT is insensitive for detection of early nonhemorrhagic stroke.2.Stable extensive left hemispheric encephalomalacia from old infarct. |
Generate impression based on findings. | Pain Three views of the right knee are provided. There is severe osteoarthritis particularly affecting the medial compartment where there is near bone on bone apposition. A 1.5-cm ossicle in the posterior aspect of the joint may represent a loose body. I see no large joint effusion.Three views of the left knee are provided. Severe osteoarthritis affects the knee, particularly the medial compartment. There also appears to be chondrocalcinosis of the menisci. I see no large joint effusion. | Severe bilateral osteoarthritis. |
Generate impression based on findings. | Complains of C7 neuropathic pain on the left. Assess for osteophytes, signs of osteoarthritis. Severe degenerative disk disease affects C3/4 and C5/6. Moderate to severe degenerative disk disease affects C6/7 and C7/T1. Moderate degenerative disk disease affects C2/3. There is multilevel facet joint osteoarthritis and moderate multilevel neuroforaminal narrowing bilaterally. There are perhaps minimal retrolistheses of C2 on C3. Calcifications in the soft tissues lateral to the cervical spine likely reside in the carotid vasculature. Surgical clips are noted anterior to C7 and T1. | Degenerative disk disease and other findings as described above. |
Generate impression based on findings. | PICC placement. Craniopharyngioma.VIEW: Chest AP (one view) 02/25/15, 1231 Left upper extremity PICC tip is at junction of superior vena cava and right atrium.Cardiothymic silhouette is normal. No focal lung opacities present. | PICC tip is located centrally. |
Generate impression based on findings. | Status post curettage of right distal femur chondrosarcoma. Evaluate for healing. There is an elongated defect along the lateral aspect of the distal femoral metadiaphysis with bone graft material in the underlying medullary space. Small densities within the soft tissues lateral to the distal femur presumably represent additional bone graft material. I see no fracture or other specific radiographic findings to suggest a postoperative complication. | Postoperative changes of chondrosarcoma curettage and grafting as described above. |
Generate impression based on findings. | Left hip pain, new onset, no known insult or injury. I see no fracture or malalignment. There is slight prominence of the anterior aspect of the femoral head/neck junction on the frog leg view which may indicate a mild CAM deformity. I otherwise see no specific findings to account for the patient's pain. | Possible mild CAM deformity of the femoral head/neck junction, but otherwise no specific findings to account for the patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 71-year-old female with HCC, status post Therasphere administration. CHEST:LUNGS AND PLEURA: 7-mm left basilar nodule (series 11, image 66) unchanged. No new other nodules or parenchymal abnormality seen. No pleural disease.MEDIASTINUM AND HILA: Mild coronary artery calcification without adenopathy or other significant abnormality noted in mediastinum. Thyroid nodules again seen unchanged..CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology liver again seen. Post ablation defects at multiple locations in the left lobe, largest at the dome appear unchanged dating back to December 17, 2014. No evidence of perilesional enhancement is seen to suggest recurrence or residual tumor.Multiple arterial phase enhancing foci are seen in the right lobe of the liver as seen on prior CT examinations. These do not exhibit and delayed phases as seen on previous examinations. Most superior of these lesions in segment 8, (series 9, image 28) has not previously changed measuring 0.8 x 0 .6 cm, previously 0.8 x 0.8 cm. largest lesion more inferiorly (series 9, image 32) measures 2.3 x 2 .1 cm, slightly smaller than previous 2.6 x 2.8 cm. The central attenuation seen on precontrast and persisting throughout all phases persist with mild peripheral enhancement. Scattered smaller hyper enhancing foci are seen more cephalad as seen on prior examinations and appear unchanged in size.No new lesions are identified. Main portal vein and right portal vein branches are well seen , patent and normal. Left portal vein branches adjacent to prior ablated lesions are not well seen and appear attenuated. Evidence of portal hypertension with portosystemic collaterals are unchanged.Gallstones and the gallbladder are again seen with distended gallbladder but without other biliary tract complication.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign cortical cysts again seen without other significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted in the stomach, small and large bowel esophagogastric varices are seen. extensive ascites without loculation and embolization coils again seen in the paraduodenal region.BONES, SOFT TISSUES: Anterior abdominal wall umbilical hernia containing only ascites and mesenteric fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy without other abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive ascites seen without other significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Most hepatic mass lesions appears stable although one larger lesion is slightly smaller as reported above. 2. Cirrhotic morphology with portal hypertension varices unchanged and no new parenchymal lesions identified. 3. Cholelithiasis with distended gallbladder unchanged. 4. Extensive ascites without loculation. |
Generate impression based on findings. | Pain. Tibial plateau fracture? Three views of the left knee are provided. The bones appear demineralized presumably from disuse. Again seen is a comminuted intra-articular fracture of the proximal tibia with fracture fragment in near anatomic alignment. The fracture lines are less distinct on the current study than on the prior study, indicating some interval healing. I see no large joint effusion.The right knee appears normal as seen on the frontal view. | Healing proximal tibial fracture. |
Generate impression based on findings. | Chest pain, shortness of breath, pain in left lower leg. History of lupus. Question of PE. PULMONARY ARTERIES: There are new mostly eccentrically located, non-occlusive filling defects within the bilateral lower lobar and segmental pulmonary arteries, right greater than left. The main pulmonary artery is not enlarged. LUNGS AND PLEURA: There is no focal airspace consolidation, pleural effusion, or pneumothorax. Multiple scattered pulmonary micronodules are unchanged. MEDIASTINUM AND HILA: There is no evidence of right heart strain. There is no pericardial effusion. No mediastinal or hilar lymphadenopathy is noted. No coronary artery calcifications are present on this non-gated examination. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. A right hepatic lobe hypodensity is unchanged and likely a hepatic cyst. | Bilateral lower lobar/segmental pulmonary emboli are new compared to a 8/19/2014 study. However, the appearance of the filling defects are not consistent with an acute or chronic process and thus these are of indeterminate age. Findings communicated to Dr Sharp via phone in the ED at 1305 hrs. PULMONARY EMBOLISM: PE: Positive.Chronicity: Indeterminate.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 7-year-old male with history of neuroblastoma, pre-ENCIT-1 study CHEST:LUNGS AND PLEURA: No pulmonary nodules or masses. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Normal size heart with no pericardial effusion. Reference right hilar lymph node measures 8 mm (series 3, image 27) previously 10 mm. No mediastinal or left hilar adenopathy.CHEST WALL: Left-sided chest wall port catheter tip in the cavoatrial junction. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. The gallbladder is normal.SPLEEN: Normal.PANCREAS: Normal. No pancreatic ductal dilatation.ADRENAL GLANDS: The left adrenal gland is not visualized. The right adrenal gland is normal.KIDNEYS, URETERS: Normal.RETROPERITONEUM, LYMPH NODES: Again seen are multiple retroperitoneal soft tissue masses. Reference lesion posterior to left renal vein measures 2.0 cm x 1.1 cm (series 3, image 81) previously measured 1.8 cm x 1.0 cm. BOWEL, MESENTERY: Balloon type gastrostomy tube is again seen. Bowel is normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: Multiple ill-defined, mixed lucent/sclerotic lesions throughout the osseous structures appear similar to the prior examination. Previously noted enhancing soft tissue lesion within the spinal canal at T6 vertebral level (series 80256, image 15) is unchanged. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Normal.BLADDER: Normal.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Bowel is normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: Multiple ill-defined, mixed lucent/sclerotic lesions throughout the osseous structures appear similar to the prior examination. OTHER: No significant abnormality noted | No significant interval change in retroperitoneal, paraspinal, and osseous metastatic disease. |
Generate impression based on findings. | 7-year-old female with fever, cough, wheezingVIEWS: Chest AP/lateral (two views) 2/25/15 12:59 Bronchial wall thickening and subsegmental atelectasis without consolidation or pleural effusion. The cardiothymic silhouette is normal. | Bronchiolitis without evidence of pneumonia. |
Generate impression based on findings. | 16 year-old male status post PICC placementVIEW: Chest AP (one view) 2/25/15 11:49 Left PICC tip is directed laterally within the SVC. NG tube tip and side-port in the stomach. The cardiothymic silhouette is unchanged.Interval increase in right pleural effusion and basilar opacity. | Left PICC tip in the SVC. Increased right pleural effusion and basilar opacity. |
Generate impression based on findings. | 14 year-old male with right wrist pain status post assaultVIEWS: Right wrist, AP, lateral, and oblique (3 views) 2/25/15 11:54 Soft tissue swelling is present about the wrist with displacement of the pronator quadratus fat pad. No visualized fracture or malalignment. | Soft tissue swelling without visualized fracture or dislocation. |
Generate impression based on findings. | 27-year-old female patient with history of ulcerative colitis, in complete remission, now with constipation and straining. Physical examination demonstrated small external hemorrhoids. There is prompt opacification of the rectum, sigmoid, and descending colon without significant abnormality.Trial straining showed appropriate descent of the perineal floor; voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed appropriate passage of rectal/neo-rectal contents with an anterior rectocele that measures 2.9 x 1.9 cm (craniocaudal and AP; series 23 and cine series 22). No evidence of sinus tracts, fistulae, or anastomotic leaks.FLUOROSCOPY TIME: 4:42 minutes. | Anterior rectocele visible during active evacuation. |
Generate impression based on findings. | 18 year-old female, evaluate for right ankle fractureVIEWS: Right ankle, AP, oblique, and lateral (3 views) 2/25/15 12:08 Alignment is anatomic. No fracture is evident. The ankle mortise is intact. | Normal examination. |
Generate impression based on findings. | 59 years old male with a history of esophageal carcinoma,currently receiving therapy on clinical trial and reassessment warranted. Please compare to previous imaging . RADIOPHARMACEUTICAL: 15.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 126 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates interval increase in size and metabolic activity in the distal esophageal tumor with SUV Max of 15.7 (it was 11.2 on prior study). Several new foci of increased activity are seen in the right upper lobe corresponding to the nodular opacities seen on CT, which are suspicious for metastasis. There is a new focus of increased activity in the left upper lobe at subpleural location, corresponding to a nodular density seen on CT, and suspicious for metastasis. There is a new focus of increased activity in the gastrohepatic ligament, corresponding to small lymph node seen on CT, consistent with nodal metastasis.Diffuse and mild FDG uptake is noted in the opacities in the lower lungs.Physiological activity is seen in the middle, spleen, kidneys, intestines and bladder. | 1.Interval progression of metastatic esophageal cancer with new metastasis in the lungs and in the abdominal gastrohepatic ligament. The primary esophageal tumor has increased in size and metabolic activity.2.Inflammatory changes/compression atelectasis in both lower lungs.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Clinical question: 48-year-old white female with no known PMH, with acute pulmonary hemorrhage a/w flue + MSSA PNA/no status post initiation of ECMO, difficulty accessing mental status. Signs and symptoms: Pinpoint pupils with minimal but equal reactivity. Requiring larger volumes of blood product. Nonenhanced head CT:Examination demonstrate a numerous varying sized foci of high density in bilateral cerebral hemispheres, extensively in the left lateral ventricle and a single focus in the dorsal paramedian aspect of the left cerebellum. Findings are consistent with multiple acute hematomas. Several of the hematomas demonstrate surrounding vasogenic edema. There is extensive effacement of cerebral cortical sulci secondary to overall increased intracranial volume. There is also mild enlargement of right lateral ventricle compared to left which could represent early onset of hydrocephalus. There is however no evidence of midline shift. The basal cistern is small however without convincing evidence of transtentorial herniation.The largest supratentorial parenchymal hematoma in the right posterior temporal lobe measures approximately at 25-mm in transaxial dimensions. The single hematoma in the left cerebellum measures approximately a 23 x 20 mm on coronal reformatted images. Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits. Small fluid levels within the bilateral maxillary and bilateral chambers of the sphenoid sinus and patchy opacification of ethmoids is also noted. Findings and concerns on this exam were discussed with the clinical service #3453 at the time of review of the exam. | 1.Several varying size acute parenchymal hematoma in bilateral cerebral hemispheres and a single hematoma in the left paramedian posterior cerebellar.2.There is extension of hemorrhage into the ventricular system extensively on the left and lesser degree in the right ventricle and minimally in the fourth.3.Effacement of cortical sulci and small size of basal cistern secondary to mass effect without midline shift. |
Generate impression based on findings. | Head and neck cancer and CRT. CHEST:LUNGS AND PLEURA: Right lower lobe spiculated nodule decreased in size but the spicules are oriented obliquely to the scanning plane. Solid portion of the nodule measures 7 x 9 mm (/54), previously 10 x 24 mm. Spiculation extending anterolaterally to the major fissure appears slightly less prominent (4/53).Bilateral nodular apical scarring, not significantly changed. Paraseptal and centrilobular emphysema. Scattered micronodules unchanged. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Moderate coronary artery calcifications. No lymphadenopathy. Normal heart size. No pericardial fluid. Left jugular chest port tip at the SVC/RA junction.CHEST WALL: Chest port. Nonspecific calcifications in the left lobe of the thyroid gland (3/12).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: Atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy two retention of these the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No new nodules or lymphadenopathy to suggest metastatic disease.2. Right lower lobe spiculated nodule decreased in size, favoring a postinfectious lesion.3. Stable nodular lesions at the lung apices, most likely nodular scarring.4. Above lesions may be followed in 3-4 months for stability. |
Generate impression based on findings. | 68 year old female with history of brainstem lesion and continuous vomiting. There is no evidence of acute intracranial hemorrhage. There is extensive periventricular and subcortical white matter hypoattenuation which is nonspecific but compatible with moderate chronic small vessel ischemic disease. The gray-white differentiation is preserved. Mild global parenchymal volume loss. The basal cisterns are intact. No hydrocephalus. Small left maxillary mucus retention cyst. The remaining paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues of the scalp are within normal limits. | 1. No intracranial hemorrhage or mass effect.2. Moderate chronic small vessel ischemic disease.3. Please note left posterior medullary lesion seen on prior MRI is not well seen on CT and recommend follow-up MR for better evaluation. |
Generate impression based on findings. | 20 year-old female patient status post IPAA. There is prompt opacification of the J-pouch of normal static morphology with Omnipaque with retrograde filling to the ileostomy. Next, barium contrast was injected to opacify the J-pouch and proximal bowel. There was normal appearing peristalsis of the bowel proximal to the J-pouch.Trial straining showed appropriate descent of the perineal floor; voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed appropriate passage of neo-rectal contents without evidence of proctocele/enterocele. No evidence of sinus tracts, fistulae, or anastomotic leaks.FLUOROSCOPY TIME: 5:06 minutes | Properly functioning J-pouch. |
Generate impression based on findings. | Evaluation preoperatively for right middle lobe adenocarcinoma. CHEST:LUNGS AND PLEURA: There is a 26 x 19 mm right middle lobe pulmonary nodule with minimal surrounding ground glass opacity. There are scattered punctate calcified granulomas and non-calcified pulmonary micronodules which are non-specific. There is suspected debris within the trachea. There is bronchial wall thickening.MEDIASTINUM AND HILA: The heart size is normal. There is a trace pericardial effusion, mostly located inferiorly. There are severe coronary artery calcifications.There is no mediastinal or hilar lymphadenopathy by CT size criteria. Calcified mediastinal lymph nodes are compatible with prior granulomatous disease. CHEST WALL: There is no axillary lymphadenopathy. There are multilevel degenerative changes of the thoracic and lumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The gallbladder is surgically absent. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The left kidney is slightly atrophic. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is heavy atherosclerotic calcification of the aorta and its branches. Surgical clips are noted adjacent to the right kidney.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. | 1. Right middle lobe solid pulmonary nodule is compatible with provided diagnosis of lung cancer. Additional scattered punctate pulmonary micronodules are non-specific.2. No evidence of mediastinal or hilar lymphadenopathy by CT size criteria. |
Generate impression based on findings. | Reason: h/o HNC and CRT at another facility, compare to previous, measurements pls. History: none LUNGS AND PLEURA: Mild apical predominant centrilobular emphysema.No suspicious pulmonary nodules or masses.Mild periesophageal fat infiltration, likely post-radiation changes.Minimal dependent atelectasis. Previously described dependent scattered tree in bud opacities are no longer seen, likely from prior inflammatory process including aspiration. No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: Tracheostomy tube in place.Heart is normal in size with a physiologic amount of pericardial fluid. No visible coronary artery calcification.Scattered mildly prominent mediastinal lymph nodes are unchanged. A right paratracheal lymph node measures 1.1 cm (series 3, image 33).CHEST WALL: Right chest port, tip in the right atrium.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Gastrostomy tube in place. Nonspecific left adrenal nodular thickening is unchanged. | 1. No significant change in mild mediastinal lymphadenopathy since the previous study. However, this area was partially included within the scanning range of neck CT dated 8/31/2014 and lymph nodes in this area are larger when comparing back to this remote exam, now at least mildly suspicious for nodal metastases. Consider correlation with PET if diagnosis would alter clinical management.2. Interval resolution of left lung base inflammatory findings likely related to prior aspiration. 3. No evidence of parenchymal lung metastases. |
Generate impression based on findings. | Lung cancer status post chemoradiation. Check response. CHEST:LUNGS AND PLEURA: There is moderate apical predominant centrilobular emphysema. Right paramediastinal radiation fibrosis is similar to the prior examination. Focal area of thickening within the medial right middle lobe measures approximately 8 mm (image 57, series 6), unchanged. No new suspicious nodules or masses are identified. No pleural effusion or pneumothorax is noted. MEDIASTINUM AND HILA: A reference right paratracheal lymph node measures 6 mm in the short axis (image 40, series 4), unchanged; this node is of non-pathologic size and of normal morphologic appearance and does not need to followed further. A localized pericardial effusion is stable. Post-surgical changes of a CABG with severe native coronary artery calcifications. CHEST WALL: Prior median sternotomy. There are multilevel degenerative changes of the thoracic spine.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: A subcentimeter right renal cyst is too small to characterize and unchanged. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is atherosclerotic calcification of the aorta and its branches.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. | No significant interval change or new evidence of metastatic disease. |
Generate impression based on findings. | T3N2cM0 squamous cell carcinoma of the base of tongue treated with 3 cycles of induction chemotherapy with carbo/taxo, and 5/5 cycles of TFHx completed on 1/9/15. There has been interval decrease in size of the left tongue base lesion, which now measures up to approximately 5 mm, previously 15 mm. In addition, there has been interval decrease in size of the cervical lymphadenopathy. For example, hyperenhancing right level 2B and left level 2A lymph nodes each measure 5 mm in short axis, previously 7 mm. There is an unchanged subcentimeter partially calcified left thyroid nodule. The salivary glands are mildly hyperemic, likely due to treatment effects. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable. There is extensive pulmonary emphysema and unchanged apical nodularity. | 1. Interval decrease in size of the left tongue base squamous cell carcinoma and bilateral cervical lymph nodes.2. Unchanged subcentimeter partially calcified left thyroid nodule. Nevertheless, thyroid ultrasound may be useful for further characterization. |
Generate impression based on findings. | Recurrent paraganglioma post-MIBG Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. Compared with 9/12/2014 there has been interval decrease in both the size and number of the numerous soft tissue and osseous lesions involving the legs, pelvic region, spine and skull. | Overall interval decrease in number and size of the diffuse soft tissue and osseous lesions when compared with the exam from 9/12/2014. |
Generate impression based on findings. | 15 year old female with history of constipation, chronic narcotic pain medication since surgery. Evaluate degree of stool burdenVIEW: Abdomen AP (one view) 2/25/2015 Surgical clips in the left upper quadrant. Average stool burden. Nonobstructive bowel gas pattern. | Average stool burden with no obstruction. |
Generate impression based on findings. | Prostate cancer with Gleason 9 score. No abnormal osseous foci are identified to indicate metastatic disease. Increased activity within the mandible bilaterally may be related to dental disease. Increased activity within the bilateral frontal sinuses may be related to sinusitis. Increase renal cortical activity can be due to dehydration or medical renal disease. | No evidence of bone metastases. |
Generate impression based on findings. | There is mild nonspecific prominence of the ventricles and sulci are diffusely without definite anterior predominance. In addition, the frontal lobes appear somewhat diminutive in size with decreased white matter volume. 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. No extra-axial fluid collection is identified. Myelination appears appropriate for age.There is an abnormal appearance of the distal body and splenium of the corpus callosum which appear diminutive in size. There is kinking of the upper cervical cord at the C1-C2 level, with narrowing of the cervical spinal canal.Normal flow-voids are demonstrated in the major intracranial vascular structures. The remainder of the midline structures and craniocervical junction are within normal limits. There is severe fluid opacification of bilateral mastoid air cells and middle ears. Mild hypotelorism is suggested. There is slight narrowing of the anterior aspect of the calvarium. | 1. Dysgenesis of the corpus callosum posteriorly with diminutive posterior body and splenium.2. Kinking of the upper cervical spinal cord at the C1-C2 level with suggestion of at least moderate narrowing of the spinal canal at this level. Findings may be developmental, and dedicated MRI of the cervical spine recommended for further evaluation.3. Slight narrowing of the anterior calvarium with overall mild global volume loss greater than expected for the patient's stated age. A small component of superimposed benign external hydrocephalus of infancy which should resolve by two years of age may be present. Calvarial contour may contribute to apparent decreased frontal lobe volume. Mild hypotelorism. If there remains concern for craniosynostosis, CT craniofacial is recommended for more detailed evaluation.4. Severe mastoid and middle ear opacification bilaterally, for which clinical correlation is recommended. |
Generate impression based on findings. | 79-year-old female with history of chronic sinusitis. There is mild mucosal thickening along the inferior aspects of the bilateral maxillary sinuses and mild opacification of scattered ethmoid air cells. The sphenoid and frontal sinuses are clear. There are postoperative changes of left uncinectomy with patent bilateral osteomeatal units. There is polypoid soft tissue along the left middle turbinate. Bilateral frontoethmoidal and sphenoethmoidal recesses are patent. The lamina papyracea are intact. There is rightward nasal septal deviation. There is a large torus palatinus which is partially visualized. | 1. Mild mucosal thickening as detailed above. 2. Prior left uncinectomy with patent bilateral osteomeatal units.3. Polypoid soft tissue along the left middle turbinate. |
Generate impression based on findings. | Clinical question: Chronic sinusitis. Sinus and symptoms: Sinusitis. Nonenhanced maxillofacial CT:All paranasal sinuses are well pneumatized. There is only a single small focus of because of thickening in the dependent left maxillary sinus and without evidence of any additional findings of chronic or acute sinusitis. The ostiomeatal units the maxillary sinuses and the sphenoethmoidal recess of the sphenoid sinus remain patent and unremarkable.Images through the nasal passage demonstrate mild leftward nasal septum deviation. There is a small bony septal spur projecting to the left which is in contact and deforms the mucosa of the left inferior turbinate.Bilateral mastoid air cells and middle ear cavities remain well pneumatized.Unremarkable images through the orbits.No detectable bony abnormality of the maxillofacial region. | 1.Negative CT of paranasal sinuses.2.Mild leftward nasal septum deviation and a bony septal spur which is in contact and deforms the mucosa of the left inferior turbinate. |
Generate impression based on findings. | Cough, shortness of breath, nodule, recurrent pleural effusions. Is the recurrence related to malignancy.RADIOPHARMACEUTICAL: 12 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates a right-sided pleural effusion and subpleural reticulation within mild bronchiectasis and minimal architectural distortion particularly in the subpleural lower lungs. The pleura effusion has increased compared to previous exam. There is a focal area of thickening of the right upper mediastinal pleura. Small mediastinal and left hilar lymph nodes are noted. Status post cholecystectomy. A left maxillary sinus mucous retention cyst is noted.Today's PET examination demonstrates a focus of abnormal increased FDG avid activity in the right upper mediastinal pleura which has SUV max of 3.55. Additional mild foci of increased activity are noted in a subpleural distribution within the right lung base posteriorly. Mild increase in FDG avid activity is noted in lymph nodes within the right precarinal and left hilar region. Increased activity is noted in the lateral facets of the upper cervical region and within an anterior osteophyte in the thoracic spine, consistent with degenerative changes. | 1.Pleural thickening with diffuse nodular uptake, especially noted within the right upper mediastinal region and right posterior lung base, which could be due to tumor (such as mesothelioma or pleural metastases) or inflammatory changes.2.Nonspecific mild increased activity within mediastinal and hilar lymph nodes.3.Interval slight increase in the size of the right pleural effusion. |
Generate impression based on findings. | Reason: Metastatic thyroid cancer, follow up with measurements History: as above CHEST:LUNGS AND PLEURA: Multiple solid nodules of varying sizes are again seen throughout the lungs.A left lower lobe nodule measures 18 x 16 mm (series 5, image 78), previously 11 mm.A right lower lobe perihilar nodule now measures 32 x 25 mm (series 5, image 83), previously 26 mm.Left basilar nodule measures 12 mm (series 5, image 92), unchanged.Right lower lobe nodule measures 7 mm (series 5, image 93), unchanged.No definite new pulmonary nodules are identified.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.Status post thyroidectomy.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.Focal areas of lucency and sclerosis in the vertebral bodies are unchanged, nonspecific.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Extrahepatic biliary ductal dilatation, unchanged. No intrahepatic ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Cystic left adrenal lesion with rim calcification measures 4.3 cm (series 3, image 106), unchanged from 2010. Additional mild left adrenal nodularity is unchanged.KIDNEYS, URETERS: Left renal hypodensity is unchanged, likely a benign cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonenlarged gastrohepatic lymph nodes are decreased from the prior exam.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: A right iliac lytic lesion with bony destruction and surrounding large soft tissue component (series 3, image 157) was not included in the field of view of prior CT imaging, compatible with a metastatic lesion. Additional areas of lucency and sclerosis in the visualized skeleton are unchanged, nonspecific.OTHER: No significant abnormality noted. | 1. Increase in size of multiple pulmonary metastatic nodules. Reference measurements as above. 2. Newly visualized right iliac lytic lesion with bony destruction and surrounding soft tissue mass, compatible with osseous metastasis, age indeterminate. |
Generate impression based on findings. | 75 years, Male. Reason: ILeus History: Ileus Again seen are multiple dilated loops of large and small bowel with residual enteric contrast in the colon. Enteric feeding tube tip projects over the expected location of the gastric antrum. Postsurgical changes from fundoplications surgery are noted. The lung bases are clear. Sclerotic osteophyte on the right at L5-S1 is again noted. | Findings compatible with ileus. |
Generate impression based on findings. | Female 69 years old Reason: pt with met breast CA to bone and liver, had g tube replaced this week and having increased focal pain deep to tube site History: focal abd pain near g tube site with fevers at home ABDOMEN:LUNG BASES: No pleural effusions. Minimal basilar atelectasis. Lung nodules seen on prior CT chest are outside of the field of view.LIVER, BILIARY TRACT: There is nodular morphology and retraction of the liver capsule consistent with pseudocirrhosis. In retrospect, a CT examination from February 2014 showed innumerable hypodense lesions within the liver with subsequent overall decreased size of lesions and response to treatment on CT scans from 4/18/2014 and 6/20/2014. Since that time, there has been interval progression of disease with increase in size and extent of the hepatic lesions.Reference segment 2 lesion measures 2.0 x 1.4 cm (series 3, image 19), previously 1.2 x 0.6 cm on the noncontrast CT from 7/23/2014.Multiple new lesions are visualized. New segment 4 reference lesion measures 3.1 by 1.8 cm (series 3, image 36). Additional new segment 4 lesion measures 1.9 x 1.2 cm (series 3, image 45).Mild perihepatic ascites which is unchanged.Status post cholecystectomy. SPLEEN: Stable splenomegaly..PANCREAS: No significant abnormality noteddADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC filter in place. Atherosclerotic calcifications of the abdominal aorta and its branches..BOWEL, MESENTERY: Gastrostomy tube in place without leakage around the gastrostomy tube site. There is some ascites anterior to adjacent left lobe of liver, but this has been seen on prior exams before and does not appear related to gastrostomy tube. The gastric balloon is slightly retracted from the abdominal wall. No evidence of obstruction or intraperitoneal free air. No fluid collections or phlegmon in the anterior abdominal wall around tube.BONES, SOFT TISSUES: Multiple lytic and sclerotic lesions involving the thoracic and lumbar spine and pelvis some of which are stable and some of which have subtly increased in size (series 3, image 63 and image 20). Status post bilateral mastectomy with partially imaged bilateral breast prostheses.. OTHER: No significant abnormality notedPELVIS: Limited study secondary to beam hardening artifact from left hip arthroplasty.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Circumferential bowel wall thickening at site of prior anastomosis in the mid pelvis (series 3, image 90). The finding is nonspecific and of unknown clinical significance.BONES, SOFT TISSUES: Multiple lytic and sclerotic lesions involving the thoracic, lumbar spine and pelvis some of which are stable and some of which have subtly increased in size (series 3, image 63 and image 20).. Left hip arthroplasty with metallic hardware.OTHER: No significant abnormality noted1. | 2.No defined leakage around the gastrostomy tube site (ascites about liver appears similar to prior exams). The gastric balloon is slightly retracted from the anterior gastric wall in teh gastric lumen.3.Multiple hepatic metastases which were initially responsive to therapy, (although not reported as such on previous exam findings), but now have progressed in both size and extent from most recent examinations. Liver morphology shows "pseudocirrhosis" pattern typical of scarring from treated metastases, but superimposed new mass lesions of presumed metastases are now seen.4.Diffuse osseous metastases with subtle enlargement of both lytic and sclerotic lesions. Accurate assessment of bone activity is better characterized by a nuclear medicine bone scintigraphy study. |
Generate impression based on findings. | 79 years old female presents to evaluate extent of diagnosis for pancreatic cancer, status-post chemotherapy and radiation study on 2013. She presents with pancreatic mass enlarging on CT. RADIOPHARMACEUTICAL: 11.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 151 mg/dL. Today's CT portion grossly demonstrates a new low-attenuation area in the left temporal lobe. There is a interval increase in size of the pancreatic tail mass. There is a new lung nodule in the left upper lobe. There are stable lingular atelectasis and emphysema. Small to moderate pericardial effusion is unchanged from the prior study. Interval increased of the small left pleural effusion. Dilated main pulmonary artery is consistent with pulmonary hypertension. Coronary artery calcifications are again noted. At gastric tube is noted.Today's PET examination demonstrates increased FDG activity in the new nodule in the left upper lobe with SUVmax of 3.1, which is highly suspicious for metastasis. There is interval increase in size of the pancreatic tail mass with central photopenic area, consistent with the central necrosis. There is slight decrease of metabolic activity of the mass as compared with prior study with SUVmax of 4.3 on current study (it was 5.5 on the prior study).Increased to FDG uptake is seen in the intervertebral disk space of L4/5, which can be due to degenerative change or diskitis. Nonspecific focus of increased activity is seen in the cecum wall.There is a decreased metabolic activity in the left temporal lobe low-attenuation lesion, which is suspicious for an infarct.There is an interval decreased FDG activity in the subcutaneous soft tissue density in the right buttock. However is an interval development of the mild FDG activity in the skin of the left buttock and the left inguinal region.Stable increased activity in the upper left atrial wall is nonspecific.Physiologic activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Interval progression of pancreatic cancer with new metastasis in the left upper lobe of the lung and increased size of the pancreatic mass.2.Low-attenuation lesion with decreased metabolic activity in the left temporal lobe, suspicious for brain infarct.3.Diskitis or degenerative change in the L4/5 intervertebral disk space.4.Soft tissue inflammatory change in the buttocks.5.Interval increased left pleural effusion and stable pericardial effusion.6.Emphysematous changes in both lungs. |
Generate impression based on findings. | Malignant neoplasm of tonsil (squamous cell), CRT follow-up. CHEST:LUNGS AND PLEURA: Mixed response in size of nodules (some larger, some smaller) but an increase in number.Left apical mass measures 4.1 x 5.8 cm (4/17), previously 2.7 x 2.6 cm.Reference right upper lobe nodule measures 11 mm, previously 7-mm. There are multiple new micronodules and new ground glass opacity in the subsegment peripheral to this lesion (4/30).Bronchiolitis along the right major fissure in the anterior aspect of the right upper lobe has partially cleared.MEDIASTINUM AND HILA: Interval progression in lymphadenopathy. The precarinal region lymph node measures 29 mm, previously 10-mm and compresses the SVC (3/46).Para-aortic/AP window region lymph node measures 18 mm, previously 11-mm (3/43).Nonindex right hilar lymph node noted previously about the same, the other surrounding lymph nodes in the right hilar and subcarinal region are larger and left hilar lymphadenopathy is new.CHEST WALL: Enhancement of the thecal sac, nonspecific by CT but at least mildly suspicious for metastatic disease. Small internal mammary chain lymph nodes on the left.Thoracic kyphosis.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Several subcentimeter lesions are most consistent with cysts but too small to accurately characterize.SPLEEN: Enlarged vasculature consistent with portal hypertension. Calcified subcentimeter arterial aneurysms. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Small (7-mm) cortical lesion interpolar region left kidney (3/127) unchanged, incompletely characterized but does not meet the criteria for a simple cyst.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. | Though a few pulmonary nodules is appears slightly smaller, the majority are larger and there is an overall increase in number. Reference lesions measure larger. Interval worsening of lymphadenopathy. Thecal sac enhancement very poorly assessed by this technique but is at least mildly suspicious for metastatic disease as this structure is normally not visible. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Unenhanced head CT:No detectable acute intracranial process. CT however is intensity for early detection of acute nonhemorrhagic ischemic strokes.Multiple foci of encephalomalacia consistent with chronic ischemic strokes of bilateral Cipro hemispheres (left greater than right) are again identified and similar to prior exam. A small chronic right cerebellar ischemic stroke as was noted on prior study.Ex vacuo dilatation of the trigone of the left lateral ventricle secondary to a large chronic ischemic stroke also remains similar to prior exam.Unremarkable calvarium, soft tissues of the scalp, orbits and paranasal sinuses. | 1.No acute or new finding since prior exam from 2014.2.Multiple bilateral hemispheric (left greater than right) and small right cerebellar chronic ischemic strokes similar to prior study. |
Generate impression based on findings. | 37 years, Female. Reason: rule out bowel obstruction History: pain Nonobstructive bowel gas pattern with slightly less than average stool burden in the colon. There is mild sclerosis of the pubic symphysis, suggestive of mild degenerative changes. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 49 years, Female. Reason: pt w/ PTLD and abd LAD s/p ERCP for biliary stent removal w/ post-procedure LUQ abd pain; eval for free air or obstruction History: LUQ abd pain Granuloma is noted in the right lung based. Central venous catheter tip is in the right atrium. Cholecystomy clips are noted quadrant. A device projects over the right hemiabdomen. Additional surgical clips project over the left hemipelvis. Nonobstructive bowel gas pattern. No pneumoperitoneum. If clinical suspicion for free intraperitoneal air persists, a left lateral decubitus view. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Metastatic follicular thyroid carcinoma to lungs, on cediranib therapy. Neck: There are postoperative findings related to total thyroidectomy. There is no evidence of measurable locoregional tumor. There is no evidence of significant cervical lymphadenopathy. The salivary glands are unchanged. The airways are patent. There is minimal plaque at the carotid bifurcations. There is multilevel degenerative spondylosis. The lungs appear unchanged. Head: There is no evidence of intracranial mass lesions or abnormal intracranial enhancement. The ventricles are stable 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, including lens implants. | 1. No evidence of locoregional tumor recurrence of significant lymphadenopathy in the neck.2. No evidence of intracranial metastases. |
Generate impression based on findings. | 41-year-old female with history of Crohn's disease with ileostomy. Patient had lysis of adhesions in the past year now with new abdominal pain and recurrent obstructive symptoms. The scout film shows a nonobstructive bowel gas pattern. Fluoroscopic evaluation showed a focal, fixed narrowing of small bowel measuring at least 7 mm in length located approximately 49 cm from the ileostomy compatible with a stricture. Mild prestenotic dilation of the bowel was noted. The patient pointed to the site of pain which correlated with the site of stricture (series 15).Multiple fixed, angulated loops of small bowel were noted predominantly in the left upper quadrant and mid abdomen associated with pain on deep palpation compatible with nonobstructive adhesions (arrows on series 24, 27, 29; circles on series 26, 31). No ulcers, sinus tracts, or fistulae were evident. Mild separation of bowel loops was present suggestive of fibrofatty proliferation. Transit time to the ileostomy was 30 minutes. No internal hernias or ventral hernias were evident.TOTAL FLUOROSCOPY TIME: 7:45 | 1.Short segment stricture in the distal small bowel as described above. 2.Multiple nonobstructive adhesions as described above.Findings discussed with clinical service at 1039 on 2/25/15. |
Generate impression based on findings. | 57-year-old with history of lymph node biopsy. 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 composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. An area of focal asymmetry in the left outer breast disperses with spot compression. Intramammary and axillary lymph nodes are significantly decreased in size compared to the prior study. | No mammographic evidence of malignancy. Interval significant decrease in symmetric axillary and intramammary lymph nodes. 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. | Clinical question: Could obscure a hemorrhage, CVA. Signs and symptoms: Headache and paresthesia. Unenhanced head CT:No acute intracranial finding. CT however is insensitive for early detection of an acute nonhemorrhagic ischemic stroke. There is widening of the left sylvian fissure with CSF density. The finding is believed to represent ex vacuo dilatation of the left sylvian fissure secondary to left frontal lobe chronic ischemic stroke. There are no prior exams available for comparison. A such studies are available and provided to the radiology an addendum to this report was submitted comparison.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white appreciation is otherwise within normal limits.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.2.There is ex vacuo dilatation of the left sylvian fissure likely secondary to a chronic left frontal ischemic stroke.3.There are no prior exam available for comparison. Consider MRI if clinical concern for stroke is high. |
Generate impression based on findings. | T4N2cM1 squamous cell carcinoma of the right tonsil, status post chemoradiation therapy and hypofractionated radiation to left apical lung nodule. There are extensive post-treatment findings in the neck. There is no definite evidence of measurable mass lesions in the oropharyngeal region, although dental streak artifact somewhat limits the assessment. Likewise, there is no significant cervical lymphadenopathy based on size criteria. However, there has been interval increase in size of upper mediastinal lymphadenopathy. While there is diffuse pharyngeal edema, there is no significant narrowing of the airway. The thyroid and major salivary glands are unchanged. The major cervical vessels are patent. The osseous structures are unchanged, including a bony excrescence medially along the left mandibular angle, mild multilevel degenerative spondylosis of the cervical spine, and right temporomandibular joint arthropathy. In particular, the C7 vertebral body appears unchanged, without evidence of pathological fracture. The imaged intracranial structures are unremarkable. There is partial opacification of the paranasal sinuses. There has been continued interval increase in size of several nodules within the partially imaged upper lungs. | 1. No definite evidence of measurable tumor in the oropharyngeal region or significant lymphadenopathy in the neck, although dental streak artifact somewhat limits the assessment.2. Continued increase in size of several metastases within the partially imaged upper lungs and upper mediastinal lymphadenopathy. Please refer to the separate chest CT report for additional details.3. The C7 vertebral body appears unchanged. |
Generate impression based on findings. | Female 30 years old Reason: Evaluate for retained foreign body and fracture History: laceration. We have two views of the left forearm which show no fracture or radiopaque foreign body. We have two views of the right tibia/fibula which show no fracture. There is a 2-mm rounded density seen on the lateral view immediately anterior to the distal diaphysis of the tibia that may represent a small focus of calcification, but not have the typical appearance of a glass fragment. | No fracture or definite foreign body. If further imaging evaluation is clinically warranted, ultrasonography may be considered. |
Generate impression based on findings. | Female 57 years old; Reason: right 5th digit trauma. Rule out fracture History: decreased ROM and swelling right 5th digit. Bruising focally Two views of the right hand demonstrate a fracture through the base of the fifth finger proximal phalanx, with dorsal angulation of the distal fracture fragment. We suspect this fracture extends to the joint, however, we do not see a discrete articular surface defect. There is a linear density in the soft tissues volar to the ring finger distal phalanx, which likely represents a foreign body. The bones appear demineralized. | 1. Fifth finger proximal phalanx fracture, as above.2. Linear foreign body within the soft tissues volar to the ring finger distal phalanx.Findings discussed with Dr. Rossi-Foulkes by telephone on 2/5/15 at 3 p.m. |
Generate impression based on findings. | Female; 62 years old. Reason: evaluate for the SB thickening seen on last CT, push enteroscopy was normal. History: abdominal pain/constipation/abnormal CT. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Prominent size of pancreas given patient age, but appearing similar to prior CT. No focal pancreatic lesions or ductal dilatation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic aortic and common iliac artery calcifications. No retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Moderately good bowel distention. There has been interval resolution of long segment wall thickening involving duodenal and proximal jejunal bowel loops since the prior CT. No evidence of acute mesenteric inflammation, obstruction or free air. Scattered sigmoid diverticula without complication. Normal appendix. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free fluid or drainable fluid collection.PELVIS:UTERUS, ADNEXA: Heterogeneous uterus with scattered calcified fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see discussion above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval resolution of long segment proximal small bowel infection/inflammation, without new acute abnormality identified. |
Generate impression based on findings. | Male 52 years old; Reason: Evaluate left hand pain. Left knee pain. LEFT HAND: Mild to moderate osteoarthritis affects the distal interphalangeal joints, particularly at the second and fifth fingers. Mild deformity of the index finger middle phalanx likely represents an old healed fracture. Tiny osteophytes are present at the metacarpophalangeal joints.LEFT KNEE: Small tricompartmental osteophytes and joint space narrowing of the medial compartment indicate mild to moderate osteoarthritis. A small joint effusion is present. Deformity of the proximal fibular diaphysis indicates an old healed fracture.Small osteophytes indicate mild osteoarthritis of the right knee, as seen on the frontal views. | Osteoarthritis. |
Generate impression based on findings. | Male 43 years old Reason: pain, fragments History: pain. We have 3 views of the right ankle that show a 12-mm elongated bone fragment in the soft tissues lateral to the distal fibula that may represent old trauma, but we see no findings to suggest an acute fracture. Tiny ankle joint osteophytes indicate mild osteoarthritis. | Chronic appearing ossific density along the distal fibula, but no evidence of acute fracture. |
Generate impression based on findings. | Male 52 years old Reason: concern for avascular necrosis History: hip pain on prednisone. Two views of the right hip appear normal for patient's age without radiographic evidence of avascular necrosis. Tiny enthesophytes along the greater trochanter are not necessarily of any current clinical significance. | No evidence of avascular necrosis or other specific findings to account for patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Right upper quadrant abdominal pain. Per Epic Notes, patient has a history of celiac disease. Angiographic images are unremarkable. Prompt clearance of radiotracer from the blood pool and uniform accumulation of the tracer by the liver is present. There is normal excretion of tracer into the intrahepatic ducts, common bile duct, gallbladder and duodenum, indicating patent common bile and cystic ducts. However there was reflux of tracer proximally through the duodenum into the stomach. | 1.Normal hepatobiliary system.2.Abnormal reflux of tracer into the stomach from the proximal duodenum which can be a cause of gastritis secondary to bile reflux. |
Generate impression based on findings. | Female 80 years old Reason: follow up History: follow up. Previously seen tibial plateau fracture is less distinct on the current study than on the prior study, suggesting some interval healing. Moderate osteoarthritis affects the knee. There is a moderate-sized joint effusion. | Healing tibial plateau fracture. |
Generate impression based on findings. | Metastatic thymic cancer. Restaging. Status post right lower lobe wedge resection. CHEST:LUNGS AND PLEURA: There has been an interval right lower lobe wedge resection with removal of the previously identified largest right lower lobe pulmonary nodule. There is non-specific soft tissue density around the suture material; given the short timing interval, this likely represents post-operative change including a small amount of blood products. Multiple additional bilateral pulmonary nodules are similar to the prior exam. The largest left lower lobe pulmonary nodule measures 11 mm (image 84, series 6). No new pulmonary nodule is identified. Areas of scarring and atelectasis within the right hemithorax is unchanged.MEDIASTINUM AND HILA: Post-surgical changes within the anterior mediastinum are noted. The heart size is normal without pericardial effusion. There is no significant mediastinal or hilar lymphadenopathy.CHEST WALL: A left chest port catheter terminates in the SVC. Status post clam shell sternotomy with incomplete healing of the sternotomy site, similar to the prior study. 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. | 1. Interval right lower lobe wedge resection with non-specific soft tissue density around the suture material; given recent surgery, this likely represents post-operative change, including a small amount of blood product. Serial imaging would be helpful. 2. Multiple bilateral pulmonary nodules are otherwise unchanged. No new pulmonary nodules are identified. |
Generate impression based on findings. | 35 year old male status post proctocolectomy with J-pouch and diverting ileostomy. There is prompt opacification of the J-pouch of normal static morphology.Trial straining showed appropriate descent of the perineal floor; voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed partial passage of neo-rectal contents without evidence of enterocele. No evidence of sinus tracts, fistulae, or anastomotic leaks. Patient was asked to evacuate on the toilet and a post-evacuation image demonstrated near complete emptying of the J-pouch. FLUOROSCOPY TIME: 3:28 minutes | Normal appearing and functioning J-pouch as described above. Findings discussed with Dr. Rubin. |
Generate impression based on findings. | Female 87 years old; Reason: Evaluate for fracture vs Lisfranc's dislocation left foot as well as left hallux History: Patient fell yesterday, now with pain and swelling of midfoot and left hallux The bones appear demineralized, suggesting osteopenia/osteoporosis. There is soft tissue swelling along the dorsal aspect of the midfoot. We see no fracture or Lisfranc dislocation. Mild osteoarthritis affects the forefoot, midfoot, and ankle. | Soft tissue swelling and osteoarthritis, without fracture or dislocation. |
Generate impression based on findings. | Female 95 years old; Reason: Evaluate for for evidence of neural foraminal stenosis, degenerative changes or lytic lesions. Remote history of breast cancer. History: radicular pain thoracic spine area radiating to breast. THORACIC SPINE: The bones are demineralized. Again seen is severe kyphosis of the lower thoracic spine, with chronic anterior wedging of the T8 and T9 vertebral bodies, appearing similar to the chest radiograph in 2008. The T8, T9, and T10 vertebral bodies are fused anteriorly, likely representing a congenital non-segmentation anomaly. Moderate multilevel degenerative disk disease affects the thoracic spine and visualized upper lumbar spine. There is mild levoscoliosis of the thoracic spine. No focal lytic lesions are seen in the spine.A round opacity in the right upper lung, best seen on the lateral view, is not seen on the prior chest radiographs and is suspicious for neoplasm. Further evaluation with chest CT is recommended.RIBS: Radiopaque markers are noted over the lower right rib cage. The bones are demineralized, limiting evaluation. Given this limitation, we see no fracture. Osteoarthritis affects both shoulders. | 1. Opacity in the right upper lung is concerning for a neoplasm, and further evaluation with chest CT is recommended if clinically warranted.2. Severe thoracic kyphosis with multilevel degenerative disk disease. No lytic bone lesion is evident.Findings were discussed by phone with Dr. Blackman 12/25/15 at 3:45 p.m. |
Generate impression based on findings. | 63 year old woman with history of left breast cysts and aspiration 2014. History of mother with breast cancer. Three standard views of both breasts and CC and two ML spot compression views of the left 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. One of two left lower breast asymmetries disperses with spot compression. The second, more anteriorly located asymmetry in the left lower breast persists. No additional dominant mass, suspicious microcalcifications or areas of architectural distortion are seen in either breast. Benign appearing lymph nodes are projected over both axillae.SONOGRAPHIC | Left breast cyst but 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: Rectal carcinoma please assess thoracic area for diease involvement History: As above LUNGS AND PLEURA: 8 x 6 mm left lower lobe subpleural nodule with somewhat poorly defined margins is seen along the fissure (series 5, image 150). Additional scattered benign-appearing micronodules.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcifications.No mediastinal or hilar lymphadenopathy.Left thyroid lobe is enlarged with a mixed density nodule. The hypoattenuating component measures approximately 1cm (series 3, image 11). This lesion is better evaluated with ultrasound imaging if required.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Due to phase of contrast, evaluation of the upper abdomen is limited. An indeterminant left renal hypodensity measures 1.2 cm (series 3, image 90). | 1. An 8 mm left lower lobe subpleural nodule may have a benign etiology such as an intrapulmonary lymph node, but should be followed closely in a patient with a known malignancy. Recommend 3 month followup CT imaging. Alternatively, outside imaging can be helpful for comparison if able to be obtained and submitted by the referring clinical service.2. An indeterminant left renal hypodensity measures 1.2 cm, incompletely assessed on this exam. Differential considerations include a cyst or infarct, but malignancy cannot be excluded. Recommend dedicated renal protocol imaging for further evaluation.2. Left thyroid lobe is enlarged with a mixed density nodule, which is better evaluated with ultrasound imaging, nonspecific. |
Generate impression based on findings. | CHEST:LUNGS AND PLEURA: Basilar reticular opacities with septal lines, bronchial thickening and mild bronchiectasis, likely chronic.MEDIASTINUM AND HILA: Moderately enlarged paratracheal and prevascular lymph nodes, likely reactive.CHEST WALL: Degenerative disease in the spine.Healing fracture of the manubrium and old fracture deformity of the upper sternum.UPPER ABDOMEN: No significant abnormality noted. | Chronic incidental findings and no acute pulmonary abnormalities. |
Generate impression based on findings. | Evaluation preoperatively right completion pneumonectomy. CHEST:LUNGS AND PLEURA: Postsurgical changes of a right upper lobectomy. 3.8 x 4.6 cm right lower lobe mass at the resection site compatible with a localized recurrence, this extends to the right paravertebral pleural surface and is inseparable from the right mainstem bronchus posteriorly and the azygous arch/SVC medially.Centrilobular and paraseptal emphysema. No pleural fluid or additional pulmonary nodules.MEDIASTINUM AND HILA: Small (6-mm) high right tracheoesophageal lymph node (3/17) and a 9mm lower right paratracheal lymph node (3/44) are nonspecific. Minimal amount of lymphatic tissue in the right inferior interlobar region (3/53), also nonspecific.CHEST WALL: Asymmetric glandular tissue left medial superior breast near a calcification with some questionable slight enhancement along its anterior aspect (3/26), nonspecific by CT and may be correlated with mammography when feasible.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: Grade 1 retrolisthesis of L3 on L4. Degenerative changes, but no suspicious appearing skeletal lesions.OTHER: No significant abnormality noted. | 1. 4.6-cm right mass occurring at the right upper lobectomy resection site extending into the right lower lobe parenchyma, consistent with localized recurrence. No conclusive metastases.2. Asymmetric left breast soft tissue containing calcification nonspecific by CT however the asymmetry, density and presence of calcification could indicate an underlying abnormality and may be correlated with mammography when feasible. |
Generate impression based on findings. | Postoperative changes from previous right pterional craniotomy for aneurysm clipping are again seen, with two vascular clips in the right suprasellar cistern. There is an adjacent stable coil mass just medial to the aneurysm clips. The configuration of these structures is unchanged. Associated streak artifact limits evaluation of surrounding structures.There is a stable course of a left frontal approach ventriculostomy catheter with tip in the anterior third ventricle. Ventricular caliber is stable and within normal limits.There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation or pathological enhancement. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.There is now scattered atherosclerotic calcification along the distal right M1 segment as well as along slightly increased along the cavernous left internal carotid artery. Other scattered mild atherosclerotic calcifications are again present along the cavernous carotids bilaterally. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. The left vertebral artery is dominant. There is no evidence of flow-limiting stenosis or definite aneurysm. | 1. Limited exam secondary to extensive streak artifact relating to previous treated aneurysms. No flow-limiting stenosis or definite aneurysm within limitations.2. Interval slight progression of intracranial atherosclerotic calcification.3. Stable left frontal approach ventriculostomy catheter with unchanged normal ventricular caliber. |
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