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Generate impression based on findings. | Anosmia and decreased taste; previous CT in 2006 showed mild ethmoid sinus disease. The paranasal sinuses are clear. The nasal cavity is also clear. The nasal septum is essentially midline. There are bilateral conchae bullosa. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | The paranasal sinuses and nasal cavity are clear. A dedicated anosmia protocol MRI may be useful for further evaluation if there are no contraindications for this modality. |
Generate impression based on findings. | Male 51 years old Reason: eval osteo History: recent GSW s/p rod to RLE, drainage from incision. Again seen is an intramedullary rod with screws affixing a comminuted fracture of the distal tibial diaphysis in near-anatomic alignment without radiographic evidence of hardware complication. There are numerous surrounding osseous and metallic bullet fragments. There is no radiographic evidence of cortical disruption to suggest osteomyelitis. | Orthopedic fixation of distal tibial fracture as described above. There is no radiographic evidence of osteomyelitis, however, if further imaging is clinically warranted an MRI or triphasic bone scan is recommended. |
Generate impression based on findings. | 45-year-old male with history of metastatic renal cancer. CHEST:LUNGS AND PLEURA: Previously described micronodule (series 5, image 37) measures 5 x 5 mm, measured 4 x 4 mm previously. Additional previously seen micronodules and small nodules have increased in size suspicious for metastatic disease. There are new diffuse micronodules in a perilymphatic distribution also suspicious for metastatic disease. New moderate bilateral pleural effusions with associated basilar atelectasis/consolidation. MEDIASTINUM AND HILA: Bilateral thoracic inlet lymphadenopathy. Reference left thoracic inlet mass (series 3, image one) is partially excluded from field of view but measures 4.6 x 4.6 cm, previously 2.5 x 3.9 cm. Mediastinal and hilar lymphadenopathy has significantly progressed. Reference left paratracheal lymph node (series 3, image 32) measures 1.6 x 2.1 cm, previously 1.1 x 1.5 cm.CHEST WALL: New left axillary lymphadenopathy. Diffuse lytic osseous metastases throughout the visualized spine and ribs significantly increased from prior. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The patient's right renal mass arising from the upper mid pole (series 3, image 110) measures 4.0 x 6.2 cm, previously 3.4 x 5.2 cm. There is new left greater than right mild hydroureteronephrosis which is thought to be related to mass effect from the bulky retroperitoneal lymphadenopathy.RETROPERITONEUM, LYMPH NODES: Extensive bulky retrocrural and retroperitoneal lymphadenopathy has significantly increased. Reference left para-aortic lymph node (series 3, image 125) measures 1.8 x 2.6 cm, previously 1.6 x 2.6 cm previously. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse lytic osseous metastases throughout the visualized spine, ribs, and pelvis, significantly increased from prior. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral common and external iliac lymphadenopathy has increased from prior. Reference left external iliac lymph node (series 3, image 159) measures 1.5 x 1.9 cm, measured 1.1 x 1.7 cm previously.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse lytic osseous metastases throughout the visualized spine, ribs, and pelvis, significantly increased from prior. Largest lesion is in the left ilium which now disrupts the cortex.OTHER: No significant abnormality noted | 1.Increase in size of patient's known right renal carcinoma.2.New mild bilateral left greater than right hydroureteronephrosis related to mass effect from extensive retroperitoneal lymphadenopathy. 3.Significant interval increase in metastatic disease including thoracic lymphadenopathy, abdominopelvic lymphadenopathy, lung metastases, and widespread lytic osseous metastases.4.New diffuse perilymphatic pulmonary micronodules suspicious for metastatic disease. New moderate bilateral pleural effusions with associated compressive atelectasis/consolidation. |
Generate impression based on findings. | Male 77 years old Reason: Evaluate for osteomyelitis left hallux History: Non-healing ulcer plantar left foot with bone exposed through wound (likely proximal phalanx). We have 3 views of the lateral foot which show a soft tissue defect and overlying gas at the plantar aspect of the proximal phalanx of the first toe. There is cortical disruption along the medial aspect of the tuft of the middle phalanx of the first toe which may reflect underlying osteomyelitis. Postoperative changes of the distal phalanx of the first toe compatible with prior amputation. | Findings suggestive of osteomyelitis of the first toe as described above. |
Generate impression based on findings. | Female 22 years old Reason: eval clicking and left knee "stiffness" associated with occasional swelling,. any OCD History: same . Four views of the left knee show no fracture, dislocation, or joint effusion.Frontal views of the right knee are unremarkable. | Left knee appears normal without specific radiographic findings to account for patient's symptoms. |
Generate impression based on findings. | Female 48 years old Reason: right total hip History: right total hip. Three views of the right hip show hardware components of a right total hip arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. There is a new area of heterotopic bone ossification of the soft tissues along the lateral aspect of the prosthesis.AP view of the pelvis shows aforementioned postoperative changes in the right hip. Mild osteoarthritic changes affect the left hip. | Right total hip arthroplasty with interval development of heterotopic ossification as described above. |
Generate impression based on findings. | 36 year old with known right breast cancer presents for research biopsy of I-SPY protocol. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 16 x 20 x 21 mm at the 10 o’clock position with increased vascularity, 10 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The 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 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, six 12-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged very good. Specimen quality was judged very good. Specimen radiograph confirmed that the marker clip was not retrieved from the mass. Specimens were placed onto the plastic plate and were handed over to research assistant. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Abe. | Successful ultrasound-guided core biopsy of the right breast cancer. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 4-month-old male with history of subdural fluid collection. There is redemonstration of a right parietal approach ventriculostomy catheter with the tip terminating within the left lateral ventricle. There is an additional anterior parietal subdural drainage catheter with the tip located posteriorly within the extra-axial space. Large left and small right subdural fluid collections with mild mass effect is stable in appearance. Significant pneumocephalus within the nondependent portion of the left frontal region with mild mass effect also appear similar to prior. Ventricular configuration is unchanged. Dolichocephalic configuration of the calvarium is unchanged. There is no evidence of new intracranial hemorrhage or new mass effect. Diffuse parenchymal volume loss, markedly progressed since remote CT from 10/13/2014. The imaged portions of the paranasal sinuses and mastoid air cells are clear. Small fluid collection is seen along the right VP shunt catheter tract in the right scalp and neck. | 1. Compared to 2/23/2015, stable appearing right ventriculostomy and left subdural drainage catheters.2. Unchanged bilateral subdural fluid collections and pneumocephalus. Unchanged size of the ventricles.3. Diffuse parenchymal volume loss, markedly progressed since remote CT from 10/13/2014. |
Generate impression based on findings. | Female 62 years old Reason: left hip OA History: left hip pain. AP view of the pelvis demonstrates moderate osteoarthritic changes of the left hip joint with joint space narrowing and osteophyte formation. There is mild loss arthritis of the right hip. Minimal degenerative arthritic changes affect the bilateral sacroiliac joints and pubis symphysis. | Moderate osteoarthritis of the left hip and mild osteoarthritis of the right hip as above. |
Generate impression based on findings. | Female 69 years old Reason: assess prosthesis History: S/P total wrist arthroplasty. Three views of the right hand show proximal row carpectomy of the right wrist and hardware components of a right total wrist arthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication. A focus of new heterotopic bone formation is seen along the dorsal aspect of the ulnocarpal joint. | Total wrist arthroplasty. |
Generate impression based on findings. | Time average mean velocities: Right middle cerebral artery: 137 cm/sec.Right internal carotid artery: 53 cm/sec.Left middle cerebral artery: 129 cm/sec.Left internal carotid artery: 82 cm/sec. | Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Reason: 25 y/o with h/o osteosarcoma 15 months off therapy History: none LUNGS AND PLEURA: Left pleural base mass with internal calcification is identified posterior and medially at the T6 level. This mass measures 18 mm x 29 mm and is concerning for recurrent neoplasm.Mild bronchial wall thickening with new tree in bud opacities and centrilobular groundglass opacities are noted in the lingula compatible with aspiration/bronchiolitis.Postsurgical changes noted in left lower lobe related to prior wedge resection.Right lung is clear. No pleural effusions.MEDIASTINUM AND HILA: Mild residual thymic tissue.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of the pericardial effusion.CHEST WALL: Demonstration of partially resected left sixth rib posteriorly.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Pleural-based left paraspinal mass at the level of T6 compatible with recurrent/ metastatic disease.2.New centrilobular groundglass and tree in bud opacities in the lingula compatible with aspiration /bronchiolitis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign left breast biopsy. History of sister with breast cancer. Two standard digital views of both breasts and additional left MLO were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. There is a focal asymmetry in the right central breast, approximately 12 o'clock position at middle depth. Biopsy clip is noted in the right breast at approximately 6 o'clock position. Additionally, there is a focal asymmetry in the left lower breast at posterior depth. No additional suspicious masses, microcalcifications or areas of architectural distortion are present. | Focal asymmetries in the right central breast and left lower breast. Comparison with outside imaging is recommended. Otherwise this will need to be further evaluated with spot compression views and possible ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | 7 year-old female with history of tibia/fibula fracture. Evaluate for healing 3 months post fracture.VIEWS: Right knee AP and lateral (2 views) 2/26/2015 10:16 Fracture line in the proximal tibia is sclerotic and alignment is anatomic. Fine horizontal linear bands of sclerosis in the metaphyses of tibia, fibula, and femur are from growth arrest/restart. Tibial physis is not prematurely fused. | Healing Salter Harris fracture of the tibia. |
Generate impression based on findings. | Clinical question: History of anaplastic hemangiopericytoma status post RT. Surveillance scan. Signs and symptoms: None. Enhanced head CT:New since prior exam there is a mildly enhancing mass along the medial/anterior aspect of the left middle cranial fossa (axial image 11). It measures approximately 21 x 13 x 20-mm in size. The lesion appears extra-axial however possibility of arising from the surface of the left temporal lobe cannot be entirely excluded. This mass abuts the adjacent left temporal lobe however without noticeable mass effect/deviation or vasogenic edema. This mass also medially abuts the left cavernous sinus and without suggestion of extension into the sinus on this exam. Further evaluation with pre-and post enhanced brain MRI is recommended.Extensive atrophic changes of right cerebellum and containing multiple surgical clips are remains stable since prior study and without evidence of abnormal enhancement to suggest recurrence of disease. Note however should be made that streak artifact from metallic clips precludes precise assessment for detection of enhancement.Stable small focus of encephalomalacia in the left superior frontal lobe under a frontal craniotomy remain similar to prior exam and without detectable abnormal enhancement.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.New since prior exam is a mildly enhancing mass (21 x 13 x 20 mm) with a punctate internal calcification in the left middle cranial fossa as detailed. Follow up with MRI is recommended.2.Stable exam otherwise as detailed. |
Generate impression based on findings. | 58 years, Male. Reason: ng/nj tubes need recheck History: as above Bilateral pleural effusions and left basilar opacity. Nasojejunal feeding tube tip is projected beyond the ligament of Treitz, over the right lower quadrant. Nasogastric tube tip projects over the distal gastric body. Contrast material is noted within the small bowel. Cystogastrostomy stent is again noted. Nonobstructive bowel gas pattern. | Nasogastric tube tip projects over the gastric body. Nasojejunal tube projects over the right lower quadrant. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast aspiration. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered, bilateral calcifications appear benign and are stable from prior examinations. Circumscribed, oval mass in the left lower inner breast appears benign and is unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable, benign appearing calcifications and mass without mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 76 year old with history of benign bilateral breast biopsies. Personal history of renal cell carcinoma. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable benign focal asymmetries and calcifications are present bilaterally. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: neutropenic fever, sob, please eval for infection History: sob, ntp fever LUNGS AND PLEURA: Mild basilar atelectasis.Scattered calcified granulomas.No suspicious pulmonary masses.No focal air space opacities.No pleural effusion.MEDIASTINUM AND HILA: Cardiac size is normal without evidence of a pericardial effusion.Right Port-A-Cath with its tip in the SVC.No hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild amount of perihepatic and perisplenic ascites . Status post cholecystectomy. Splenomegaly. | No acute pulmonary abnormalities identified. No specific evidence of infection. Interval development of ascites. |
Generate impression based on findings. | Reason: evaluate for changes to ILD indicating acute worsening History: worsening DOE LUNGS AND PLEURA: Continued progression of diffuse, predominantly subpleural reticular opacities, without significant basilar predominance. Dense fibrosis, with traction bronchiectasis and a microcystic honeycombing pattern with basilar predominance are again increased from the prior exam. Minimal scattered areas of ground glass, without new focal airspace consolidation. Continued decrease in lung volumes.No pleural effusions.No significant airtrapping seen on expiratory images.MEDIASTINUM AND HILA: The heart is normal in size of pericardial effusion. Moderate coronary artery calcification. The main pulmonary artery is minimally enlarged, suggestive of pulmonary hypertension.Stable mildly prominent mediastinal and hilar lymph nodes, some calcified, compatible with prior infection.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Continued increase in diffuse chronic interstitial disease in a pattern most consistent with UIP, compatible with rapid progression of disease from 05/2013. |
Generate impression based on findings. | Spastic quadriplegia.VIEW: Pelvis AP (one view) 02/26/15 Ventriculoperitoneal shunt tubing is noted. Mildly dilated bowel loops are seen.The femoral heads are well directed into the acetabula. Bilateral coxa valga is seen. | Femoral heads well directed into acetabula. |
Generate impression based on findings. | 66-year-old with personal history of left lumpectomy for breast cancer. History of benign right breast biopsy. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Postsurgical distortion and density in each breast does not appear significantly changed. There are bilateral benign calcifications again noted. Biopsy clip in the upper outer left breast again noted.Benign appearing lymph nodes are projected over the right axilla. Surgical clips again noted in the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed 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. Scattered, bilateral calcifications appear benign and are stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable bilateral benign-appearing calcifications without mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: ro PE History: tachy, tachypnic, SOB PULMONARY ARTERIES: Evaluation of the pulmonary arteries is somewhat limited by motion artifact. No evidence of pulmonary embolism to the lobar level. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Bilateral small effusions, right greater than left, with left sided compressive atelectasis. Near complete atelectasis of the right lower lobe.Scattered patchy ground glass opacities, most prominent in the left upper lobe (series 13, image 67) are nonspecific and may be related to atelectasis and expiratory phase imaging.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. No visible coronary artery calcification.Calcified mediastinal and hilar lymph nodes from prior granulomatous disease. A mildly prominent prevascular lymph node measures 11 mm (series 12, image 91).CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered hepatic calcifications from prior granulomatous disease. A large cystic structure is partially visualized in the left upper abdomen (series 12, image 294), and may represent a large exophytic left renal cyst, but can be further evaluated on abdominal imaging as clinically warranted. | 1. limited exam without evidence of large central pulmonary embolus.2. Small pleural effusions and bilateral atelectasis. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 62 year-old history of right breast ILC status post lumpectomy in March 2011, sentinel lymph node biopsy and radiation therapy. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Numerous benign calcifications are present in both breasts, including benign ductal calcifications, not significantly changed. Surgical clips are again seen in the right upper outer breast at the site of lumpectomy. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Status post right ureterolysis and reimplant with persistent right hydronephrosis - please assess for obstruction. There is normal perfusion of the left kidney and overall decreased relative perfusion of the right kidney.The left kidney demonstrates prompt uptake and secretion without evidence of hydronephrosis or obstruction. The right kidney has very poor to minimal parenchymal uptake and no demonstrable excretion. It appears significantly enlarged, likely from a dilated right pelvocalyceal collecting system. The estimated contribution of the right kidney to total renal function is 7% and that of the left kidney is 93%. Images of the bladder demonstrate a large outpouching in the right superior aspect likely related to the ureteral re-implantation. | 1.No demonstrable excretory function of the right kidney, most likely due to obstruction of the collecting system. 2.Normal appearing left kidney. |
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 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is a stable asymmetry in the right medial 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 73-year-old with history of left breast cancer status post mastectomy. Right sided scar from prior Port-A-Cath. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Areas of asymmetry under the surgical scar are not significantly changed. Benign calcifications and dilated veins are again noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral 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. | 67-year-old female with large protrusion right of umbilicus. Assess for ventral hernia. Grayscale ultrasound still images and video clips are maintained through the anterior abdominal wound. Large anterior ventral hernia seen to the right of the umbilicus with peristalsis of bowel seen within the hernia contents. No evidence of intrinsic bowel abnormality is noted with no wall thickening, no dilation of the bowel loops and no evidence of associated free mesenteric fluid..Although comparing difficult techniques is difficult, the hernia appears similar in size as demonstrated on 9/18/14 CT examination. | Large Umbilical ventral wall hernia containing bowel without other complications seen. |
Generate impression based on findings. | Clinical question: Follow-up hydrocephalus. Signs and symptoms: Status post VP shunt revision. Nonenhanced head CT:Examination demonstrates subtle postoperative changes of a right frontal approach shunt revision.There is interval decreased size of lateral ventricles since prior exam and the minimal expected post procedural air within the lateral ventricles.Extensive ventricle and subcortical low attenuation of white matter is stable since prior study. Stable exam otherwise and without detectable acute or any additional finding since prior exam. | 1.Interval decreased size of supratentorial ventricular system since prior study.2.Subtle expected post procedural findings of a right frontal approach shunt revision.3.Stable exam otherwise as mentioned above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of mastopexy and 2011. Personal history of cervical cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Postoperative changes of bilateral mastopexy with architectural distortion and stable left lower inner breast oil cyst are noted. 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, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with additional bilateral CC views were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | The ventricles and sulci are prominent consistent with mild global volume loss slightly greater than expected for the patient's stated age. There are a few scattered punctate and oval areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter. The largest of these is in the right frontal periventricular white matter. Some of these are oriented perpendicular to the long axis of the lateral ventricles. The right frontal lesion, one in the right corona radiata, and tiny linear left parietal lesion demonstrate ill-defined enhancement on the axial T1 fat saturated postcontrast images, although appear T1 hypointense on the 3D T1 postcontrast images which are more delayed. Punctate FLAIR hyperintense foci in the right lateral frontal subcortical white matter and also within the left periatrial white matter do not demonstrate any definitive enhancement even on the axial T1 fat saturated postcontrast images.The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a right maxillary sinus mucosal retention cyst. | 1. Scattered white matter lesions, several of which demonstrate subtle enhancement on earlier fat saturated postcontrast images, with orientation of a couple perpendicular to the long axis of the lateral ventricles. Findings are very suggestive of demyelinating disease, without definite infratentorial involvement at this time. Overall, minimal T1 and T2 burden disease. Please correlate clinically.2. Mild global volume loss greater than expected for the patient's stated age, also a finding seen in demyelinating disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. 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, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Reason: ? SVC syndrome History: dialysis c cathether in place in R subclavian LUNGS AND PLEURA: Demonstration of a small right pleural effusion.Scattered nonspecific micronodules.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Right central venous catheter with its tip at the SVC/RA junction.There is noted to be narrowing of the SVC at the level of the catheter tip as well as narrowing at the confluence of the innominate veins. There is subsequent prominence of the azygos with chest wall collaterals.Prominent mediastinal lymph nodes with several calcified nodes indicative of a prior granulomatous disease. There is enlargement of the pulmonary artery compatible with pulmonary hypertension.Cardiac size is normal without evidence of pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Prominent left supraclavicular lymph node (image 46 series 5) measuring 16 mm.Marked degenerative changes and degenerative disk disease in the lower thoracic spine with endplate deformities and levoscoliosis. Anasarca.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. The partially imaged kidneys demonstrate end-stage disease. | 1.Demonstration of areas of stenosis involving the SVC /RA junction near the tip of an indwelling catheter as well as at the level of the confluence of the innominate veins. There is subsequent prominence of the azygos system with chest wall collaterals2.Mild right pleural effusion. .3.Multiple prominent mediastinal and supraclavicular lymph nodes some of which are calcified and may related to a prior granulomatous infection.4.End-stage renal disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of mother and aunt diagnosed with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed 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 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 26-year-old male with sudden onset left flank pain. Assess for stone. The limits of a non-IV contrast-enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse low-attenuation to liver is seen indicative of diffuse hepatic steatosis. No focal mass lesions are seen, however lack of IV contrast and the presence of fat markedly limit sensitivity of CT in this regard. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys are of normal size and morphologic appearance. No parenchymal or collecting system calcifications are seen, however a pinpoint calcification is seen in the bladder indicative of urinary tract stone disease.. No renal mass lesions are seen, however lack of IV contrast markedly limit sensitivity of CT. No hydronephrosis. There is slight increased perinephric stranding about the left kidney. This, combined with the slightly dilated left ureter and the presence of pinpoint calcification in the bladder suggests a recently passed stone from the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Pinpoint calcification seen in the dependent bladder, most consistent with right stone passed into bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Recent passage of pinpoint stone into bladder wwith left kidney signs indicating origin. 2. Diffuse hepatic steatosis. |
Generate impression based on findings. | CHARGE syndrome with right cochlear implant, now with displacement. Right: There has been interval cochlear implantation into the dysplastic cochlea that features deficient modiolus and interscalar septum with a paucity of turns. The electrode portion of the implant appears to be grossly intact and forms approximately one-and-a-half turns within the cochlea. There is partial opacification of the middle ear and mastoid air cells. There is an enlarged and dysplastic vestibule and vestibular aqueduct. In addition, the lateral semicircular canal is markedly enlarged with absence of the bone island and there is severe stenosis of the oval window. The internal auditory canal is patent and the cochlear aperture measures up to 2 mm in diameter. The facial nerve in more inferomedially situated than normal and appears to cover the oval window.Left: There is severe narrowing of the internal auditory canal, measuring approximately up to 2 mm in diameter. Likewise, the cochlear fossette is markedly stenotic. The singular canal and labyrinthine facial nerve canal are intact. There is deficiency of the modiolus and cochlear turns as well as a dysplastic vestibule and enlargement of the vestibular aqueduct. In addition, the lateral semicircular canal is mildly enlarged and there is severe stenosis of the oval window. The short process of the incus appears to contact the lateral wall of the middle ear cavity and fixation cannot be excluded. The ossicular chain is otherwise intact. The mastoid air cells are partly opacified. The round window niche is also opacified. There is interval clearance of opacification or tympanic membrane thickening adjacent to the tympanostomy tube, which has a different orientation. The labyrinthine segment of the facial nerve canal is narrow and the tympanic segment appears dehiscent. The mastoid segment segment of the facial nerve canal appears to be bulbous, perhaps due to an anomalous vascular channel.Miscellaneous: There is a dysmorphic, hypoplastic right cerebellar hemisphere. There is partial opacaification of the left ethmoid sinuses. | 1. Interval insertion of a right cochlear implant in the setting of inner ear dysplasia associated with CHARGE syndrome. Although the electrode component of the implant appears to be grossly intact and situated within the cochlea, assessment of implant displacement is limited due to the lack of baseline imaging for comparison.2. Nonspecific right otomastoid opacification.3. Left temporal bone anomalies related to CHARGE syndrome with severe internal auditory canal stenosis.4. Interval clearance of nonspecific opacification or tympanic membrane thickening adjacent to the tympanostomy tube, which now has a different orientation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of colon cancer. Two standard digital views of both breasts and additional right CC were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. There is an enlarged left axillary lymph node, which is better seen on CT from 2/11/15. Given that normal morphology is seen on that CT, this is considered benign. No suspicious masses, microcalcifications or areas of architectural distortion are present. | 1.Left axillary lymph node, partially visualized. This lymph node appears to have normal morphology on the CT from 2/11/15. Correlation with patient's clinical history and physical exam is recommended.2.No mammographic evidence of malignancy in the breasts. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.3.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Female 53 years old Reason: pancreatic leak and LUQ abscess s/p transgastric and percutaneous drainage; evaluate interval change History: above ABDOMEN:LUNG BASES: Small left pleural effusion and atelectasis diminished compared to the prior exam. The might be some loculation of fluid in the most lateral portion of the costophrenic angle.Stable cardiophrenic and diaphragmatic nodes.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Percutaneous pigtail catheter in place in the left quadrant with no measurable residual fluid around the pigtail catheter. There is fat stranding and minimal soft tissue density lateral to the pigtail catheter unchanged the prior exam small amount of fluid may be loculated in the pleural or peritoneal space abutting the diaphragm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left subphrenic space described in pancreas paragraph above.Nasojejunal catheter. Gastric to pancreatic cyst stent in place.No evidence of generalized ascites. Based ventral hernia unchanged.BONES, SOFT TISSUES: Broad based ventral hernia.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Broad based ventral hernia.OTHER: No significant abnormality noted | Decrease in size of fluid collection in the distal pancreatectomy bed.Persistent but decreased left pleural effusion.Other findings as above. |
Generate impression based on findings. | Reason: For repeat CT surgery pre-op History: Concern for subacute bacterial endocarditis s/p MV replacement LUNGS AND PLEURA: Scattered pulmonary micronodules, including a 4-mm left upper lobe nodule (series 5, image 106). No suspicious pulmonary nodules or massesno focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. Surgical changes of a mitral valve replacement. Status status post tricuspid valve repair. Mild coronary artery calcification. Hypoattenuation of the blood pool, suggestive of anemia.No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post median sternotomy. Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Coarse calcification, probably within the gallbladder. A 2-cm left adrenal nodule measures 5-10 Hounsfield units, likely an adenoma, but can be evaluated with dedicated imaging if clinically warranted. | Surgical changes in the mediastinum, without acute abnormality. No evidence of infection. |
Generate impression based on findings. | Male 76 years old; Reason: Pt has pancreatic cancer s/p duodenal stent for gastric outlet obstruction - please eval for resectability of tumor (portal abutment seen on OSH CT scan uploaded to EPIC) History: Pancreatic cancer ABDOMEN:LUNGS BASES: Pacer wire. Small left effusion. Bibasilar scarring. Some areas but the appearance. Correlate for infection or aspiration.LIVER, BILIARY TRACT: Few scattered subcentimeter foci, likely cysts. No lesions concerning for metastases.SPLEEN: No significant abnormality noted.PANCREAS: Ill-defined hypoattenuation inseparable from the wall of the duodenum and medial inferior aspect of the pancreatic head. Site of origin of neoplasm is uncertain pancreatic versus duodenal. Tumor cannot be accurately measured. The intrapancreatic common bile duct and pancreatic ducts are normal. No pancreatic calcifications. No peripancreatic fat stranding.There is no evidence of involvement of the superior mesenteric artery, celiac artery and trifurcation or hepatic artery.Superior mesenteric vein, portal vein and splenic vein are normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst.Punctate focus of nephrolithiasis right lower pole. RETROPERITONEUM, LYMPH NODES: Attenuated origin of the celiac artery but without evidence of atherosclerosis. Extensive large tortuous arterial collaterals communicate between the superior mesenteric artery and hepatic artery.Accessory right renal artery originates just caudal and to the right of the superior mesenteric artery origin.BOWEL, MESENTERY: Gastroduodenal stent in place. Proximal end of the stent is in the antrum and distal end of the stent is in the third portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Ill-defined mass in the region of the pancreaticoduodenal groove of uncertain origin, pancreatic versus duodenal. No evidence of arterial or venous vascular encasement.2.Highly attenuated celiac artery origin, may be congenital, with extensive large collateral vessels communicating between hepatic artery and superior mesenteric artery circulation.3.Accessory right renal artery originates close to the superior mesenteric artery.4.Hepatic lesions likely cysts. No definite distant metastatic disease.5.Bibasilar fibrosis and bud-and-tree opacities concerning for infection. Small left effusion. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy in 2008. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral asymmetries appear stable to 2009 including a left breast asymmetry containing wing biopsy clip. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable bilateral asymmetries without mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography. Regional, coarse calcifications in the left upper outer breast appear benign in morphology 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, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Age: 74 years. Sex : Male. Reason for study: Reason: h/o HNC, baseline OPM Fluoroscopic guidance was provided for an oropharyngeal motility study performed by the Speech Pathology section of the ENT service. The examination was recorded on videotape. No static or hard copy films were obtained. The exam was negative for penetration and negative for aspiration. FLUOROSCOPY TIME: Fluoroscopy time was 1 minute 24 seconds. | The exam was negative for penetration and negative for aspiration. Please see speech pathologist report for additional findings and feeding recommendations. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal architectural changes in the left breast appear stable and are compatible with a prior biopsy. 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 53 years old Reason: r/o stone and hydro History: urosepsis concern, chronic uti's, foley in place, partial quadriplegic ABDOMEN: Limited examination secondary to lack of oral and intravenous contrast. Evaluation of vascular and solid organ pathology is suboptimal without intravenous contrast. Evaluation of pathology is suboptimal without oral contrast. Within these limitations, the following observations were made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral perinephric fat stranding, left greater than right, which is not significantly change from prior CT examination at 2012. The renal contours are unremarkable bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter in place within a collapsed bladder. No fat stranding around the collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fat induration in the perianal region (series 3, image 157).BONES, SOFT TISSUES: Degenerative changes of the visualized spine.OTHER: No significant abnormality noted | 1.Limited examination secondary to lack of oral and intravenous contrast which makes evaluation of solid organ and bowel pathology suboptimal. Within these limitations, there is no definite evidence of abscess. 2.Bilateral, asymmetric perinephric fat stranding, which is unchanged from CT examination from 2012. 3.No evidence of fat stranding around the collapsed bladder.4.Fat induration is present in the perianal region. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal and paternal grandmothers with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 22-year-old female with scoliosis post partial rod removal. Evaluate healing after removal of spinal fixation.VIEWS: Thoracolumbar spine upright PA and lateral (2 views) 2/26/2015 11:07 Superior aspect of the rods and hooks have been removed. The remaining rods, hooks and pedicle screws extend from approximately T6 to L3. Left cervicothoracic curve, right thoracic curve and left lumbar curve are again seen. Spondylolysis of L5 and spondylolisthesis of L5 on S1. | Interval removal of superior portions of the spinal rods and hooks. Unchanged spinal curves. |
Generate impression based on findings. | Ms. Francopayne is a 40-year-old female with screened detected asymmetry in the right inferior breast. An ultrasound correlate was identified and will be the target for today's ultrasound-guided biopsy. Right breast ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a mixed echogenicity area measuring 2.0 x 0.5 x 1.8 cm at the 6 o’clock position with increased vascularity, 3 cm from the nipple. The lesion was somewhat subtle.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 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, six 12-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed 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. Sheth. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesion with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderately severe age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with mild-moderate age-indeterminate small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial hemorrhage. Mild-moderate age-indeterminate small vessel ischemic changes. |
Generate impression based on findings. | 72-year-old male status post LAR with end to side diverting loop ileostomy in August of 2014. Evaluate anastomosis prior to ostomy takedown. Scout radiograph demonstrates to material reflecting a low anterior resection. Degenerative changes affect the lumbar spine. Contrast opacifies a U-shaped segment of colon with a end-to-side anastomosis with the anus. There is approximately 7 cm of blind-ending colon before the end-to-side anastomosis without extravasation of contrast to suggest a leak. Scattered diverticula are noted in the descending colon. Contrast opacification was noted proximally to the proximal third of the transverse colon. No fixed stricture, fistula, or obstruction is evident. TOTAL FLUOROSCOPY TIME: 4:53 minutes | No evidence of leak at the anastomosis as described above. |
Generate impression based on findings. | There is redemonstration of significant abnormal attenuation throughout the left cerebral hemisphere white matter consistent with known vasogenic edema related to a dominant metastasis as well as two smaller lesions towards the vertex. Additional abnormal low density is seen in the right temporal lobe posterior to the right temporal horn, associated with additional metastasis. There is also more subtle abnormal low density in the right frontal lobe deep white matter lateral to the right frontal horn, in an area of known metastasis.There is decreased attenuation of the rim of the dominant metastasis, which previously demonstrated a thick wall. A central presumably necrotic cavity of the metaphysis is likely increased in size, now measuring 1.5 cm transverse as compared to previous 1.3-cm. There is increased confluence of left superior posterior temporal lobe extent of abnormal low density as best seen on 4/16.Overall, the vasogenic edema elsewhere does not appear significantly changed, There is diffuse cerebral sulcal effacement and persistent partial effacement of the left lateral ventricle. Midline shift appears slightly improved now measuring 7 mm, previously at 9 mm. There is no intracranial hemorrhage. There is no extraaxial fluid collection. There is mild mucosal thickening in the right maxillary sinus. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. No acute intracranial hemorrhage.2. Increased confluence of low attenuation at least in part to relating to vasogenic edema involving the left superior posterior temporal lobe, immediately posterior to the dominant previous thick walled metastasis which has likely increased its central necrotic component.3. Stable appearance of other extensive left cerebral and scattered right cerebral areas of hypoattenuation relating to known metastases and associated vasogenic edema.4. Slight decreased degree of midline shift with persistent partial effacement of left lateral ventricle. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, 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, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Female 66 years old Reason: r/o compression at the cecum. request IV and PO contrast History: had colonoscopy and noted to have extrinsic compression of the cecum. Had study in the past. Any change? ABDOMEN:LUNG BASES: No pleural effusions. Previously seen right lower lobe nodule is outside the field of view.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Mildly distended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Again seen is a well-defined tubular fluid-density lesion with a rim enhancement and multiple intramural calcifications. The lesion is seen posterior/inferior to the ascending colon with mild extrinsic compression of the cecum. The lesion stretches from the level of the inferior pole of the right kidney down to the level of pelvis with increased extension across the midline to the left. The lesion has increased in size and measures 14.0 x 4.4 x 7.4 cm is best seen on sagittal views (series 80253, image 42) comment previously 11.0 x 4.3 x 5.9 cm. This lesion likely represents an appendiceal mucocele. No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine most prominent at L5/S1.OTHER: No significant abnormality noted | 1.Long tubular, calcified cystic lesion posterior to the ascending colon which has increased in size with mild extrinsic compression of the cecum. This lesion is consistent with a mucocele likely arising from the appendix.2.No evidence of bowel obstruction. |
Generate impression based on findings. | C6 cord compression evaluate for bony abnormalities. There are multilevel degenerative changes in the cervical spine with severe loss of disk height at the C7-T1 level and to a lesser degree at the C5-C6, C6-C7, and T1-T2 levels. There is 5-mm anterolisthesis of C7 on T1 with vacuum phenomena noted at the C7-T1 level. There are endplate sclerotic and destructive changes at the C7-T1 level with deformity involving the T1 vertebral body including moderate loss of height anteriorly.Degenerative changes are noted involving the bilateral facet joints at the C7-T1 level with vacuum phenomena, osteophytes, and subchondral cyst formation. Advanced facet arthropathy is also seen at the C3-C4 and C4-C5 levels with distention of the facet joints on the left at C3-C4 and on the right at C4-C5. Remainder of the vertebral body heights and alignment are preserved. Linear lucencies are noted involving the bilateral pedicles at C7 which are likely related to the above changes and less likely acute trauma.There are disk osteophyte complexes at C3-C4, C4-C5, C5-C6, C6-C7, and C7-T1 which along with ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis at C7-T1 and moderate spinal canal stenosis at the above levels. There is severe right and moderate to severe left neural foraminal stenosis at C7-T1. There is moderate right and mild left neural foramina narrowing at C4-C5 related to uncovertebral hypertrophy and facet arthropathy. There is also moderate right C5-C6 and mild right C6-C7 neural foramina stenosis. | 1. Advanced endplate destructive changes at the C7-T1 level with anterolisthesis, vacuum disk phenomenon, endplate sclerosis, subchondral cyst formation, and moderate loss of vertebral body height involving the T1 vertebral body. Advanced degenerative changes extend into the bilateral facet joints. Remote trauma or infection at this level may be possible with superimposed degenerative disease, correlate with clinical history. Charcot/neuropathic joint can be considered in the appropriate clinical setting although uncommon. No findings to definitively suggest active infection or acute trauma.2. Moderate to severe spinal canal stenosis at the C7-T1 level with cord edema noted at this level on MRI from 2/25/2015. There is severe right and moderate to severe left neural foraminal stenosis at C7-T1.3. Additional level degenerative changes including disk osteophyte complexes, ligamentum flavum thickening, and facet arthropathy, as detailed above.4. There is a sclerotic focus involving the posterior right aspect of the right T2 vertebral body which may represent a bone island, but is nonspecific. Comparison with prior studies would be helpful if available. |
Generate impression based on findings. | Ms. Pointer is a 49-year-old female presenting with tenderness at the site of cyst in the left lower inner breast. Patient presents today for ultrasound guided aspiration of cyst. Left breast ultrasound re-identified the target cyst for aspiration. The lesion to be aspirated is an anechoic cyst measuring 0.8 x 0.6 x 1.3 cm at the 8 o'clock location, 5 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially. Using aseptic technique, continuous ultrasound guidance and an inferior to superior approach, a 19-gauge needle was inserted into the cyst and approximately 1 cc of straw-colored fluid was aspirated. The cyst completely disappeared on ultrasound after completion of aspiration. No fluid was sent for cytology.Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Band-Aid. 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. Sheth. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided aspiration of left breast cyst.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Redemonstrated are postoperative findings related to a left frontal craniotomy and tumor resection. There is unchanged T2 hyperintensity adjacent to the resection cavity, which extends across the genu of the corpus callosum into the right frontal white matter. There is unchanged linear and minimally nodular enhancement posterior and inferior to the resection cavity. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. | Compared to MRI brain of 11/5/2014, no evidence of tumor progression. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (9/15/14), ultrasound images of left breast (9/15/14) performed at Northwestern Memorial Hospital, and digital mammographic images (3/5/14, 2/11/14) performed at Central DuPage Hospital. For comparison, digital mammographic images (10/15/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (3/5/14, 2/11/14):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. S shaped marker clip is present in the lower outer quadrant of left breast, denoting the site of benign biopsy.There are scattered benign appearing calcifications in the lower outer quadrant of left breast, posterior to the marker clip.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. DIGITAL MAMMOGRAPHIC IMAGES OF LEFT BREAST (9/15/14), ULTRASOUND IMAGES OF LEFT BREAST (9/15/14):Short term follow up of left breast was performed. There are no interval changes, including the scattered benign appearing calcifications in the lower outer quadrant.ULTRASOUND IMAGES OF LEFT BREAST (9/15/14):Sonographic images of left breast demonstrate no abnormal findings. | Benign appearing calcifications in the left breast. Follow up left mammogram in 6 months is recommended. Right annual mammogram can be performed at the same time.BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female 63 years old. Reason: assess disease progression. CHEST:LUNGS AND PLEURA: Mild emphysematous changes.Few scattered nodular opacities in the lingula decreased in extent compared to the prior exam. Series 5 image 56.Nodular opacities in the lateral aspect of the left lower lobe base also decreased in size and extent, see Series 5 image 70.Scarring right base, unchangedNo new nodules. No effusions.MEDIASTINUM AND HILA: Catheter tip SVC above are a junction. Small nonpathologic sized mediastinal nodes, unchanged.CHEST WALL: Port-A-Cath right chest wall.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Expected pneumobilia post Whipple procedure. No focal liver lesions. Hepatic vasculature enhances normally.SPLEEN: Punctate hypodensity lower pole likely cysts.PANCREAS: Status post Whipple procedure. Mildly dilated pancreatic duct in the region of the body is unchanged. Peripancreatic fat is normal.ADRENAL GLANDS: Minimal nodularity left adrenal gland unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Fat planes preserved and the celiac axis and superior mesenteric artery and their branches.Minimal atherosclerotic disease. No evidence of aneurysm.BOWEL, MESENTERY: Broad-based nonobstructive incisional hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Decreased multifocal nodularity in the lungs as described. Correlate for resolving infection. Much less likely metastatic disease.Status post Whipple with persistent mild to moderate dilatation of the pancreatic duct in the region of the body.Other findings as above. |
Generate impression based on findings. | 25 year old male with seminoma, stage II. Treated with RT to the abdominal and pelvis regions, evaluate response to treatment and serve as baseline for future comparison. CHEST:LUNGS AND PLEURA: No parenchymal lung nodules, masses or evidence of airspace disease. No pleural disease.MEDIASTINUM AND HILA: No adenopathy or other significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No lymphadenopathy is now seen. The prior precaval lymph node was seen on lemon size 6/14 on today's examination only a small remnant cysts measuring 0.8 x 0.4 cm (series 4, image 146) previously 2.5 x 1.2 cm. The second smaller node more inferiorly adjacent to the gonadal vessels (series 4, image 157) have similarly decreased due barely visible and measures 0.8 x 0.4 cm, previously 1.7 x 0.9 cm. Scattered small subcentimeter normal-sized lymph nodes remain unchanged..BOWEL, MESENTERY: No significant abnormality noted in the intestinal tract. No free mesenteric fluid. Again, scattered small subcentimeter mesenteric lymph nodes are seen unchanged..BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No enlarged lymph nodes meeting criteria for lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No evidence for lymphadenopathy and current examination. Prior mildly enlarged isolated lymph nodes in retroperitoneum have markedly reduced in size with barely visible remnants persisting.. |
Generate impression based on findings. | Male 58 years old Reason: CRC stage IV on chemo - evaluate interval change History: none CHEST:LUNGS AND PLEURA: Index cluster of nodules in the left upper lobe, series 5 image 39, 1.2 x 0.6 cm. Previously 1 x 0.7 cm.Index nodule in the posterior aspect of the superior segment of the right lower lobenow demonstrates some cavitation. It measures 1.4 x 0.9 cm on series 5 image 50. Previously 0.9 x 0.7 cm.Several of the other nodules also increased in size.Nodule in the anterior aspect of the right upper lobe MIP image 29 may be new.Small right cardiophrenic nodes more prominent than on the prior exam. See series 2 image 75MEDIASTINUM AND HILA: Scattered small mediastinal nodes some slightly more prominent. Moderate to marked coronary artery calcifications.CHEST WALL: Old fractures, unchangedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: 2.1. x 1.9 cm enhancing mass exophytic off the neck of the pancreas as measured on series 2 image 103, previously 1.8 x 1.6 cm. Distal pancreatic body and tail are atrophic.Small peripancreatic nodes unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index preaortic node 1.1 x 1.2-cm series 2 image 120. Previously 1.2 x 0.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small lymph node. Index left femoral noted measures 1.8 x 1.3 cm series 3 image 187. Previously 1.9 x 1.4 cm.BOWEL, MESENTERY: Stent seen within a sigmoid to descending colon mass. Extent of the fat stranding and nodularity in the pericolonic mesentery is increased. There is no evidence of ascites however. No evidence of obstruction. No new sites of peritoneal disease.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Increase in size of some lesions as measured above and possible new lung nodule suggesting impression of disease. |
Generate impression based on findings. | There is minimal leftward convexity in the lumbar spine The scout lateral view and the sagittal reformatted images demonstrate the lumbar spine to be in normal alignment, with straightening of the normal lumbar lordosis. There is mild disk narrowing at L3-L4 with vacuum phenomenon. The vertebral body and disk space heights are otherwise well-maintained. There is mild developmental narrowing of the lumbar spinal canal due to short pedicles. There are prominent lateral osteophytes on the right at L3-L4 and L4-L5.There is no acute fracture.At T12-L1, there is bilateral facet arthropathy and ligamentum flavum thickening.At L1-L2, there is bilateral facet arthropathy and ligamentum flavum thickening with mild developmental variant is dysfunctional.At L2-L3, there is a mild disk bulge with left paracentral/foraminal prominence. There is significant bilateral facet arthropathy and ligamentum flavum thickening resulting in overall moderate-severe central spinal stenosis. There is mild right and mild to moderate left foraminal narrowing.At L3-L4, there is a diffuse disk bulge with also prominence of dorsal epidural fat. There is mild bilateral facet arthropathy and ligamentum flavum thickening contributing to overall moderate central spinal stenosis and mild to moderate bilateral foraminal narrowing.At L4-L5, there is a mild disk bulge with left paracentral prominence and bilateral facet arthropathy and ligamentum flavum thickening. There is moderate bilateral foraminal narrowing.At L5-S1, there is a trace disk bulge. There is right greater than left facet arthropathy with severe right and moderate-severe left foraminal narrowing.Limited views through the retroperitoneum demonstrate scattered aortoiliac atherosclerotic calcification. | Mild developmental narrowing of the lumbar spinal canal with superimposed moderate spondylotic changes resulting in up to moderate-severe central spinal canal stenosis at L2-L3, as well as severe right and moderate-severe left foraminal narrowing at L5-S1. |
Generate impression based on findings. | Female 57 years old Reason: HBV evalaute for HCC History: HBV LIMITED ABDOMENLIVER: Limited evaluation shows heterogenous hepatic parenchyma.BILIARY TRACT: No biliary dilatation.PANCREAS: Not well-visualizedKIDNEYS: The right kidney measures approximately 10 cm with suggestion of cortical thinning, but difficult to visualize. The left kidney is not well-visualized.SPLEEN: Not well visualized.OTHER: No significant abnormalities noted. | 1.Limited examination with no definitive evidence of focal hepatic lesion. |
Generate impression based on findings. | Cerebral palsy.VIEWS: Pelvis AP/frog leg (two views) 02/26/15 In the interval, the right femoral head has migrated from the acetabulum. It is superiorly and laterally displaced. The left femoral head remains well directed into the acetabulum. Very limited left femoral motion is seen.Spinal fusion instrumentation is noted. A small to moderate amount of feces is seen in the rectosigmoid. | Right developmental hip dysplasia with dislocation. |
Generate impression based on findings. | 48-year-old male with left lower quadrant pain progressing to right midabdomen. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic morphology again seen with evidence of portal hypertension with marked splenomegaly and diffuse portosystemic collaterals. No focal mass lesion is seen the liver, however limited to only portal venous phase images is not adequately screening liver for neoplastic change in patients with cirrhosis. Nonocclusive portal vein thrombus is seen unchanged in its proximal course. Remainder of portal vein peripheral distribution appears normal. Hepatic veins are patent.Gallstones are again seen. Low-density thickening of the gallbladder wall is seen which is been noted on prior examinations and is frequently encountered in patients with chronic liver disease. If concern over cholecystitis exists in light of gallstones and these findings, nuclear medicine hepatobiliary scanning could provide additional imaging information..SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderately prominent scattered lymph nodes are seen in the hepatoduodenal ligament and scattered retroperitoneum with a similar pattern to seen previously and frequently encountered in patients with chronic liver disease and not indicative of concerning lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted. No ascites seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Cirrhotic liver morphology with evidence of portal hypertension. 2. Cholelithiasis with low density thickening of gallbladder wall unchanged since 2012 -- this most likely relates to chronic liver disease but if concern over cholecystitis exists, CT cannot differentiate this. Stability and lack of change greatly favors benign finding. 3. No significant change in abdominal CT findings since 2012 without source of patient's abdominal pain identified. |
Generate impression based on findings. | Fracture.VIEWS: Left elbow AP/lateral (two views) 02/26/15 The two K wires remain in place in the distal humerus. The obliquely oriented transverse fracture of the humeral diametaphysis is again seen. The distal fracture fragment is minimally displaced laterally and appears to be posteriorly angulated in that the anterior humeral line passes anterior to the capitellum. Periosteal reaction encircles the distal humerus. | Healing distal humeral fracture. |
Generate impression based on findings. | Postoperative changes from prior left frontal cranioplasty are again seen with predominantly fat signal of the graft. Small left frontal extra-axial collection is stable to slightly smaller. The previously noted nodular enhancement along the inferolateral aspect of the left frontal resection cavity is interval enlarged compared to 10/29/2014 measuring approximately 19 x 23 x 25 mm (axial post gad image 17/30 and sagittal post gad image 21 of 34), previously approximately 13 x 16 x 18 mm. Susceptibility artifact limits evaluation of this region on perfusion images. More superiorly, nodular enhancement is also slightly increased along the lateral aspect of the resection cavity. 6-mm enhancing nodule involving the left frontal corona radiata is not significantly changed. There is slight increase in masslike FLAIR hyperintensity involving the left inferior frontal lobe, measuring 17 mm in the transverse dimension, previously 12 mm. Remainder of the masslike flair hyperintensity involving the anterior and medial temporal lobe including the hippocampus demonstrates no interval enlargement. FLAIR hyperintensity involving the left greater than right corona radiata is also not significantly changed. There is evidence of Wallerian degeneration along the left corticospinal tracts. Chronic left frontal lobe and left basal ganglia encephalomalacia again seen. Unchanged ventricular size without evidence of hydrocephalus. There is mass effect on the left temporal horn which is also unchanged. | 1. Compared to 10/29/2014, there are findings suggestive of interval tumor progression involving the left inferior frontal lobe where there is slight increase in masslike FLAIR hyperintensity and more prominent increase in enhancing mass now measuring 19 x 23 x 25 mm.2. Remainder of the masslike and non-masslike areas of FLAIR hyperintensity and enhancement as detailed above are not significantly changed. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. The vertebral body and disk heights are stable, with mild disk narrowing especially anteriorly at L3-L4 and disk desiccation at this level through L5-S1. There is mild hyperintensity within the L3 pedicles bilaterally which likely is reactive given the appearance of the adjacent facet disease. There are scattered endplate degenerative changes. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.Sagittal images suggest a minimal disk bulge at T11-T12 which is unchanged with minimal indentation of the ventral thecal sac.At T12-L1, there is bilateral facet arthropathy and ligamentum flavum thickening.At L1-L2, there is bilateral facet arthropathy and ligamentum flavum thickening with mild developmental central spinal canal narrowing.At L2-L3, there is a mild disk bulge with left paracentral/foraminal prominence. There is significant bilateral facet arthropathy and ligamentum flavum thickening resulting in overall moderate-severe central spinal stenosis. There is mild right and mild to moderate left foraminal narrowing.At L3-L4, there is a diffuse disk bulge with also prominence of dorsal epidural fat. There is mild bilateral facet arthropathy and ligamentum flavum thickening contributing to overall moderate central spinal stenosis and mild to moderate bilateral foraminal narrowing.At L4-L5, there is a mild disk bulge with left paracentral prominence and bilateral facet arthropathy and ligamentum flavum thickening. There is slight dorsal displacement of the descending left L5 nerve roots with mild-moderate central spinal stenosis. There is moderate bilateral foraminal narrowing.At L5-S1, there is a trace disk bulge with right paracentral annular fissure. Previously described right posterior S1 vertebral subchondral fracture appears to correlate with the fissure. There is right greater than left facet arthropathy with severe right and moderate-severe left foraminal narrowing. There is indentation of the ventral thecal sac.There is a partially visualized small lobulated T2 hyperintense likely cystic structure which may arise off the posterior right lobe of the liver. | Mild developmental narrowing of the lumbar spinal canal with no significant interval change in superimposed moderate spondylotic changes resulting in up to moderate-severe central spinal canal stenosis at L2-L3, as well as severe right and moderate-severe left foraminal narrowing at L5-S1. |
Generate impression based on findings. | Chest wall painVIEWS: Chest AP, right rib obliques and left rib obliques No displaced rib fractures noted. Cardiothymic silhouette normal. No focal lung opacity. | No displaced rib fractures noted. |
Generate impression based on findings. | There is minimal grade 1 anterolisthesis of C7 on T1. The cervical spine is otherwise in normal alignment, with significant straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated.Sagittal T2 weighted images are degraded by artifact. The spinal cord is of normal caliber. Comparison to previous images is limited secondary to extensive previous and current motion artifact. However, within the limitations, distribution of patchy abnormal cord signal appears similar, most conspicuous and focal at the C2-C3 level where findings are located centrally and dorsally, extending most cranially from mid C2 down to a lesser degree along the left paramedian dorsal cord to the C4-C5 level.Facet arthropathy is noted on the left at C2-C3, right at C3-C4, and left at C4-C5. There is mild to moderate left foraminal narrowing at C4-C5. There is no gross disk bulge, herniation, other spinal canal or foraminal stenosis within the cervical spine. There are multiple T2 hyperintense lesions within right lobe gland is minimally enlarged. The largest of these measures 1.2 x 1.8 cm and is located anteriorly. | 1. Significantly limited exam second or to patient motion with also difficulty in comparison to prior imaging secondary to previous motion. Grossly similar patchy nonspecific abnormal signal within the cervical cord at C2 level down to C4-C5. While this would be compatible with clinically suspected transverse myelitis, the differential would also include neurosarcoid and demyelinating disease.2. Right thyroid T2 hyperintense lesions. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated. |
Generate impression based on findings. | Reason: metastatic mucoepidermoid carcinoma History: metastatic mucoepidermoid carcinoma CHEST:LUNGS AND PLEURA: Right sided chest tube unchanged with significant interval reduction in the right-sided pleural effusion. Marked residual pleural thickening and nodularity with loculated right pleural effusion.Increased septal thickening throughout the right lung with right basilar atelectasis.Left basilar referenced nodule (image 41 series 5) now measuring 11 mm previously measuring 8 mm.Multiple new as well as enlarging left lung nodules identified.MEDIASTINUM AND HILA: Right chest Port-A-Cath with its tip in the SVC.Increasing pericardial effusion and pericardial nodularityCHEST WALL: Innumerable nodules within the subcutaneous and muscular tissue involving the chest and abdominal walls demonstrate interval increase in number and size. Reference right chest wall nodule (image 44 series 3) now measuring 19 mm x 26 mm previously measuring 17 mm x 20 mm.Breast and axillary nodules have increased.Solitary sclerotic lesions in the T1 and T9 vertebrae unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic metastatic lesions demonstrating interval increase in sizeSPLEEN: Multiple splenic opacities demonstrating interval increase in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval increase in size of left renal metastasisPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.G-tube.BONES, SOFT TISSUES: New osteolytic lesions in the L4 vertebrae.OTHER: No significant abnormality noted. | Interval progression of metastatic disease. |
Generate impression based on findings. | Reason: Patient with elevated white count s/p CABG, risk for aspiration, please evaluate for PNA, evidence of aspiration, abscess/ fluid collections History: As above LUNGS AND PLEURA: Mild apical predominant centrilobular and paraseptal emphysema. The previously described spiculated right upper lobe nodule measures 14 x 12 mm (series 4, image 18) not significantly changed from the prior exam dated 02/07/2015.The previously described spiculated nodule at the right lung base is significantly decreased in size from the prior exam (series 4, image 79).Multiple new areas of patchy ground glass, tree-in-bud opacities, and areas of consolidation in the dependent lower lobes bilaterally, as well as local bronchial wall thickening, compatible with aspiration and mucous plugging, with possible superimposed infection.Interval resolution of bilateral effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. Severe coronary artery calcification.The main pulmonary artery is enlarged, suggestive of pulmonary hypertension. Lipomatous hypertrophy of the intra-atrial septum.The ascending aorta measures 3.9 cm, unchanged.Enlarged mediastinal and nodes are unchanged. Reference precarinal lymph node measures 15 mm (series 3, image 39), unchanged from 02/07/2015.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenic granuloma. | 1. Patchy ground glass, tree-in-bud opacities, and areas of consolidation in the dependent lower lobes bilaterally, as well as local bronchial wall thickening, compatible with aspiration and mucous plugging, with possible superimposed infection.2. A spiculated right upper lobe nodule is highly suspicious for malignancy, likely a primary lung cancer. Previously described right lower lobe mass is decreased from the prior exam and likely inflammatory, related to prior aspiration. |
Generate impression based on findings. | 5-year-old male with history of osteosarcoma, end of therapy evaluation. LUNGS AND PLEURA: No nodules or masses.MEDIASTINUM AND HILA: Left port catheter tip extends to the the right atrium. No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: Left chest wall port. Status post right upper extremity amputation.UPPER ABDOMEN: Limited views of the upper abdomen appear normal. | No evidence of metastatic disease |
Generate impression based on findings. | Time average mean velocities: Right middle cerebral artery: 159 cm/sec.Right internal carotid artery: 100 cm/sec.Left middle cerebral artery: 126 cm/sec.Left internal carotid artery: 104 cm/sec. | Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). |
Generate impression based on findings. | Total knee arthroplasty Two views of the left knee reveal a total knee arthroplasty in anatomic alignment. No evidence of any fractures or dislocations. | Left total knee arthroplasty in anatomic alignment. |
Generate impression based on findings. | 6-year-old female with right hip painVIEWS: Pelvis AP and frog leg (2 views) 2/26/15 11:50 The femoral heads are well directed with respect to the normal acetabula. No evidence of fracture or malalignment. | Normal examination. |
Generate impression based on findings. | 2-year-old male with right tibial shaft fractureVIEWS: Right ankle AP, oblique, and lateral (3 views) 2/26/15 12:09 Oblique distal tibia fracture in near anatomic alignment with adjacent callus formation indicating interval healing. There persistent soft tissue swelling about the distal tibia and ankle. | Healing distal tibia fracture in near anatomic alignment. |
Generate impression based on findings. | 7 year-old male with CPVIEWS: Pelvis AP and frog leg (2 views) 2/26/15 12:08 Bilateral coxa valga deformity. There is approximately 50% lateral uncovering of the left femoral head and a shallow left acetabulum as well as 25% lateral uncovering of the right femoral head and mild right acetabular dysplasia. Large rectal stool burden. | Bilateral hip dysplasia, left greater than right. Large rectal stool burden. |
Generate impression based on findings. | 14 year old male with increasing abdominal distention per clinical service.VIEW: Abdomen AP (one view) 2/26/2015 12:24 Gastrostomy tube is again noted. VP shunt is seen coursing through the right hemi abdomen with tip coiled in the pelvis.There is more gas seen throughout the bowel compared to recent radiograph with no definite evidence of obstruction. No evidence of free air on this AP radiograph. Thoracolumbar levoscoliosis continues. | More air seen throughout the bowel with no definite evidence of obstruction. No free air based on this single view AP abdominal radiograph. If there is concern for free air, recommend cross-table lateral or lateral decubitus view for further evaluation. Findings were discussed with Dr. Kerby Samuels by phone on 2/26/2015 at 1:20 PM. |
Generate impression based on findings. | 58-year-old male with history of biliary obstruction status post ERCP and stent placement. ABDOMEN:LUNG BASES: Previously seen small left pleural effusion has resolved. Severe coronary artery calcifications.LIVER, BILIARY TRACT: Hepatomegaly. Numerous low-attenuation sharply marginated lesions of various sizes with attenuation of simple fluid are present throughout the liver which appear grossly similar to prior and are compatible with polycystic liver disease. Some of the cystic lesions have marginal calcifications, similar to prior. There has been interval insertion of a common bile duct stent with the distal tip in the duodenum. There is moderate dilation of the intrahepatic biliary ducts, similar to prior. A large cyst compresses the left and right biliary ducts near their confluence, similar to prior. There is a moderate amount of pneumobilia which is likely related to the recent procedure. One of the cystic lesions in the caudate lobe (series 3, image 35) has a new air-fluid level suggesting continuity with the bile ducts and/or recent instrumentation.The main portal vein is patent.Cholelithiasis. Ascitic fluid surrounds the gallbladder.SPLEEN: Small nonspecific sharply marginated lesions in the spleen are similar to prior.PANCREAS: There is mild focal dilatation of the pancreatic duct just proximal to the ampulla, similar to prior. The remainder of the pancreatic duct is normal in caliber.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The left kidney is surgically absent. The right kidney is markedly enlarged and the parenchyma has been nearly completely replaced with numerous cystic lesions of various sizes, some of which are atypical (higher attenuation than simple fluid and/or calcified walls) appearing grossly similar to prior.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications affect the abdominal aorta and its branches. The origins of the SMA and right renal artery are narrowed. Small retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A moderate amount of abdominal pelvic ascites is present decreased compared to the prior exam.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings compatible with polycystic kidney and liver disease status post left nephrectomy grossly similar to prior. Some of the right renal cysts have complex features.2.Moderate intrahepatic biliary ductal dilatation similar to prior. Interval placement of a common bile duct stent. One of the hepatic cysts in the caudate lobe contains a new air-fluid low suggesting continuity with the bilary ducts and/or recent instrumentation.3.Moderate abdominal pelvic ascites, decreased from prior.4.Extensive atherosclerotic disease the visualized arteries.5.Cholelithiasis. |
Generate impression based on findings. | Wrist pain. Evaluate fracture Three views of the right wrist reveal a cortical break in the distal radial metaphysis consistent with a nondisplaced fracture. No change from previous exam. Incidental note is made of negative ulnar variance. | Nondisplaced distal radius fracture unchanged from previous |
Generate impression based on findings. | 5-year-old male with osteosarcoma, status post disarticulationVIEWS: Shoulder, AP external and internal rotation (2 views) 2/26/15 12:36 Interval right upper extremity amputation. The remaining osseous structures are normal for the patient's age. A left central venous catheter is partially visualized. | Interval right upper extremity amputation. |
Generate impression based on findings. | Male 53 years old Reason: pt slipped on ice 2 days ago, unable to walk on right ankle History: pain and swelling to lateral and medial aspect of right ankle. Three views of the right ankle show an oblique/spiral fracture of the distal fibula extending to the joint line with minimal lateral displacement of the distal fracture fragment. There is widening of the medial joint space. There is mild soft tissue swelling about the lateral ankle.Four views of the right knee show no acute fracture, dislocation, or joint effusion. | Distal fibular fracture as described above. |
Generate impression based on findings. | Ankle injury several weeks ago Three views of the right ankle reveal no evidence of any fractures or dislocations. Note is made of a plantar heel spur. | No fractures or dislocations |
Generate impression based on findings. | 49 years, Female. Reason: evaluate for obstruction vs. ileus in patient s/p RYGB History: nausea, emesis Bibasilar atelectasis. Surgical clips project over the right and left upper quadrant. Air distended loops of predominantly large bowel. Average stool burden. | Large bowel ileus pattern. |
Generate impression based on findings. | Reason: extent of disease History: esophageal cancer s/p stent, chemotherapy LUNGS AND PLEURA: Apical predominant centrilobular emphysema.Bilateral linear and nodular parenchymal and pleural scarring is unchanged. Prominent left lower lobe focus of bronchiectasis/scarring is unchanged from prior exams, may be related to prior aspiration. Scattered micronodules, some calcified, unchanged. No new suspicious pulmonary nodules or masses.No focal air space consolidation. New small bilateral pleural effusions.MEDIASTINUM AND HILA: Esophageal stent is unchanged in position, at the GE junction. Distal esophageal thickening around the stent appears grossly unchanged from the prior exam. Soft tissue extending into the upper and lower ends of the stent is increased from prior exam, and may represent tumor or granulomatous tissue. Reference GE junction lymph node measures 8 mm (series 3, image 78), not significantly changed. Additional mildly prominent mediastinal lymph nodes, including a right tracheoesophageal node (series 3, image 11) and a prevascular node (series 3, image 17) are stable.CHEST WALL: Left chest port, tip in the SVC.A previously described right lower cervical lymph node (series 3, image 7) is unchanged.Degenerative disease of the thoracic spine, with unchanged anterior wedging of multiple lower thoracic vertebral bodies.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. Gastrostomy tube in place. | 1. Unchanged distal esophageal thickening around the esophageal stent. Soft tissue extending into the upper and lower ends of the stent is increased from prior exam, and may represent tumor or granulomatous tissue. Lymphadenopathy is stable, with reference measurements as above. No new sites of disease.2. New small pleural effusions. |
Generate impression based on findings. | Ankle injury playing roller Derby Four views of the left knee are unremarkable. No fractures or dislocations. | Negative left knee exam |
Generate impression based on findings. | Female 53 years old Reason: Rule out AAA, other intaabdominal process, LLQ pain History: Abd pain CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Mild mediastinal lymphadenopathy. Reference prevascular lymph node measures 1.3 x 1.2 cm (series 3, image 24). CHEST WALL: No significant abnormality noted.ABDOMEN: Limited exam secondary to lack of intravenous and oral contrast. Lack of intravenous contrast limits evaluation of vascular and solid organ pathology. Lack of oral contrast limits evaluation of bowel pathology.LIVER, BILIARY TRACT: Status post cholecystectomy. Small perihepatic free fluid.SPLEEN: Peripheral calcification adjacent to the capsule which may be secondary to prior result hematoma or prior episode of peritonitis.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis. No renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple dilated loops of small bowel, with a single loop measuring up to 3.2 cm (series 3, image 123) in the left upper quadrant. A portion of collapsed distal ileum and the terminal ileum are best seen on coronal images (series 80220, image 42 and 49). There is some elongation of small bowel in the pelvis which may be secondary to adhesive disease. These findings are consistent with a high-grade mechanical obstruction with uncertain transition point, although it is likely located in the pelvis. The cecum and ascending colon are abnormally located in the left lower quadrant. The colon is collapsed. There are several hyperdense foci adjacent to the appendix which may represent appendicoliths best seen on coronal images (series 80220, image 56). However, appendicitis is unlikely given the appendix is full of stool and air. A large amount air is present in the left lower quadrant contiguous with the ascending colon which is likely secondary to a large diverticulum (series 3, image 145).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter in place in a collapsed bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Limited exam secondary to lack of intravenous and oral contrast. Within these limitations, there is high grade mechanical small bowel obstruction. Unclear transition point although it is likely located in the pelvis and secondary to adhesions. No intraperitoneal free air or pneumatosis. Small perihepatic free fluid.2.Abnormally located left lower quadrant cecum and ascending colon. 3.Probable appendicoliths without evidence of appendicitis. Findings were discussed by telephone with the emergency medicine physician, Dr. Mulenga, at 2:00pm on 2/26/2015. |
Generate impression based on findings. | Status post fall. Evaluate for fracture. Two views of the right hip reveal no evidence of fractures or dislocations. | No evidence of fractures or dislocations |
Generate impression based on findings. | Pain at metatarsals and dorsum of foot Three views of the right ankle are unremarkable. No fractures or dislocations. | Negative right foot exam |
Generate impression based on findings. | 7-year-old male history of seizures and altered mental status. Evaluate for encephalitis. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or discernible cerebral edema. However, non-contrast CT is insensitive for the evaluation of encephalitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | IgA plasmacytoma of left parotid/neck/face resected 2012, now with IgA kappa spike.RADIOPHARMACEUTICAL: 6.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates a large approximately 4.5 x 7.0 cm soft tissue density mass in the gastrohepatic region. No additional gross pathology.Today's PET examination demonstrates a large markedly hypermetabolic (SUV max = 11.8) gastrohepatic lymph node/mass, compatible with tumor activity.No additional suspicious FDG avid lesion is identified on whole body PET. Crescentic bilateral adnexal activity is most commonly benign in a menstruating female. | 1.Large markedly hypermetabolic gastrohepatic lymph node mass, compatible with tumor activity.2.No FDG avid tumor identified elsewhere on whole body PET.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 63 years, Male. Reason: distention History: decreased stool output and distention Enteric feeding tube tip projects over the gastric body. Nonobstructive bowel gas pattern with less than average stool burden in the colon. Round radiodensity projects over the right upper quadrant. Bilateral air space opacities are better evaluated on chest radiograph performed the same day. | Enteric feeding tube tip projects over the gastric body. Nonobstructive bowel gas pattern with less than average stool burden in the colon. Round radiodensity projecting over the right upper quadrant may represent enteric/ingested material versus cholelithiasis, recommend correlation with patient history. |
Generate impression based on findings. | 55-year-old female had left lower quadrant persistent pain for two months. Rule-out ovarian pathology. History of breast cancer. ABDOMEN:LUNG BASES: No significant abnormality noted LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Patient is status post cholecystectomy with slightly prominent intrahepatic and extrahepatic bile ducts with the common hepatic duct diameter measuring 8 mm.. This most likely reflects a post cholecystectomy state is no intrinsic or extrinsic abnormality to suggest obstruction is seen.. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from prior gastric surgery without evidence complication. Small bowel and colon show no diagnostic abnormalities. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus and adnexa appear normal without abnormal mass or abnormal fluid collections.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes from prior gastric surgery without evidence complication. Small bowel and colon show no diagnostic abnormalities. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post cholecystectomy with mildly prominent intrahepatic and extra bile ducts but without findings seen to suggest biliary obstruction. 2. Status post gastric surgery changes without complication seen. 3. No evidence for ovarian or adnexal mass or other abnormality. |
Generate impression based on findings. | Multiple myeloma. Pre-autoSCT The bones are demineralized, limiting evaluation.SKULL: Innumerable lytic lesions compatible with myeloma are noted.CERVICAL SPINE: Innumerable lytic lesions compatible with myeloma are noted. There is perhaps mild vertebral body height loss at C5. No malalignment is noted. THORACIC SPINE: Innumerable lytic lesions compatible with myeloma are noted. Multiple mild compression deformities are noted throughout the thoracic spine, most prominent at T7, likely pathologic.LUMBAR SPINE: Innumerable lytic lesions compatible with myeloma are noted. Multiple moderate compression deformities are noted of all 5 lumbar vertebral bodies, likely pathologic.RIBS: The bones are demineralized. No discrete myelomatous lesions are noted.PELVIS: Innumerable lytic lesions compatible with myeloma are noted. There is myelomatous destruction of the pubic symphysis.UPPER EXTREMITY: Innumerable lytic lesions compatible with myeloma are noted throughout the upper extremities, extending to the distal radii and ulnae. An intra-medullary rod and screw device affixes an old healed fracture of the right humerus. LOWER EXTREMITY: Innumerable lytic lesions compatible with myeloma are noted throughout the upper extremities, extending to the distal tibias and fibulas. An intra-medullary rod and screw device affixes an old healed fracture of the proximal right femur. Moderate osteoarthritis affects the knee joints bilaterally. | Innumerable myelomatous lesions and other findings throughout the axial skeleton, as described above. |
Generate impression based on findings. | Male 53 years old Reason: ankle pain at left medial malleolus, assess for fracture History: ankle pain at left medial malleolus, assess for fracture . No acute fracture or dislocation. Mild to moderate osteoarthritic changes affect the midfoot. | Osteoarthritis without evidence of fracture or dislocation. |
Generate impression based on findings. | Pain Severe osteoarthritis affects the left knee. A Pellegrini-Stieda lesion is noted, indicating prior left MCL injury. There are 6 degrees of genu valgum.A right total knee arthroplasty device appears in anatomic alignment as seen on the frontal view. A Pellegrini-Stieda lesion is noted, indicating prior right MCL injury. Mild osteoarthritis affects the left hip. | Osteoarthritis and other findings, as above. |
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