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Generate impression based on findings. | 81 years, Female. Reason: abdominal pain Differential air-fluid levels are noted on upright imaging and a general paucity of small bowel gas without specific evidence of bowel obstruction. Moderate to large stool burden in the colon with air in the rectum. Soft tissue density noted in the pelvis, correlating with patient's cyst seen on prior CT. Osteopenia noted. | No specific evidence of bowel obstruction. Moderate to large stool burden in the colon. Soft tissue density in the pelvis correlates with known pelvic cystic neoplasm. |
Generate impression based on findings. | Male 54 years old; Reason: right total hip The right hip total arthroplasty device is situated in near-anatomic alignment without radiographic evidence of hardware complication. Skin staples overlie the right hip.Severe osteoarthritis affects the left hip as seen on the single frontal view of the pelvis. | Right total hip arthroplasty, without evidence of complication. |
Generate impression based on findings. | Female 42 years old Reason: ankle fx History: ankle fx A spiral fracture of the distal fibula extending to the joint line is again seen with posterolateral displacement of distal fracture fragment, which appears unchanged from the prior exam. There is widening of the lateral joint space. There is no widening of the medial joint space. A well corticated ossicle is seen inferior to medial malleolus is unchanged from the prior exam and most likely due to prior injury to the deltoid. | Distal fibular fracture as described above, unchanged from prior exam. |
Generate impression based on findings. | 87 year-old female with lung mass on chest x-ray -- evaluate for malignancy workup. Weight loss. CHEST:LUNGS AND PLEURA: Left upper lobe large mass (series 5, image 42) measuring 4.5 x 5.4 cm, abuts the mediastinal fat at the aortopulmonary window and it is associated with distal loculated pleural effusion anteriorly. Mass is consistent with primary lung carcinoma. No other parenchymal lung nodules or masses are seen. More inferiorly there is free dependent small left pleural effusion.MEDIASTINUM AND HILA: Aortopulmonary window cluster of mildly enlarged lymph nodes are seen, the largest of which measures 1.4 x 0.9 cm. These are worrisome for metastatic disease but do not meet CT size criteria for lymphadenopathy. Similarly small pretracheal and subcarinal lymph nodes are seen, with the subcarinal node (series 4, image 40) measuring 1.0 x 1.0 cm.Severe coronary artery calcifications are seen. Mild aneurysmal dilatation of the descending aorta is seen just proximal to the diaphragmatic crus with diameter 3.3 x 3.1 cm. Aorta achieves normal diameter after passing through diaphragmatic crus. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted - benign perfusion abnormality seen in expected location in the segment 4 liver..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign cortical cysts are seen without other significant abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged uterus with fibroid tumor changes. No other abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse degenerative skeletal changes changes seen with osteopenia. No focal abnormalities otherwise seen.OTHER: No significant abnormality noted. | 1. Large left upper lobe along mass most consistent with primary carcinoma. 2. clustered small mediastinal lymph nodes suspicious for metastases but not meeting CT criteria for lymphadenopathy. 3. No evidence for metastatic disease L2 air in the chest, abdomen or pelvis. |
Generate impression based on findings. | Initial treatment strategy for lymphoma. Lymphadenopathy on recent neck and chest CTs.RADIOPHARMACEUTICAL: 11.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates an enlarged conglomerate of lymph nodes in the left inferior posterior jugular region. Borderline enlarged bilateral axillary lymph nodes are present. A large central mesenteric soft tissue density mass is present with a medium-sized calcific region posteriorly. Numerous additional separate enlarged mesenteric and retroperitoneal lymph nodes are also noted. Ascites is present.Today's PET examination demonstrates markedly hypermetabolic focus (SUV max = 18.1) corresponding to the enlarged left lower posterior jugular lymph nodes, consistent with lymphoma activity.Multiple moderately hypermetabolic bilateral axillary lymph nodes, left greater than right, indicate additional tumor activity (SUV max = 5.2).Within the abdomen, centrally within the larger mesenteric mass there is a smaller medium-sized region of central hypermetabolic activity (SUV max = 7.9) consistent with additional lymphoma tumor activity. One additional punctate hypermetabolic focus likely representing additional small tumor is seen in the right aspect of this lesion. However, the remaining enlarged soft tissue mass and other enlarged abdominal lymph nodes are not hypermetabolic which suggests coexisting indolent tumor/lymphoproliferative disorder. | 1.Markedly hypermetabolic lymph nodes/masses involving the left postero-inferior jugular, bilateral axillary, and abdominal mesenteric stations, consistent with FDG avid lymphoma.2.Note the majority of the enlarged abdominal lymph node masses are not FDG avid, suggestive of a coexisting more indolent tumor/lymphoproliferative disorder. |
Generate impression based on findings. | Female 43 years old; Reason: eval sagittal balance- preop planning for possible fusion History: back and bilateral leg pain . There is 13 degrees of thoracic dextroscoliosis measured from the superior endplate of T4 to the inferior endplate of T12. There is 10 degrees of lumbar levoscoliosis measured from the superior endplate of L1 to the superior endplate of L5. The coronal balance is within normal limits. There is approximately 2.9 cm of positive sagittal balance. No segmentation anomalies are seen. Mild multilevel degenerative disk disease affects the thoracic spine. Moderate multilevel degenerative disk disease affects the lumbar spine. | Scoliosis and positive sagittal balance, as above. |
Generate impression based on findings. | Evaluation of pulmonary nodulesRADIOPHARMACEUTICAL: 10.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 185 mg/dL. Today's CT portion grossly demonstrates multiple enlarged lymph nodes throughout the left neck measuring up to 3 cm. A surgical clip is also noted in the left neck. The right neck cystic fluid collection is again noted and not grossly changed. Multiple enlarged mediastinal lymph nodes are also seen, including within the right paratracheal region, and measuring up to about 3 cm. Multiple bilateral pulmonary nodules are seen and measure up to about 1.5 cm. Extensive atherosclerotic calcifications are noted, including of the coronary arteries. Today's PET examination demonstrates multiple significantly hypermetabolic lymph nodes throughout the left neck extending from the mandibular angle to the supraclavicular region with an SUVmax of 20.1. Multiple significantly hypermetabolic mediastinal, right paratracheal, pre-carinal and right hilar lymph nodes are noted with an SUVmax of 22.8, consistent with additional metastases. Multiple markedly hypermetabolic pulmonary nodules are seen compatible with additional metastases. For reference, the right middle lobe nodule has an SUVmax of 9.1. There is a punctate significantly hypermetabolic focus involving the C3 vertebral body with an SUVmax of 5.9, indicating a bone metastasis. No suspicious lesions are visualized in the abdomen or pelvis. Benign appearing bowel and adrenal activity is present. | Extensive hypermetabolic metastases including lymph nodes of the left neck and chest as well as bilateral pulmonary nodules and osseous metastasis at C3. Given the metastatic distribution and patient's history, thyroid cancer is considered likely. |
Generate impression based on findings. | 75 years, Male. Reason: evaluate ileus History: abdominal pain The lung bases are clear. Postsurgical changes from fundoplication surgery again noted. NG tube tip projects over the gastric antrum. Residual contrast is noted throughout the colon. No pneumoperitoneum. Unchanged bowel gas pattern. Osteophyte formation at right L5-S1 again noted. | Unchanged bowel gas pattern compatible with ileus. |
Generate impression based on findings. | 58-year-old female patient with end colostomy and remaining rectal pouch. The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Suture material projects over the right lower quadrant and hemipelvis.A urinary catheter was inserted into the rectal pouch and contrast was injected in a retrograde fashion. There was good contrast distension of the rectal pouch without evidence of leak, sinus tract, or fistula. Next, the colostomy in the right lower quadrant was cannulated and contrast was injected in retrograde fashion. Round filling defects seen within the colon were compatible with fecal matter. There was opacification of the colon to the splenic flexure.Fluoroscopy time: 4:42 minutes | 1.Rectal pouch without leak. 2.Colon containing stool as described above. |
Generate impression based on findings. | 63 years, Female. Reason: Recheck placement of NGT placed yesterday History: Recheck placement of NGT placed yesterday NG tube is coiled with tip projecting over the gastric cardia. Subcutaneous drain and surgical staples overlie the lower abdomen. A pessary device is noted. Interval increase in gaseous distention of small bowel. Gas is noted in the expected region of the sigmoid colon. | NG tube tip projects over the gastric cardia. Interval increase in small bowel dilatation may represent ileus although small bowel obstruction is not entirely excluded. Clinical correlation is advised. |
Generate impression based on findings. | Reason: eval for infection, retained Hickman, persistently septic LUNGS AND PLEURA: Scattered punctate micronodules. No suspicious pulmonary nodules or masses.Mild subsegmental atelectasis/scarring and mild chronic interstitial abnormalities. Moderate dependent atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size. Small pericardial effusion. No visible coronary artery calcification. The pulmonary arteries are severely enlarged, with peripheral calcifications, suggestive of pulmonary hypertension.Right IJ central venous catheter, tip at the cavoatrial junction. As seen on recent prior exams dating back to 2008, a catheter fragment extends along the course of the left brachiocephalic vein and SVC, terminating in the right atrium. The peripheral tip is in the central left subclavian vein, just distal to its junction with the left IJ vein.Scattered small mediastinal lymph nodes. Hilar lymph nodes, some calcified, are difficult to evaluate on noncontrast imaging.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. | 1. No evidence of infection.2. A catheter fragment extends along the course of the left brachiocephalic vein and SVC, terminating in the right atrium. This appears to be unchanged in position dating back to 2008.3. The pulmonary arteries are severely enlarged, suggestive of pulmonary hypertension. |
Generate impression based on findings. | 51-year-old male with history of pancreatic cancer, s/p surgery and chemoradiation therapy. Evaluate for response and establish new baseline. CHEST:LUNGS AND PLEURA: Calcified micronodules likely from prior granulomatous disease. No suspicious nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Fatty infiltration of the liver. No focal hepatic lesions are identified. The hepatic vasculature is patent. Postsurgical changes of Whipple procedure including hepaticojejunostomy.SPLEEN: No significant abnormality notedPANCREAS: Status post resection of the head of the pancreas. The remainder of the pancreatic body and tail are unremarkable. The pancreatic duct is not dilated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Ill-defined area of soft tissue between the portal vein confluence and IVC (series 3, image 107) which showed increased activity on recent PET measures 3.0 x 0.8 cm, unchanged. There is also a small amount of nonspecific soft tissue along the common hepatic artery, similar to prior.BOWEL, MESENTERY: Post operative changes in the stomach and small bowel from a Whipple procedure. No bowel obstruction. Nodularity of the anterior abdomen in the area of prior surgery is 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 significant abnormality notedBOWEL, MESENTERY: Postoperative changes as detailed above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postsurgical changes of Whipple procedure for pancreatic neoplasm.2.Portacaval soft tissue which was hypermetabolic on recent PET and is suspicious for neoplastic recurrence stable in size. 3.Fatty infiltration of the liver. |
Generate impression based on findings. | Time average mean velocities: Right middle cerebral artery: 97 cm/sec.Right internal carotid artery: 115 cm/sec.Left middle cerebral artery: 122 cm/sec.Left internal carotid artery: 146 cm/sec. | Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). |
Generate impression based on findings. | Male 56 years old; Reason: assess rotator cuff History: left shoulder pain, S/P TSA Evaluation of the shoulder is limited by streak artifact from the patient's left total shoulder arthroplasty.The left total shoulder arthroplasty device is situated in near-anatomic alignment, without radiographic evidence of hardware complication. Note is made of an os acromiale.Intra-articular contrast does not extend into the subacromial or subdeltoid bursa, excluding a full thickness rotator cuff tear. The subscapularis is mildly atrophic. | No specific evidence of a full-thickness rotator cuff tear. |
Generate impression based on findings. | 35-year-old female patient with history of Crohn's disease presents with nausea and vomiting. Concern for bowel obstruction or delayed gastric gastric emptying. UPPER GI:Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal.There was a small duodenal diverticulum in the first portion of the duodenum (series 21). SMALL BOWEL FOLLOW THROUGH:Transit time to the ileostomy site was 30 minutes. Fluoroscopic evaluation showed no ulcers, sinus tracts, or fistulae. There was no evidence of obstruction. There was a loop of jejunum that was directed into the pelvis, which may be postsurgical in etiology. Just proximal and extending to the ileostomy there is a loop of hypoperistaltic ileum (cine series 33 and series 31). However, there is no fixed narrowing or abnormal dilatation. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 7:56 minutes | 1.No evidence of bowel obstruction or delayed gastric emptying.2.Hypoperistaltic bowel proximal to the ileostomy. Deviation of jejunal loop into pelvis seen on early imaging, may represent nonobstructive adhesive disease versus iatrogenic fixation of bowel. Recommend correlation with surgical history.3.Small duodenal diverticulum. |
Generate impression based on findings. | Clinical question: Bodytom. Signs and symptoms: Bodytom intraoperative CT. Nonenhanced head CT:Examination is performed after a surgical/treatment planning the study and is not a true diagnostic test.There is no detectable complication from placement of stereotactic device on patient calvarium.Extensive post operative pneumocephalus centered primarily in the bilateral anterior frontal region.There are bilateral frontal approach DBS lead placement traversing brain parenchyma and extending inferiorly with the tips of the electrodes appear to be at the level of bilateral cerebral peduncles. There is extensive streak artifact from the leads which obscures the detail for precise assessment of their location. The appropriateness of placement should be determined by the referring physician.There is no detectable hemorrhage or edema secondary to this procedure. The ventricular system remain within normal size and maintained midline. | 1.Expected postoperative changes of DBS placement with out detectable complication.2.The appropriateness of the placement of the electrodes should be determined by referring physician. |
Generate impression based on findings. | The risks (including, but not limited to, those of bleeding, infection, allergic reaction, temporary nerve block, pain, and inability to access the joint) and benefits of the procedure were explained to the patient, and informed written consent was obtained. A pre-procedural “time-out” form was completed.The patient was placed supine on the fluoroscopy table. The left shoulder was localized fluoroscopically, and a spot radiograph was obtained. The skin was cleansed and covered with a sterile drape. The skin and subcutaneous tissues were anesthetized with 1% lidocaine using 25-gauge and 22-gauge needles.Under fluoroscopic guidance, a 20-gauge spinal needle was advanced into the joint. Attempted aspiration yielded no fluid. Next, 10 ml of a 50/50 mixture of Omnipaque 240 and saline was injected into the joint. Contrast opacified the joint in the expected manner. A spot radiograph was obtained for documentation. The needle was withdrawn. Blood loss was negligible (<1cc), and patient tolerated the procedure well without immediate complication. An adhesive bandage was placed on the patient’s skin. Routine post procedure instructions were communicated to the patient. The patient was escorted to the CT suite for further imaging in stable condition. Please refer to the subsequent CT report for further information.Exposure time: 40 seconds | Successful left shoulder arthrogram injection. Please refer to the subsequent CT report for further information. |
Generate impression based on findings. | Reason: s/p 4.5 right lower lobectomy following neoadjuvant therapy for stage IIIa NSCLC History: annual f/u LUNGS AND PLEURA: Scarring and mild bronchiectasis in the anterior segment of the right upper lobe, unchanged.As post right lower lobectomy.9-mm nonsolid nodule in the left lower lobe with thickening in the wall of a small cyst, unchanged since 5/12/2011, but still suspicious for indolent adenocarcinoma, and further follow-up is recommended.Status post right lower lobectomy.MEDIASTINUM AND HILA: No significant lymphadenopathy.Small hypodense nodule in the right lobe of the thyroid gland, unchanged.No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of metastases.2. Persistent very small left lower lobe sub-solid nodule, unchanged, but with morphology still somewhat suspicious for indolent adenocarcinoma, and continued long-term follow-up is recommended. |
Generate impression based on findings. | Female 21 years old; Reason: Are there degenerative changes at the 1st MTP joint? History: pain and limited mobility at the 1st MTPJ Mild hallux pelvis deformity is present at the first metatarsophalangeal joint. No fracture or dislocation is present. Otherwise, no specific findings are seen to account for the patient's symptoms. | Mild first toe hallux valgus deformity, without fracture or dislocation. |
Generate impression based on findings. | Male 18 years old; Reason: Evaluate fracture. History: pain Two vertically-oriented intramedullary orthopedic screws affix the patella in anatomic alignment, without radiographic evidence of hardware complication. The fracture line is indistinct, indicating some healing, appearing similar to the prior study. No additional fracture or dislocation is seen. No joint effusion is evident. | Postoperative changes of a patellar fracture fixation. |
Generate impression based on findings. | Pain. Preop. Severe osteoarthritis affects the right knee with tricompartmental osteophyte formation and bone on bone apposition in the medial tibiofemoral compartment. A joint effusion is present. There are 11 degrees of genu varum.The left total knee arthroplasty device appears in near-anatomic alignment as seen on the frontal view. Mild osteoarthritis affects the right hip and ankle joints. | Osteoarthritis, as above. |
Generate impression based on findings. | Reason: new dx lung cancer, baseline/pre-chemo scan, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: A left upper lobe spiculated mass with central cavitation and adjacent stranding groundglass was hypermetabolic on recent PET/CT, compatible with a known diagnosis of non-small cell lung cancer. The soft tissue component of the mass measures 5.0 cm in transverse diameter (series 80260, image 43), not significantly changed from recent PET imaging dated 1/8/2015. The length is not accurately measured on this exam due to a component of atelectasis.Multiple additional left lower lobe pleural-based nodules were hypermetabolic on recent PET imaging, including a left basilar nodule measuring 2.2 x 1.4 cm (series 10229, image 230).The right lung remains clear.Scattered basilar subsegmental atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes were up to moderately hypermetabolic in recent PET imaging. A prevascular lymph node measures 1.2 cm (series 80260, image 33) not significantly changed from prior imaging. A right paratracheal lymph node measures 10 mm (series 80260, image 27), unchanged.CHEST WALL: Degenerative disease of the thoracic spine. No focal osseous lesions.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: A left adrenal mass measures 5.5 X 4.3 cm (series 80260, image 102), with central low density compatible with necrosis and mild surrounding fat infiltration, increased from prior pet imaging and compatible with metastasis.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | A large left upper lobe spiculated mass compatible with a known diagnosis of non-small cell lung cancer, with left lung base pleural-based nodules, mediastinal lymphadenopathy, and a left adrenal mass all of which likely represent metastatic disease. |
Generate impression based on findings. | 55 year old with history of multiple screening call-back presents for annual mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. Subcentimeter masses in both breasts are stable. 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. | Reason: 69 yo with large neck mass, bx c/w scc, unknown primary, imaging to screen for lung, liver and other organ involvement History: large left-neck mass CHEST:LUNGS AND PLEURA: Multiple micronodules, some of which are calcified, compatible with previous infection.No suspicious nodules.Moderate upper zone centrilobular emphysema.Very small left pleural effusion. Underlying opacity in the left lower lobe suggestive of rounded atelectasis. Mild dependent atelectasis at the right base.MEDIASTINUM AND HILA: No significant lymphadenopathy.Multiple calcified lymph nodes compatible with previous infection.Severe coronary artery calcification. Marked aortic valve calcification.No pericardial effusion.Moderately dilated and patulous esophagus.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive aortic calcification.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Small left pleural effusion and with rounded atelectasis at the left base. No specific evidence of metastatic disease in the chest. |
Generate impression based on findings. | Ms. McCall is a 60 years year old female with a personal history of bilateral benign breast biopsies (right breast -- intraductal papilloma, left breast -- UDH). She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Linear markers were placed on scars overlying both breasts. A lock clip is seen in the right retroareolar region and a wing clip is seen in the left retroareolar region, at sites of prior benign breast biopsies. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified 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 recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 48 year old with inflamed skin lesion presents for mammographic study. Two standard 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. A triangular marker is placed at lower inner quadrant of left breast, indicating the area of skin lesion. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. Focused ultrasound was performed for the skin lesion at lower inner left breast. There is a skin thickening with increased blood flow and ill-defined hypo/anechoic component, measuring 31 x 18 mm, suggesting pus formation. The lesion is located within skin - subcutaneous region. | Inflamed skin lesion in the left lower inner region. No mammographic evidence for malignancy. Clinical follow up is recommended for the skin lesion. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Increased hip pain Mild osteoarthritis affects the right hip. No fracture or malalignment is present. | Mild osteoarthritis of the right hip. |
Generate impression based on findings. | 10 month old male with history of right femur fracture. Evaluate for healing.VIEWS: Right femur AP and Lateral (2 views) 2/26/2015 14:02 Interval removal of cast material. Transverse fracture through the distal femoral metaphysis is in anatomic alignment. Callus has been incorporated into the cortex compatible with healing. | Continued healing of distal femoral metaphyseal fracture. |
Generate impression based on findings. | Clinical question: Memory loss. Signs and symptoms: Memory loss. Nonenhanced head CT:Examination demonstrates patchy foci of periventricular and subcortical low attenuation white matter suggestive of age indeterminate small vessel ischemic strokes with subtle interval progression since prior exam.Additionally there is a focus of encephalomalacia and resultant ex vacuo dilatation of right lateral ventricle in the right high convexity posterior frontal lobe consistent with a chronic ischemic stroke. Unremarkable calvarium, scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute findings.2.Findings suggestive of mild to moderate age indeterminate small less ischemic stroke with interval progression.3.Chronic high right posterior frontal ischemic stroke which is new since prior exam from 2008. |
Generate impression based on findings. | Multiple myeloma. Evaluate for sternal or rib fracture. No rib fracture or displaced sternal fracture is evident. No pneumothorax is present.The vertebral body heights are preserved. Mild multilevel degenerative disk disease affects the thoracic spine.No discrete myelomatous lesions are evident. | No rib fracture or vertebral body compression fracture evident. No displaced sternal fracture is evident, however radiographs are insensitive for the detection of sternal fractures. If further evaluation of the sternum is clinically warranted, chest CT is recommended.Findings discussed with APN Dimeglio at 3 p.m. on 2/26/15. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in sister and maternal cousin. Two standard digital views of both breasts with additional bilateral MLO views 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 an asymmetry in the posterior left breast, best seen on the CC view. No suspicious microcalcifications or areas of architectural distortion are present. | Left breast asymmetry for which spot compression views and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female 41 years old Reason: left hip pain s/p Dr. Leland hip scope History: left hip pain. Two views of the left hip show mild osteoarthritic affecting the left hip.The AP view of the pelvis again demonstrates mild osteoarthritic changes of the left hip as well as very mild degenerative changes of the right hip with minimal acetabular sclerosis bilaterally | Mild osteoarthritis of the left hip as described above. |
Generate impression based on findings. | Male 28 years old; Reason: left ankle ORIF History: left ankle ORIF A side plate and screw device as well as two syndesmotic screws affix the distal fibula in anatomic alignment. Two additional screws affix the medial malleolus. The tibial fracture line is indistinct, compatible with healing. There is increased surrounding callus formation at the fibular fracture, also indicating some interval healing. | Orthopedic fixation of healing ankle fractures, as above. |
Generate impression based on findings. | Pain at fifth metatarsal base No fracture or malalignment is identified. No significant abnormality is otherwise seen. | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of mastopexy in 1994. 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. Bilateral asymmetries and benign-appearing calcifications are stable to 2008. At least some of these findings probably relate to prior mastopexy. 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. | Male 64 years old Reason: right lower extremity alignment History: right knee pain. Right bone length study reveals one degree of varus angulation of the knee compared to the neutral mechanical axis. Hardware components of a right total knee arthroplasty device seen in anatomic alignment without radiographic evidence of hardware complication. Mild degenerative arthritic changes affect the right hip.Four views of the right knee again show hardware components of a right total knee arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. Severe degenerative arthritic changes effect the left knee on frontal views with near bone on bone apposition of the medial compartment. | 1.One degree of varus angulation of the knee compared to the neutral mechanical axis.2.Osteoarthritic changes of the right hip and left knee as described above. |
Generate impression based on findings. | Dorsal wrist pain No fracture is identified. There is a positive ulnar variance. Subtle sclerosis at the proximal ulnar portion of the lunate likely represents ulnar abutment. | Findings compatible with ulnar abutment of the lunate. |
Generate impression based on findings. | 55-year-old male with history of AML and neutropenic sepsis now with abdominal pain. ABDOMEN:LUNG BASES: Mild basilar atelectasis without consolidation or pleural effusions.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: Normal caliber bowel without evidence of obstruction. No abnormal bowel wall thickening or adjacent inflammatory changes. The appendix has been resected. Scattered small mesenteric lymph nodes are not pathologically enlarged. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No intraperitoneal free air or free fluid.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. No abnormal bowel wall thickening or adjacent inflammatory changes. The appendix has been resected. Scattered small mesenteric lymph nodes are not pathologically enlarged. BONES, SOFT TISSUES: Right iliac sclerotic lesion probably benign bone island.OTHER: Surgical clips in the scrotum. | 1.Interval appendectomy.2.No acute findings to account for the patient's symptoms. |
Generate impression based on findings. | Male 48 years old Reason: SEVere PAIN History: Right elbow PAin: can't use . Four views of the right elbow show no joint effusion, fracture, or dislocation. No radiographic findings to account for patient's pain. | Four views of the right elbow show no specific radiographic findings to account for patient's pain. |
Generate impression based on findings. | Female 65 years old; Reason: pre-op right THA robotic History: pain There is severe osteoarthritis of the right hip with joint space narrowing, osteophyte formation, and subchondral cysts.A lumbar spine fusion is partially visualized. Degenerative changes are noted at the right sacroiliac joint. Mild osteoarthritis affects the knee joints bilaterally, with chondrocalcinosis of the menisci. | Osteoarthritis. |
Generate impression based on findings. | Male 63 years old; Reason: LLQ pain, wound drainage., hx of Crohn's s/p partial colectomy with diverting loop ileostomy c/b wound dehiscence and persistent ventral hernia. perforation?abscess? colitis? History: as above. Exam is not sensitive for detecting lesions in the solid organs or vasculature to the lack of intravenous contrast. Given that limitation, the following observations are made:ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cholelithiasis unchanged. No intra-hepatic or extra-hepatic biliary dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several calcifications near the right renal hilus and a few in the left upper pole. Probable nonobstructive nephrolithiasis although some of this may be vascular in nature.RETROPERITONEUM, LYMPH NODES: Small shotty retroperitoneal nodes.Atherosclerotic calcifications aorta. No evidence of aneurysm.BOWEL, MESENTERY: Broad-based incisional hernia with lack of abdominal musculature and bowel seen up against the skin. Evidence of prior surgery. No obstruction. No free or loculated intraperitoneal fluid to suggest abscess.BONES, SOFT TISSUES: Degenerative changes osseous structures.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate. Axial plane series 2 image 117, 7.4 x 6.8 cm..BLADDER: No significant abnormality noted.LYMPH NODES: Scattered small nodes.BOWEL, MESENTERY: Absent abdominal musculature broad-based herniation of abdominal contents. No evidence of obstruction. There is minimal fat stranding around the sigmoid colon, coronal image 61 axial image 91. Mild diverticulitis or activity of Crohn's disease in this location cannot be excluded. No extraluminal gas. No loculated fluid to suggest abscess. No evidence of generalized ascites.BONES, SOFT TISSUES: Osteoporosis and degenerative changes. Absent intra-abdominal musculature as described above.OTHER: No significant abnormality noted. | Absent abdominal wall musculature with broad based weakness and herniation. No evidence of bowel obstruction. No fat stranding or loculated fluid to suggest abscess.Mild fat stranding around the sigmoid colon could represent mild diverticulitis or activity of Crohn's disease. |
Generate impression based on findings. | Pain around AC joint after fall. There is mild widening of the acromioclavicular joint likely representing traumatic AC joint separation, given the clinical history. No fracture is seen. The glenohumeral joint alignment is normal. | Mild widening of the acromioclavicular joint likely representing traumatic AC joint separation, given the clinical history. |
Generate impression based on findings. | Status post fracture There has been interval removal of the cast. Again seen is a transverse fracture of the distal radius with fracture fragments in near anatomicalignment. The fracture line is less distinct, compatible with some interval healing. The ulnar styloid fracture appears similar to prior.Mild osteoarthritis affects the basilar joint. | Healing fracture of the distal radius. |
Generate impression based on findings. | Reason: Hypoxia, evalute for acute etiologies, evalute size of pulmonary vasculature History: Hypoxia LUNGS AND PLEURA: Moderate predominantly upper zone centrilobular emphysema.Moderately large bilateral pleural effusions with underlying dependent atelectasis.Interstitial opacity with multiple septal lines at the bases compatible with edema.Focal areas of subpleural consolidation, mainly in the lung bases which could represent pulmonary infarcts. However the scan was performed without intravenous contrast material and therefore pulmonary embolism cannot be evaluated.MEDIASTINUM AND HILA: ICD leads in place.Swan-Ganz catheter extending to the right middle lobe pulmonary artery.Severe coronary artery calcification.Marked cardiomegaly but no pericardial effusion.Radiopaque surgical material at the cardiac apex.CHEST WALL: Status post median sternotomy with apposition of the sternal fragments.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited visualization with no gross abnormalities | Findings consistent with CHF with focal subpleural opacities that could represent infarction secondary to pulmonary embolism. This could be evaluated by contrast-enhanced CT or a ventilation perfusion radionuclide scan. |
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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral stable, benign-appearing calcifications and asymmetries. No suspicious dominant masses, microcalcifications or areas of architectural distortion are present. | Stable bilateral asymmetries and 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. | 9-year-old male, rule out pneumothorax after pigtail catheter removalVIEW: Chest AP (one view) 2/26/15 14:22 Interval removal of right pigtail catheter without pneumothorax. A left chest tube is directed apically. Left PICC tip in right atrium.The previous noted left subpulmonic pneumothorax is not well-visualized. Patchy basilar opacities are not significantly changed. The cardiothymic silhouette is unchanged. | Interval removal of right pigtail catheter without residual pneumothorax. |
Generate impression based on findings. | Female 33 years old Reason: pt struck a box with the top of her right foot, no ankle pain History: point pain to dorsal aspect of right foot . There is mild soft tissue swelling along the dorsal aspect of the foot. Otherwise, there is no evident fracture or dislocation. | Soft tissue swelling without underlying fracture or dislocation. |
Generate impression based on findings. | Male 53 years old Reason: R ankle stress view History: above . Two views of the right ankle show a distal spiral fibular fracture extending to the joint line with widening of the medial ankle joint space neutral and stress views | Distal fibular fracture with widening of the medial joint space as described above. |
Generate impression based on findings. | 53-year-old male with history of rectal cancer status post low anterior resection with ileostomy and ileostomy reversal presenting with possible right ischial abscess Hand injection of water soluble contrast demonstrated opacification a U-shaped, end-to-side anastomosis of colon to the rectum. Opacification of a complex web of sinus tracts at the level of the anastomosis was noted, one of which is a fistula appearing to extend to the expected region of the right ischioanal fossa and likely to the grossly visualized cutaneous lesion in the patient's right buttock. The largest collection of contrast measures 1.9 x 1.6 cm with additional sinus tracts extending from this collection (series 18). There is also at least one thin caliber tract that extends to the left hemipelvis as well. Extensive diverticular disease makes assessment less than optimal.Valsalva maneuver demonstrated proper descent of the pelvic floor (cine loops series 20). The patient was able to evacuate bowel contents without evidence of significant prolapse or rectocele. TOTAL FLUOROSCOPY TIME: 5:08 minutes. | 1. Right colocutaneous fistula involving the neorectum and gluteus.2. Complex web of sinus tracts at the level of the anastomosis, primarily on the right, extending superiorly. Largest collection measures 1.9 x 1.6 cm, an abscess cavity a consideration. 3. CT may be considered for further evaluation of the intraabdominopelvic disease.Findings discussed with pager 2701 at 1215 on 2/26/15. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal aunt 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 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. | Male 57 years old Reason: HCC screening History: hep C cirrhosis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nodular liver morphology consistent with cirrhosis. No focal enhancing hepatic lesions. Small nonspecific hypodense focus in segment 7 seen on delayed imaging (series 13, image 19). Small punctate calcification in the right lobe of the liver. No biliary ductal dilatation. Cholelithiasis without evidence of cholecystitis. Hepatic vasculature is patent.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions bilaterally which are too small to characterize but likely represent cysts. Bilateral punctate nonobstructing renal calculi.RETROPERITONEUM, LYMPH NODES: Esophageal varices. Atherosclerotic calcifications of the abdominal aorta. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Cirrhotic liver morphology. No focal hepatic lesion suspicious for HCC. |
Generate impression based on findings. | Female 87 years old Reason: 87F hx pancreatitis and CT with concern of pancreatic cysts s/p EGD/EUS with evidence of IPMN vs. complicated pancreatitis. Now with gastric perforation History: r/o gastric perforation s/p clips The exam is not sensitive for detecting lesions in the solid organs of vasculature to the lack of intravenous contrast. Given those limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Intrathoracic stomach. Although located in the chest these findings were described below.Moderate-sized bilateral pleural effusions and associated atelectasis or consolidation.MEDIASTINUM AND HILA: Heavy granulomatous calcifications. Moderate to severe atherosclerotic calcifications aortic root and coronary arteries. Right subclavian line tip in the region of the SVC RA junction.CHEST WALL: Severe rotatory S-shaped scoliosis to the right in the chest.ABDOMEN:LIVER, BILIARY TRACT: No evidence of fatty liver. No definite focal liver lesions or biliary dilatation. Cholecystectomy clips.SPLEEN: Scattered calcific granulomata.PANCREAS: Peripancreatic fat stranding concerning for pancreatitis. No evidence of pancreatic calcifications, hemorrhage or ductal dilatation. Ill-defined hypodensity near the tail of the pancreas seen on series 2 image 78 measuring 2.1 x 2 cm may represent a pseudocyst.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The intrathoracic stomach demonstrates marked wall thickening consistent with submucosal edema. Reported pancreatic pseudocyst that abutted the intrathoracic stomach is not clearly visible probably because it was drained. There is a clip placed endoscopically and the wall of the stomach. There is no evidence of extraluminal contrast to suggest active perforation or leak. There is fat stranding in the perigastric fat however.BONES, SOFT TISSUES: Marked scoliosis with degenerative changes. Atherosclerotic calcifications.Anasarca.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis and degenerative changes. Marked anasarca.OTHER: No significant abnormality noted. | Intrathoracic stomach with marked submucosal edema. No evidence of extraluminal contrast to suggest active perforation or leak.Limited due to lack of IV contrast, but probable pseudocyst in the region of the tail of the pancreas and extensive fat stranding around the pancreas and around the perigastric fat within the thorax.Marked anasarca.Other findings as above.Discussed by telephone with Dr. Waxman 2:33 p.m. |
Generate impression based on findings. | Clinical question: Aneurysm. Signs and symptoms: Headache, syncope. Nonenhanced head CT: Examination demonstrates no detectable acute intracranial process and no interval change since prior exam.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation remains within normal. Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells and the orbits.Head CTA:There is normal appearing bilateral vertebral arteries across to skull base, bilateral pica branches, basilar artery and its distal branches.The right internal carotid artery is unremarkable across the skull base and its supraclinoid segment. The right ophthalmic artery and its origin are visualized are unremarkable. A small right posterior communicating artery is identified and unremarkable. Unremarkable right supraclinoid internal carotid artery bifurcation.Normal appearing right A1, anterior communicating artery and the A2 segment of right anterior cerebral artery.The left internal carotid artery remains within normal crosses skull base and its supraclinoid segment. The left ophthalmic artery and its origin is identified and unremarkable. The left anterior cerebral artery is visualized and unremarkable. The left middle cerebral artery and its branches are unremarkable.Neck CTA:The visualized aortic arch and the origins of major vessels are widely patent and unremarkable. There is anatomical variation of the left common carotid artery arising from the brachial cephalic (bovine arch).The right brachial cephalic and bilateral subclavian arteries are unremarkable.Bilateral vertebral arteries and including their origins are unremarkable.Bilateral common carotid arteries, bilateral carotid bifurcations, bilaterally internal carotids and the external carotid arteries are widely patent and widely patent. There is a short segmental mild vascular ectasia of distal cervical tortuous right internal carotid artery is noted. 3-D reformatted images were not available at the time of interpretation of this exam. An addendum to this report will be submitted after 3-D reformatted images are acquired and available for review. | 1.Unremarkable nonenhanced head CT.2.Unremarkable head CTA.3.CTA of the neck demonstrate no evidence of any vascular lumen compromise or stenosis. There is a short segmental mild ectasia of the distal tortuous right internal carotid artery which may be secondary to atherosclerotic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of mastopexy in 2003. 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, 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. History of aspirated left breast abscess. 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. | 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. 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: NSD - Screening Mammogram. |
Generate impression based on findings. | 67 years, Male. Reason: LLQ pain, BRBPR, C.diff infection, evaluate for megacolon History: LLQ pain, BRBPR Nonobstructive bowel gas pattern. Right percutaneous biliary drain tip and multiple surgical clips project over the right upper quadrant. IVC filter is again noted. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Benign left biopsy in 1992. 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. | Male 50 years old Reason: evaluate TSA, perform after arthogram History: same. Evaluation of the shoulder is limited due to streak artifact related to the total shoulder arthroplasty device. There is no evidence of contrast extravasation to suggest a rotator cuff tear. Hardware components of a right total shoulder arthroplasty device are situated in near anatomic alignment with no evidence of hardware complication or dislocation. There is no evidence of hardware loosening. The surrounding soft tissues and musculature appear unremarkable. There is mild basilar dependent atelectasis seen on the partially imaged right lung. Hardware components of a cardiac pacemaker and sternotomy wires are partially imaged. | Limited evaluation of the shoulder due to streak artifact related to a total shoulder arthroplasty device without gross evidence of hardware complication or contrast extravasation to suggest a full-thickness tear. |
Generate impression based on findings. | Female 81 years old Reason: metastatic breast cancer - evaluate response to treatment and compare to previous scan on 1/5/15 per recist 1.1 with bidimensional measurements History: pulmonary mets and adenopathy CHEST: LUNGS AND PLEURA: Reference right middle lobe subpleural nodule unchanged, measuring 1.6 x 0.7 cm (series 4, image 52), previously 1.6 x 0.8 cm. Another index nodule seen in right upper lobe near the fissure without significant change, measuring approximately 6 mm (series 4, image 38).Previously seen pleural-based focal nodularity in region of peripheral left major fissure is not visualized on the current examination and may have been secondary to atelectasis. Additional calcified and noncalcified micronodules without significant change. Peripheral pulmonary scarring is seen likely secondary to post radiation sequela particularly on the left and sequela of chronic interstitial lung disease visualized.No new suspicious masses or nodules.MEDIASTINUM AND HILA: Mild coronary artery calcifications. Stable size of right axillary lymph node, measuring 1.8 x 1.2 cm (series 3, image 19), previously measured 1.7 x 1.1 cm.CHEST WALL: Right chest wall port seen with tip in right atrium. Status post left mastectomy with associated surgical clips seen in chest wall and axillary area.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hepatic parenchymal hypoattenuation seen in hepatic segment IVb, (series 3, image 88), which is stable dating back to examination from August 2013. Given its stability, this is likely benign in etiology and may reflect focal hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate to severe aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Small hiatal hernia. Descending and sigmoid colonic diverticulosis without evidence of acute diverticulitis.BONES, SOFT TISSUES: Superior endplate deformity of T11 is unchanged from the prior study. Degenerative changes of the spine with severe degenerative disease seen at the L5-S1 disk space.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: Multilevel degenerative changes of spine.OTHER: No significant abnormality noted. | Stable examination without change in pulmonary nodules or right axillary lymph node. |
Generate impression based on findings. | Female 74 years old Reason: eval EVAR with bilateral iliac artery stents History: AAA with bilateral iliac artery aneurysm ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Two large hepatic cysts and several smaller ones are again seen scattered throughout the liver, unchanged. No biliary dilatation. Hepatic vasculature enhances normally.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Pre-IV contrast can scan shows multifocal scattered punctate nephrolithiasis both kidneys, unchanged. No hydronephrosis or hydroureter. No perinephric fat stranding There is also some vascular calcification of the renal arteries.RETROPERITONEUM, LYMPH NODES: Previously seen abdominal aortic aneurysm is now been stented. There is aortobiiliac stent graft in place. Graft is patent without evidence of thrombus. There is no evidence of endo- leak. Maximal diameter of the aorta is measured on series 15 image 109, 4.6-cm AP by 4.5-cm transverse outer to outer dimensions. This is minimally smaller than on the pre-stent examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Right adnexal cystic mass is unchanged as previously described.Uterus is atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Osteoporosis and severe degenerative changes particularly both hips.OTHER: Stent in the right and left common iliac arteries are patent. No evidence of endo- leak. Maximal diameter is seen in the coronal plane the left common iliac artery is 2.6-cm image 54 arterial phase.Maximal diameter of the right common iliac artery coronal image 53, 2.4-cm.Diminish flow is still present distal to the left femoral artery. | Slight decrease in size of aneurysm sac. Patent stents with no evidence of endo- leak.Numerous chronic findings including bilateral nephrolithiasis, right adnexal cystic mass with calcifications, numerous hepatic cysts. |
Generate impression based on findings. | 46 year old with high probability benign mass in the right breast presents for follow up ultrasound study. Focused ultrasound was performed for the known mass in the right breast. Detected is an isoechoic mass surrounded by hyperechoic component, measuring 7 x 3 x 7 mm at 10 o'clock position, a cm from nipple. The size and appearance of this mass is unchanged when compared to the prior study. This mass is likely a fibroadenoma. | Stable mass in the right breast, likely fibroadenoma. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended in October 2015. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Time average mean velocities: Right middle cerebral artery: 83 cm/sec.Right internal carotid artery: 160 cm/sec.Left middle cerebral artery: 166 cm/sec.Left internal carotid artery: 99 cm/sec. | Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). |
Generate impression based on findings. | Mr. Clemons is a 45 year old male presenting with a painful nodule in the medial right breast for the past two months. Three standard views of both breasts and two right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A triangular marker is placed at the site of palpable abnormality. Asymmetric, flame-shaped fibroglandular breast tissue is identified in the right retroareolar region. There is no mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | Benign gynecomastia of the right breast. No mammographic evidence of malignancy. The etiology and causes of gynecomastia were explained to the patient. No further workup is necessary at this time. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Male 53 years old Reason: eval bony deformity 2 MT, callous and pain at plantar 2nd MT head History: same. Three views of the right foot appear normal. Specifically, there is no evidence of a bony deformity or fracture involving the second metatarsal. | Normal appearing right foot as described above without evidence of acute fracture or deformity. |
Generate impression based on findings. | History of right-sided facial pain radiating to right ear and nose. There is no significant paranasal sinus mucosal thickening. Haller air cells are present on the left. The infraorbital nerves appear to be partly dehiscent bilaterally, which is an anatomic variant. The infundibulae, frontoethmoidal, and sphenoethmoidal recesses are patent. The nasal cavity is clear. There is mild S-shpaed nasal septal deviation with bilateral nasal septal spurs. The lamina papyracea are intact. The imaged intracranial structures and orbits are unremarkable. | Mild nasal septal deviation, but clear paranasal sinuses without evidence of sinonasal mass lesions. A trigeminal nerve MRI may be useful for further evaluation, however. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 10-year-old female, evaluate healing of fractureVIEWS: Left ankle, AP, oblique, and lateral (3 views) 2/26/15 14:47 An oblique fracture line extends from the distal tibial metadiaphysis to the epiphysis, consistent with a Salter Harris IV fracture in anatomic alignment. Periosteal reaction about the distal tibia is consistent with healing. | Healing Salter Harris IV fracture of the distal tibia in anatomic alignment. |
Generate impression based on findings. | 69-year-old female with history of thyroid cancer with bone metastases. Compared to previous. CHEST:LUNGS AND PLEURA: Left apical sub-solid nodule (series 5, image 17) and left upper lobe nodule (series 5 come image 46) are unchanged the left upper lobe nodule measures 0.8 cm compared with 0.9 cm previously. A right subpleural nodule (series 5 come image 53) is unchanged. Scattered other small micronodules are unchanged.No new nodules, masses or airspace disease are seen. No pleural effusions.The clustered lingular nodules have decreased in number and prominence and presumably represent resolving inflammatory change.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Sclerotic lesions of the right anterior third fourth and fifth ribs in a linear distribution are again seen unchanged and may well represent healed fractures rather than metastatic disease. Sclerotic lesions about the right eighth rib laterally and in multiple left anterior ribs near the costosternal junctions are unchanged. New Foci of sclerosis are seen in scattered areas about the thoracic vertebral bodies (for example T11, series 3, image 79) indicative of progressive metastatic bone disease.ABDOMEN:LIVER, BILIARY TRACT: Benign cyst seen in liver unchanged -- no significant abnormality seen to suggest metastatic disease. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality noted is unchanged splenic calcified granulomas..PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive lumbar spine degenerative disk and degenerative joint disease again seen. Superimposed on this are scattered foci of punctate sclerosis appearing similar to prior examination and representing metastatic disease. Extensive streak artifact from left hip prosthesis is visualization of the left aspect of the pelvis internally.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased foci of sclerosis are seen about the iliac bones bilaterally indicative of progressive skeletal metastatic disease. The extensive left iliac wing destructive mass with extensive soft tissue component has increased in size since the prior exam with a larger soft tissue component (see series 3, image 146). Left hip prosthesis remains subluxed.OTHER: No significant abnormality noted. | 1. Multiple foci of osseous metastases with increasing number of foci seen suggesting progressive metastatic disease -- nuclear medicine bone scintigraphy is a more accurate indicator of skeletal metastatic disease activity. 2. Subluxed left hip prosthesis with adjacent destructive bony changes of the acetabulum. Unchanged. 3. Extensive left iliac crest destructive bone lesion with increasing associated soft tissue mass. 4. Stable reference lung nodules as described above. The clustered nodular densities in the lingula have decreased and most likely represent resolving inflammatory process. |
Generate impression based on findings. | 13 year old female with right upper quadrant and right lower quadrant pain with quiescent colitis on recent colonoscopy. Evaluate for small bowel inflammation.EXAMINATION: MR enterography without and with IV contrast 2/26/2015 ABDOMEN:LIVER, BILIARY TRACT: Normal with no evidence of intra-or extrahepatic biliary ductal dilatation. Gallbladder is normal.SPLEEN: Normal.PANCREAS: Normal with no evidence of pancreatic ductal dilatation.ADRENAL GLANDS: Normal.KIDNEYS, URETERS: Normal with no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: The retroperitoneum is normal. No lymphadenopathy.BOWEL, MESENTERY: Normal caliber with no evidence of bowel wall thickening, abnormal enhancement or obstruction. The appendix is visualized and appears normal. BONES, SOFT TISSUES: No suspicious osseous lesions are noted. The soft tissues are normal. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Normal.BLADDER: Normal.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: Normal caliber with no evidence of bowel wall thickening, abnormal enhancement or obstruction.BONES, SOFT TISSUES: No suspicious osseous lesions are noted. The soft tissues are normal. OTHER: Small amount of free fluid in the pelvis. | Normal examination. |
Generate impression based on findings. | Time average mean velocities: Right middle cerebral artery: 154 cm/sec.Right internal carotid artery: 114 cm/sec.Left middle cerebral artery: 123 cm/sec.Left internal carotid artery: 116 cm/sec. | Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). |
Generate impression based on findings. | 46 year-old female with left lower quadrant abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix appears unremarkable. Colonic diverticulosis. There is wall thickening of the sigmoid colon (coronal series, image 35) with surrounding inflammatory stranding compatible with acute diverticulitis. Small foci of gas adjacent to the sigmoid colon probably represent microperforations. No drainable abscesses are present. No intraperitoneal free air is present elsewhere in the abdomen and pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is atrophic or surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix appears unremarkable. Colonic diverticulosis. There is wall thickening of the sigmoid colon (coronal series, image 35) with surrounding inflammatory stranding compatible with acute diverticulitis. Small foci of gas adjacent to the sigmoid colon probably represent microperforations. No drainable abscesses are present. No intraperitoneal free air is present elsewhere in the abdomen and pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Acute sigmoid diverticulitis with probable microperforations but without drainable abscess. |
Generate impression based on findings. | 47-year-old male with history of LVAD with pain at drive line site. ABDOMEN:LUNG BASES: Trace left pleural effusion and left basilar atelectasis, decreased from prior. Cardiomegaly. Partially visualized LVAD device which causes metallic streak artifact obscuring adjacent structures. A small amount of fluid is present in the right cardiophrenic area, unchanged. The visualized portion of the LVAD drive line is continuous. There is a subcentimeter focus of soft tissue attenuation along the medial aspect of the drive line as it exits the left anterior abdominal wall which is nonspecific.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Several small hypoattenuating foci in the spleen are nonspecific and are not significantly changed.PANCREAS: Atrophic pancreas with diffuse calcifications consistent with chronic pancreatitis.ADRENAL 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: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.Cardiomegaly and LVAD. Subcentimeter focus of soft tissue attenuation at the medial aspect of the drive line as it exits the anterior abdominal wall is nonspecific but could represent a small focus of infection. No drainable fluid collections. 2.Findings compatible with chronic pancreatitis.3.Trace left pleural effusion and basilar atelectasis, improving from prior. |
Generate impression based on findings. | 5-month-old male, left humerus fractureVIEWS: Left humerus, AP and lateral (two views) 2/26/15 15:03 Bridging callus formation about the proximal humerus fracture with progression of remodeling consistent with continued healing. | Healing proximal humeral fracture in near anatomic alignment. |
Generate impression based on findings. | Male 67 years old Reason: bladder cancer History: bladder cancer Exam is not sensitive for detecting lesions in the solid organs of vasculature due to lack of intravenous contrast. Given nodes limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Calcific granuloma right upper lobe. No other lung nodules. No effusions.MEDIASTINUM AND HILA: Central line tip in region of SVC RA Junction. Heavy atherosclerotic calcifications coronary arteries.CHEST WALL: Port right chest wall. Minimal gynecomastiaABDOMEN: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: Moderate atherosclerotic calcifications. No evidence of aneurysm. No pathologic size nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy. Previously seen air fluid collection in the left pelvic side wall is no longer present.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Expected bowel anastomoses. Some distortion consistent with effusions no evidence of obstruction. No bowel wall thickening or dilatation.New fluid density collection seen in the right proximal external iliac distribution series image 66 measuring 2.5 x 2.3 cm. with fat stranding extending from somewhat medially. This could represent a lymphocele, seroma or hematoma. Infected fluid collection cannot be excluded.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New small fluid collection in the right hemipelvis dorsal to the common iliac vein. Differential diagnosis as above. Correlate clinically to rule infection. Discussed with Dr. Patricia Yates. |
Generate impression based on findings. | 69 years, Male, Reason: acute pain, passage of clots, possible stone passed; history of prostate cancer History: as above. Exam is not sensitive for detecting lesions in the solid organs of vasculature to the lack of intravenous contrast. Given that limitation, the following observations are made:ABDOMEN:LUNG BASES: At least mild atherosclerotic calcification in the coronary arteries the visualized.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic left lower pole cyst. No evidence of nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branches. No evidence of aneurysm. Small shotty retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No sclerotic or lytic lesion seen.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality noted. No calcifications seen.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Scattered diverticulosis. No free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate atherosclerotic calcifications common evidence of aneurysm. | No evidence of metastatic disease. Atherosclerotic disease. No evidence of nephrolithiasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Hyperparathyroidism. A subtle focus of mild activity posterior to the right upper pole of the thyroid is noted which faintly persists on delayed imaging. There is even more faintly increased activity corresponding to posterior bilateral lower poles which faintly persists on the left on delayed imaging. The right lower lobe activity does not persist on delayed imaging. This correlates with ultrasound. | Three subtle foci of abnormal activity posterior to the right upper and bilateral lower poles are suspicious for abnormally functioning parathyroid tissue either representing hyperplasia or multiple adenomas. Given the only faint activity, hyperplasia is considered more likely. Of the three, the right upper is the most intense, although still fairly subtle. |
Generate impression based on findings. | Assess mandibular anatomy and airway. Pierre Robin sequence with airway compromise. There is severe micrognathia with 16 mm of overjet and glossoptosis that results in oropharyngeal airway stenosis, which measures a minimal of 8 mm in the anteroposterior dimension. There is also a cleft palate. The temporomandibular joints are intact. The paranasal sinuses are unremarkable for age. The middle ear and mastoid air cells are clear. The orbits and imaged intracranial structures are unremarkable. | Stigmata of Pierre Robin sequence with severe micrognathia with 16 mm of overjet and glossoptosis that results in mild oropharyngeal airway stenosis. |
Generate impression based on findings. | Prostate cancer status post total radical proctectomy one year ago with positive lymph nodes. Now with elevated PSA.RADIOPHARMACEUTICAL: 11.9 mCi F-18 sodium fluoride (NaF). Today's CT portion grossly demonstrates sinusitis involving sphenoid, bilateral maxillary, and ethmoid air cells. Right chest Port-A-Cath with tip in the SVC.Today's PET examination demonstrates numerous small foci of moderately increased activity corresponding to degenerative changes on CT including the right acromioclavicular joint, the cervical spine, bilateral knees, feet, and ankles. Benign activity correlates with enthesopathic changes posterior to both ischial tuberosities, left greater than right.Three very faint foci of adjacent activity is seen involving the left sixth and seventh lateral ribs. This is most likely benign, possibly related to old trauma. No convincing suspicious osteoblastic lesion is identified to indicate osseous metastases. | No convincing evidence of osseous metastases. Three faint left rib foci considered most likely benign. |
Generate impression based on findings. | Male 27 years old; Reason: Left Testicular Nodule, Distal Aspect, 0.25cm, Firm, Nodular, Fixed, Tender. RIGHT TESTIS: Measures 4.2 x 3.0 x 2.1 cm with normal echotexture. There is a single punctate calcification. No worrisome mass is identified. Color Doppler flow is symmetric.LEFT TESTIS: Measures 4.0 x 2.8 x 2.3 cm with normal echotexture. No worrisome masses identified. Color Doppler flow is symmetric.RIGHT EPIDIDYMIS: Measures 0.7 x 0.1 x 0.6 cm and contains a 0.4 x 0.5 x 0.4 cm anechoic structure.LEFT EPIDIDYMIS: Measures 0.9 x 1.2 x 0.8 cm and contains a 0.2 x 0.2 x 0.1 cm anechoic structure in the tail deep to the area of the patient's palpated abnormality.OTHER: Small bilateral hydrocele and varicocele. | 1.No suspicious testicular lesion is identified.2.Bilateral simple epididymal cysts. A 2 mm epididymal cyst is seen deep to the area of the patient's palpated abnormality.3.Small bilateral hydrocele and varicocele. |
Generate impression based on findings. | 83 years, Male. Reason: dht placement History: dht Dobbhoff tube is coiled in the fundus with tip projecting over the expected area of the pylorus. Numerous external staples are scattered over the thorax, abdomen and pelvis. Air filled redundant colon with small to moderate stool burden. Nonobstructive bowel gas pattern. | Dobbhoff tube tip projects over the expected area of the pylorus. |
Generate impression based on findings. | 65-year-old female with history of bladder cancer status post cystectomy and nephrectomy, evaluate for metastatic disease. Within the limits of a non-IV contrast enhanced examination, which limits ability to evaluate solid parenchymal organs and vascular, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted, lack of IV contrast limits sensitivity for lesion detection. Gallstones are again seen without other biliary tract complication.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right prior adrenalectomy. Left adrenal gland appears normal.KIDNEYS, URETERS: Left-sided percutaneous nephrostomy pigtail catheter in residual contrast within the collecting system and foci of air is present from catheter exchange earlier today. Nephroureteral stent is seen extending into the urinary diversion in right pelvis.Right nephrectomy andRETROPERITONEUM, LYMPH NODES: Dependent lymph nodes have continued to increase in size. For example left para-aortic lymph node (series 3 Image 58) measures 1.1 x 1 .0 cm, previously 0.8 x 0.7 cm. A larger lymph node more cephalad is seen measuring 1.2 x 1.6 cm (series 3, image 47) which measured 1.1 x 0.8 cm previously. BOWEL, MESENTERY: Omental nodularity is unchanged when compared with prior examination (series 3, image 67) and remains of uncertain significance.BONES, SOFT TISSUES: Sclerotic focus in of the L2 vertebral body is unchanged no new foci of sclerosis are seen elsewhere the benign appearing lytic lesion in left iliac bone is unchanged.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Prior hysterectomy.BLADDER: Cystectomy with Indiana pouch urinary diversion.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic focus in of the L2 vertebral body is unchanged no new foci of sclerosis are seen elsewhere the benign appearing lytic lesion in left iliac bone is unchanged.OTHER: No significant abnormality noted | 1. Status post cystectomy with urinary diversion . Numeral head increasing size of several retroperitoneal lymph nodes worrisome for metastatic disease -- reference measurements are provided above. 3. No other changes since prior CT examination. |
Generate impression based on findings. | Male 64 years old; Reason: abscess, assess PFCs after 2nd necrosectomy History: sepsis The exam is not sensitive detecting lesions in the solid organs of vasculature to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNGS BASES: Persistent large left pleural effusion with associated atelectasis or consolidation. Small areas of atelectasis consolidation right lower lobe as well.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Percutaneous pigtail drainage catheter and a least 3 gastric pancreatic cyst stents are identified. The extensive air fluid collection in the lesser sac and pancreatic bed measures approximately 11.7 x 4.6 cm on series 2 image 66. Previously 14.3 x 5.2 cm. Fluid tracks throughout the retroperitoneum and intraperitoneal cavity. No new loculated fluid collections.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification there is no evidence of aneurysm. Caval filter in place. Somewhat slitlike cava. Currently to fluid status.BOWEL, MESENTERY: Naso jejunal tube in place. Large to moderate volume generalized ascites. Extensive fat stranding secondary to the pancreatitis. Small loculated collections in the recent mesenteric probably present. Generalized ileus without evidence of obstruction. 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: Large volume generalized ascites. Rectal catheter.BONES, SOFT TISSUES: Marked generalized anasarca.OTHER: Mild atherosclerotic calcifications. | 1. Decrease in size of air-fluid collection in the pancreatic bed and lesser sac. Persistent large volume ascites. Persistent bilateral pleural effusions and atelectasis consolidation, large on the left. Other findings as above. |
Generate impression based on findings. | For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. There is levocurvature of the lumbar spine with apex at the L2-L3 level. Alignment is otherwise maintained. Particularly, alignment at the L5-S1 level is normal.Postsurgical changes of posterior interbody fusion are seen at L5-S1. Interbody bone graft and fusion device, posterior paraspinous rods, and bilateral pedicle screws at L5 and S1 are intact and well-positioned without evidence of complication. Facetectomy at the left L5-S1 level is also noted.There are small multilevel disk bulges without significant spinal canal or neural foramina stenosis at any level. There is posterior paraspinous fluid collection with foci of air consistent with post surgical change. Small amount of fluid within the pelvis is also noted. | Postsurgical changes of posterior interbody fusion at L5-S1 and left L5-S1 facetectomy as detailed above. Hardware is intact and well positioned without evidence of complication. |
Generate impression based on findings. | 10-year-old female status post surgical repair of large ASD.VIEW: Chest AP (one view) 2/26/2015 15:27 Sternotomy wires intact. Right internal jugular central venous catheter tip in the right atrium. Cardiothymic silhouette is normal. Pulmonary vascularity is still slightly increased however improved from prior study. No focal pulmonary opacity. Small right apical pneumothorax, no left pneumothorax. No pleural effusion. | Small right apical pneumothorax. Interval improvement in bilateral pulmonary vascular engorgement. |
Generate impression based on findings. | Reason: mets lung cancer. has been on Nivolumab, pls c/w previous study and evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Scar like nodular opacity with internal calcifications at the right apex, unchanged.Additional micronodules and emphysema also unchanged.MEDIASTINUM AND HILA: Reference right hilar lymph node stable at 12 mm, unchanged.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: Subtle right T5 transverse process presumed metastatic lesion stable in size and appearance (series 4/32). ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic hypodensities are too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodule measuring approximately 10 x 13 mm, not significantly changed using comparable measurement parameters.KIDNEYS, URETERS: Small bilateral cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Punctate indeterminate sclerotic foci in the L1 vertebra, unchanged.OTHER: No significant abnormality noted. | Stable disease. |
Generate impression based on findings. | Refractory epilepsy.RADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG)BLOOD GLUCOSE (FASTING): 79 mg/dL Today's CT portion demonstrates no gross intracranial pathology.Today's PET examination demonstrates no significant cerebral hypometabolism to indicate an interictal focus.Slight hypometabolism is seen throughout the right cerebellar hemisphere. | Slight hypometabolism throughout the right cerebellar hemisphere raises the question of a left cerebral seizure focus although no cerebral hypometabolic focus is visualized on this exam. |
Generate impression based on findings. | 44-year-old female with abdominal pain, fevers chills.? Cholecystitis. LIVER: No significant abnormalities noted. Normal portal venous flow.GALLBLADDER, BILIARY TRACT: Multiple gallstones with shadowing is seen. Gallbladder is normal in caliber without wall thickening. No pericholecystic fluid. Patient did not exhibit point tenderness with palpation by transducer probe as reported by technologist. Hepatic bile duct diameter measures approximately 7 mm, upper limits of normal. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted. | 1. Cholelithiasis without other evidence biliary complication. |
Generate impression based on findings. | Female 55 years old Reason: probable soft tissue, meniscal injury, eval fx History: effusion, limited ROM, pain medial joint line . We have 4 views of the left knee. A small joint effusion is seen. There is marked osteoarthritis of the left knee with joint space narrowing of the medial compartment and tricompartmental osteophytes. Moderate osteoarthritic changes affect the right knee as seen on the frontal views. | Severe osteoarthritis of the right knee as described above. |
Generate impression based on findings. | Reason: evidence of mets History: pt with recent dx of invasive gallbladder adeno; already had CT ab/pelv LUNGS AND PLEURA: Scattered benign-appearing micronodules. No suspicious pulmonary nodules or masses.Minimal basilar subsegmental atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Interval placement of a biliary stent. Heterogeneous liver parenchyma is partially visualized and appears similar to the prior CT exam.Nonspecific low attenuation cyst lesion measures 1.6 x 1.4 cm (series 3, image 85), unchanged from the prior CT exam dated 2/22/2015. Partially visualized right hydronephrosis appears similar to the prior CT exam.See recent prior CT abdomen pelvis imaging for additional findings. | No evidence of thoracic metastases. |
Generate impression based on findings. | Male 33 years old Reason: pt in MVA yesterday around 1800 History: tender in midline L-spine. We have 6 views of the lumbar spine. The lumbar vertebral body heights and intervertebral disk spaces are preserved. There is no acute fracture or subluxation.We have 3 views of the thoracic spine. The thoracic vertebral body heights and intervertebral disk spaces are preserved. There is no acute fracture subluxation.We have a single AP view of the pelvis. There is no acute fracture or dislocation. | No acute fracture or dislocation of the lumbar spine, thoracic spine, or pelvis as described above. |
Generate impression based on findings. | Facial swelling, poor dentition, new periorbital involvement. There are multiple dental caries. There is a crescentic peripherally-enhancing fluid collection that measures up to approximately 8 x 20 mm overlying the left maxillary alveolus, which appears focally dehiscent. There is extensive stranding and swelling of the overlying facial soft tissues, including the left preseptal region. However, there is no evidence of postseptal involvement. Indeed, the bilateral orbital contents are unremarkable and the orbital walls are intact. There is opacification of the bilateral ethmoid air cells and left maxillary sinus with suggestion of fluid components. There is left suprahyoid reactive lymphadenopathy. The middle ears and mastoid air cells are clear. The imaged intracranial structures appear to be unremarkable. | Dental caries with associated left maxillary alveolar region abscess that measures up to 20 mm with associated facial cellulitis and acute sinusitis, but no evidence of post-septal extension. |
Generate impression based on findings. | Status post patella fracture TECHNIQUE 4: Views including weight-bearing Four views the right knee reveal a horizontal fracture of the patella in anatomic alignment. Fracture line is last distinct than on the previous exam of February 5. | Healing nondisplaced fracture of the patella |
Generate impression based on findings. | Reason: r/o fluid collection around LVAD History: left upperquadrant abd pain CHEST:LUNGS AND PLEURA: Bilateral paramediastinal radiation reaction, consistent with a remote history of Hodgkin's disease.Mild pleural thickening at the left base but no pleural effusion.Elevation of the left hemidiaphragm.MEDIASTINUM AND HILA: Heartmate 2 type LVAD in place type causing severe streak artifact in the upper abdomen. Device is located in the anterior left upper quadrant of the abdomen and no abnormal fluid collection is visible. Patency of the cannulae cannot be evaluated in the absence of intravenous contrast material. A small amount of radiopaque material of uncertain significance is present within the lumen of the efferent cannula adjacent to the ascending aortic anastomosis. This could represent partially calcified chronic adherent thrombus or surgical material.ICD lead extending to the apex of the right ventricle.Aortic and mitral valve prostheses in place.CHEST WALL: Pacemaker generator in the left anterior chest wall.Status post median sternotomy with slight separation of the manubrial fragments, though the fixation wires are intact.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Detail is also limited by marked motion and streak artifact.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical scarring and nonobstructive calculi in in the left kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Suboptimal examination due to streak artifact and respiratory motion with no visible evidence of a fluid collection around the LVAD. |
Generate impression based on findings. | Hand pain Three views of the right hand reveal vascular calcifications. Patient is unable to hold flattened the hand and in the fingers are held in flexion .no acute abnormalities. No fractures or dislocations. | The fingers are held in flexion. No fractures or dislocations |
Generate impression based on findings. | Male 53 years old Reason: mortise and lateral only please. s/p right ankle fracture and splinting History: above. Overlying splint material obscures fine bone detail. Interval splinting of right distal fibular fracture with the distal fracture fragment in anatomic alignment. | Interval splinting of distal fibular fracture as described above. |
Generate impression based on findings. | Evaluate pes planus No significant pes planus deformity is noted. Mild osteoarthritis affects the foot. | No significant pes planus deformity. |
Generate impression based on findings. | Female 49 years old Reason: dislocation of shoulder vs fracture after fall History: shoulder pain and asymmetry We have views of the right shoulder. The alignment of the glenohumeral and acromioclavicular joints is within normal limits. There is no acute fracture or dislocation. Minimal osteoarthritic changes affect the right shoulder.We have two views of the right humerus. There is no underlying fracture or dislocation. | Mild osteoarthritis of the right shoulder without evidence of fracture or dislocation of the right shoulder or humerus. |
Generate impression based on findings. | Severe pain after fall PELVIS: Multiple surgical clips are noted throughout the pelvis, similar to prior. Mild arthritis affects the hip joints bilaterally. Sclerotic deformity of the left iliac wing likely represents a prior bone graft donor site or may be posttraumatic, though unchanged since 2005. No fracture or malalignment is seen.LEFT FEMUR: No fracture is present.LEFT KNEE: Moderate osteoarthritis affects the left knee. A joint effusion is noted. No fracture or dislocation is seen. The right total knee arthroplasty device appears in near anatomic alignment, as seen on the single frontal view. | No fracture evident. Osteoarthritis and other findings as described above. |
Generate impression based on findings. | Wrist pain Four views of the right wrist are unremarkable. No fractures or malalignments. The radial and ulnar deviation views are unremarkable | Negative right wrist exam |
Generate impression based on findings. | Papillary thyroid carcinoma with bone metastases. Neck: There are postoperative findings related to total thyroidectomy. There is no evidence of measurable locoregional mass lesions or significant cervical lymphadenopathy. The salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis. The airways are patent. There are several subcentimeter nodules in the partially imaged lungs.Head: There is no evidence of intracranial mass or abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged 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. | 1. No evidence of recurrent tumor or significant lymphadenopathy.2. No evidence of intracranial metastases.3. Several subcentimeter nodules in the partially imaged lungs. Please refer to the separate chest CT report for additional details. |
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