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Generate impression based on findings. | Reason: eval atypical mycobacterial PNA, uncontrolled AIDS History: none LUNGS AND PLEURA: The left apical subpleural nodular opacity is decreased in size, measuring 16 x 11 mm (series 4, image 15), previously 20 x 13 mm. A right lower lobe nodular opacity (series 4, image 59) and a right upper lobe nodular opacity (series 4, image 47) are also mildly decreased from the prior exam.A right lower lobe nodule along the major fissure is new from the prior exam.Persistent bronchial wall thickening.Scattered central predominant reticulonodular and ground glass opacities throughout the right lung are new/increased from the prior exam.Mild prominence of septal lines. Small bilateral pleural effusions, increased from the prior.Scattered small cysts throughout the lungs are unchanged.MEDIASTINUM AND HILA: Cardiomegaly. No pericardial effusion. No visible coronary artery calcification. Hypoattenuation of the blood pool, suggestive of anemia. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension.Scattered mildly enlarged mediastinal and hilar lymph nodes, some calcified, are unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. A small amount of perihepatic ascites is new from the prior exam. | 1. Scattered nodular opacities, most of which are decreased in size. At least one new right lower lobe nodular opacity and increasing scattered right lung groundglass. Findings suggest resolution in some areas and new infection in others. 2. Increasing areas of groundglass, with septal lines and increasing effusions suggest at least a component of edema. In an AIDS patient, the differential includes pneumocystis infection, however the above findings suggest that edema is more likely. |
Generate impression based on findings. | Female 49 years old Reason: r/o fracture, broken hardware History: pain. Three views of the left ankle show a sideplate and screws device affixing a distal fibular fracture in anatomic alignment. The previously seen fracture line now appears nearly indistinct with residual minimal deformity seen on lateral views. Two orthopedic pins affix a previously seen medial malleolus fracture in anatomic alignment. The fracture lines are indistinct consistent with healing. There is no radiographic evidence of hardware complication. | Orthopedic fixation of healing/healed distal fibular and medial malleolar fractures in anatomic alignment without radiographic evidence of hardware complication. |
Generate impression based on findings. | Osteoarthritis versus avascular necrosis. Joint pain. History of IV drug use and hepatitis C. LEFT HIP: Limited two view examination of the left hip demonstrates mild osteoarthritis. No subchondral fracture, articular surface collapse, or specific features of osteonecrosis are evident. LEFT HAND: Scattered osteoarthritic changes are noted, most prominent in the ring finger interphalangeal joints. No specific features of osteonecrosis are evident.LEFT FOOT: No specific features of osteonecrosis are seen.RIGHT FOOT: No specific features of osteonecrosis are seen. | Osteoarthritic changes, without specific features of osteonecrosis. |
Generate impression based on findings. | T3N0 laryngeal carcinoma, s/p CRT. Neck: There are post-treatment findings with mild diffuse edema in the pharyngeal mucosal space. There is no measurable residual supraglottic mass. There is upper mediastinal lymphadenopathy, including a right paratracheal lymph node that measures 16 mm in short axis. There is a tracheostomy tube in position. The airway inferior to the tracheostomy is patent. The salivary glands appear unchanged. The remaining portions of the thyroid gland are unremarkable. There is a right internal jugular venous catheter. There is significant plaque at the proximal subclavian arteries bilaterally. The osseous structures are unchanged. There is a left posterior lower neck lipoma that measures up to 35 mm. There is extensive pulmonary emphysema and persistent consolidation with air-bronchograms in the right lung.Head: There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. There is diffuse cerebral volume loss. 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 measurable residual treated supraglottic tumor.2. Partially-imaged upper mediastinal lymphadenopathy. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.3. Extensive pulmonary emphysema and persistent right consolidation with air-bronchograms that may represent pneumonia. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Seizure-like episode with desaturation to 20-30s requiring bagging, posturing, eye movement, bradycardia. There is hyperattenuating material along the posterior falx cerebri and cerebelli that measures up to 8 mm in width. There may also be trace subarachnoid hyperattenuation in the right parieto-occipital region versus artifact. There is slight diastasis of an accessory intraoccipital suture near the midline. There is no midline shift or herniation. The brain parenchyma is grossly unremarkable. The ventricles are normal in size and configuration. There are mildly prominent extra-axial CSF spaces anterior to the bilateral temporal lobes, which may represent a developmental variant. The imaged paranasal sinuses and mastoid air cells are clear. There is a partially-imaged enteric tube. | Slight diastasis of an accessory intraoccipital suture with acute subdural hemorrhage the posterior falx cerebri and cerebelli that measures up to 8 mm in width, but no midline shift or herniation. Possible trace subarachnoid hemorrhage in the right parieto-occipital region versus artifact. Discussed with Dr. Weiss at 4:15 PM on 2/26/15. |
Generate impression based on findings. | Breast cancer. Innumerable osteoblastic lesions are noted throughout the spine, pelvis, bilateral femurs, bilateral humeri, skull, sternum and bilateral ribs, which are indicative of widespread osseous metastases. There is an enlarged lesion of the left hip which could conceivably be orthopedic significance and could be further evaluated with a plain radiograph. Increased soft tissue activity in the right breast is consistent with known breast cancer/therapy. | 1.Numerous widespread osseous metastases. 2.Particular note is made of a large lesion in left hip, which could conceivably be of future orthopedic significance and could be further evaluated with a plain radiograph. |
Generate impression based on findings. | 13-year-old male status post tibia and fibula osteotomyVIEWS: Right tibia and fibula, AP and lateral (two views) 2/26/15 15:44 External fixation device affixes the tibia osteotomy without evidence of hardware publication. An osteotomy of the mid-diaphysis of the fibula is also noted. Skin staples and drain reflect recent surgery. | External fixation of tibial osteotomy without evidence of hardware complication. |
Generate impression based on findings. | Status post total hip arthroplasty AP pelvis reveals a total arthroplasty in anatomic alignment. There is no evidence of significant fracture or dislocation.Additional portable view of the right hip again reveals a total hip arthroplasty in anatomic alignment. | THA in anatomic alignment |
Generate impression based on findings. | Female 75 years old Reason: pt slipped on ice this am, has been able to walk with assistance History: left knee pain--mostly on medial aspect. There is soft tissue swelling about the medial aspect of the knee. There is severe osteoarthritis of the right knee joint with marked joint space narrowing and tricompartmental osteophytes. There appears to be an age indeterminate discontinuity medially of an orthopedic pin affixing the proximal tibia. | Severe osteoarthritis with age indeterminate discontinuity of an orthopedic tibial pin. |
Generate impression based on findings. | Female 36 years old Reason: r/o acute process History: bite to hand. Three views of the left hand demonstrate no acute fracture, dislocation, or bone abnormalities. | Normal appearing left hand without radiographic evidence of fracture or underlying bone abnormality. |
Generate impression based on findings. | There is linear T1 hypointense signal involving the S2 segment, compatible with a sacral insufficiency fracture. There are new areas of low T1 signal in the sacrum with enhancement, suspicious for infiltrative tumor. There are areas of non enhancement predominantly in the left hemisacrum. There is mild presacral soft tissue edema and enhancement seen on the sagittal images. There is a background of intrinsic T1 hyperintensity of the lower lumbar spine and sacrum, consistent with radiation effects. There is fatty atrophy of the left gluteal muscles. Incidentally noted is a right renal cyst.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The lumbar vertebral body and disc heights are grossly maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level. T12-L1: No significant disc bulge, spinal canal or foraminal stenosis. L1-L2: No significant disc bulge, spinal canal or foraminal stenosis. L2-L3: No significant disc bulge, spinal canal or foraminal stenosis. L3-L4: Mild disc bulge. No significant spinal canal stenosis or left foraminal stenosis. Minimal right foraminal stenosis. L4-L5: Mild disc bulge. No significant spinal canal stenosis. Mild right and minimal left foraminal stenosis. L5-S1: Mild disc bulge. No significant spinal canal stenosis or foraminal stenosis. | 1. Sacral insufficiency fracture at the S2 vertebral level.2. Confluent areas of low T1 signal and enhancement involving the sacrum bilaterally are suspicious for infiltrative tumor. Relative lack of soft tissue component and relatively mild uptake on prior PET from 10/2014 raise possibility of osteoradionecrosis. May consider tissue sampling as clinically appropriate. Please refer to the separate pelvic MRI report for additional details.3. No significant spinal canal stenosis. |
Generate impression based on findings. | History of any left renal mass and IVC thrombus now with chest wall pain. No abnormal osseous foci are identified to indicate metastatic disease. | No evidence of bone metastases. |
Generate impression based on findings. | Time average mean velocities: Right middle cerebral artery: 104 cm/sec.Right internal carotid artery: 86 cm/sec.Left middle cerebral artery: 111 cm/sec.Left internal carotid artery: 77 cm/sec. | Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). |
Generate impression based on findings. | Male 26 years old Reason: table saw injury to r leg, eval bony healing, 3 months ago History: same. A predominately nondisplaced fracture of the mid tibial diaphysis is seen near anatomic alignment. There is bony bridging of the fracture lines suggesting partial healing. | Partial healing of nondisplaced tibial fracture as described above. |
Generate impression based on findings. | Reason: hx of head and neck cancer, now with new esoph lesion on PET, restaging History: dysphagia CHEST:LUNGS AND PLEURA: Severe centrilobular and paraseptal emphysema.Right apical consolidation and fibrosis are increased from the prior exam.Scattered subsegmental scarring/atelectasis. Debris noted within the right lower lobe bronchi.No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Tracheostomy tube in place.The heart is normal in size without pericardial effusion. Severe coronary artery calcification.An enlarged right upper paratracheal lymph node measures 14 mm (series 3, image 25), previously 13 mm.A precarinal lymph node measures 11 mm (series 3, image 45), unchanged.No esophageal mass lesion is identified.CHEST WALL: Right chest port, tip at the cavoatrial junction.Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: Scattered subcentimeter hypodensities are unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal hypodensity, likely a benign cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A reference right retrocrural lymph node measures 10 mm (series 3, image 93), unchanged.Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube in place.BONES, SOFT TISSUES: Mild degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | 1. Mediastinal lymphadenopathy is not significantly changed from the prior exam.2. Right apical fibrosis with increasing consolidation, suggestive of superimposed infection. |
Generate impression based on findings. | Patient with a 1 cm LOQ breast cancer. Surgery is 2-27 at 7:30 am.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.0 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. Several foci of increased activity are noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel nodes identified in the right axilla. |
Generate impression based on findings. | 24 year old male with a history of pacemaker removed in 2014 and retained lead fragment in the right ventricle and subsequent development of thrombosis on the lead. Preop robotic tricuspid valve repair, thrombus removal, removal of pacemaker lead fragment CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left Sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is a deep myocardial bridge which initiates at the mid left anterior descending artery. The distal LAD remains intramyocardial and is poorly visualized. Several diagonal branches are present; the second is dominant. No significant stenoses are visualized.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right Sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 126ml).Right Ventricle: Visually, the right ventricular late diastolic volume is moderate to severely increased. There is a retained metallic electrode that extends from the level of the tricuspid valve to the apical 1/3 of the interventricular septum.Interventricular Septum: There is a small, mid-ventricular muscular channel which may represent an incomplete or very small muscular septal defect. It measures 2-3 mm in diameter.In addition, at the inferior proximal 1/3 of the interventricular septum, there is a small contrast collection (4/440) which appears to communicate with the left ventricular blood pool. This raises the question of a small diverticulum.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is moderately enlarged. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not included. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Extracardiac findings: Mild scoliosis of the thoracic spine. Normal appearing thymic tissue. Incidental note is made of a replaced left hepatic artery and two right renal arteries. | 1. There is a deep myocardial bridge initiating at the mid left anterior descending artery. Beyond this, the apical LAD remains intramyocardial and is poorly visualized. A dominant second diagonal is present and is visualized to the apex. There are no significant coronary stenoses.2. A 2-3mm, mid ventricular, muscular septal channel which may be an incomplete or very small interventricular septal defect. 3. Normal left ventricular late diastolic volume.4. Moderate to severely enlarged right ventricular late diastolic volume by visual estimation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 86 years old Reason: recurrent stage IIIB fallopian tube cancer, now with weight loss, increase fatigue and rising CA 125 History: weight loss, fatigue CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Reference right epicardial lymph node is stable size measuring 3.0 x 1.4 cm (series 4, image 58), previously 3.0 x 1.5 cm. Surrounding small right epicardial lymph nodes appear similar. Interval increase in the two cardiophrenic lymph nodes. Right lymph node measures 2.4 x 0.6 cm (series 4, image 61), previously 1.9 x 0.9 cm. Left lymph node measures 2.5 x 1.4 cm (series 4, image 66), previously 1.4 x 1.0 cm. Prevascular and pretracheal lymphadenopathy is noted.Mild coronary artery calcification. Cardiac size is unremarkable. No evidence of pericardial effusion.CHEST WALL: Right chest wall port tip in SVC. ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated of the nodular implant at hepatic dome, which is stable in size measuring 3.4 x 1.4 cm (series 4, image 75), previously measured 3.3 x 1.7 cm.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: Again seen is a conglomeration of lymph nodes along the gastrohepatic ligament (series 4, image 79) which appear to have increased in size. There is slight increase in size of the paraaortic and retroperitoneal lymph nodes. For reference, lymph node adjacent to left renal vein measures 1.8 x 1.6 cm (series 4, image 91), previously 1.7 x 1.3 cm.Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Gastric serosal mass again measures approximately 3.9 x 2.8 cm (series 4, image 80), previously 3.9 x 2.9 cm. No evidence of bowel obstruction. No evidence of intraperitoneal free air. Interval improvement of the mesenteric disease adjacent of the splenic flexure, now with small loculated fluid collection. Significant interval increase in the mesenteric disease adjacent to the splenic flexure now measuring 5.2 x 4.3 cm (series 4, image 95), previously 4.0 x 2.8 cm.Redemonstration of multiple mesenteric nodules with slight increase in size. For reference, mesenteric nodule at right lower quadrant now measures 2.4 x 2.2 cm (series 4, image 123), previously 2.2 x 1.9 cm. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple lymph node chain adenopathy with slight increase in size including the inguinal, external iliac, and common iliac chains. For reference, left inguinal lymph node now measures 1.5 x 1.3 cm (series 4, image 151), previously measured 1.5 x 1.3 cm. Left obturator lymph node now measures 2.6 x 1.4 cm (series 4, image 153), previously 2.5 x 1.1 cm. BOWEL, MESENTERY: Multiple mesenteric nodules as above.BONES, SOFT TISSUES: Multilevel degenerative disease of the thoracolumbar spine.OTHER: No significant abnormality noted. | Significant interval increase in mesenteric disease and slight interval increase in lymphadenopathy in multiple lymph node chains consistent with progression of disease. |
Generate impression based on findings. | Female 62 years old Reason: 62 yo female with history of severe necrotizing pancreatitis, c/b severe walled off necrosis with severe abdominal pain, sp ERCP with necrosectomy x 2, most recently 2/26, with residual necrotic debris in the cavity. IR was initially consulted for percutaneous drain, however this procedure was canceled. ABDOMEN: Limited exam secondary to lack of oral and intravenous contrast. Evaluation of vascular and solid organ pathology is suboptimal due to lack of intravenous contrast. Evaluation of bowel pathology is suboptimal without oral contrast. The lung bases and dome of the liver are excluded from the field of view.LIVER, BILIARY TRACT: Status post cholecystectomy. Small scattered abdominal free fluid is present. Hepatic vasculature is not well evaluated.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes from prior pancreatic necrosectomy. Peripancreatic multiloculated fluid collection with foci of gas is present (series 2, image 32) which measures 6.3 x 2.7 cm in the axial plane, previously measuring 13.0 x 6.2 cm. An additional fluid collection at the splenic hilum also appears to have decreased in size. Multiple pigtail drainage catheters extend from the stomach into the fluid collection. An additional drainage catheter extends from the fluid collection to the duodenum along the course of the pancreatic duct. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical changes to the stomach of prior pancreatic necrosectomy as described above. BONES, SOFT TISSUES: Degenerative changes of visualized spine.OTHER: No significant abnormality noted | Limited exam secondary lack of intravenous and oral contrast with a limited field of view. Within these limitations, there has been marked decrease of the multiloculated peripancreatic fluid collection. |
Generate impression based on findings. | Status post fracture Four views of the left shoulder reveal a comminuted slightly impacted surgical neck fracture. There is slight pseudosubluxation of the humeral head. | Comminuted fracture of the surgical neck of the humerus |
Generate impression based on findings. | Pain status post motor vehicle accident RIGHT SHOULDER: Mild osteoarthritis affects the acromioclavicular joint. No fracture or malalignment is present.LEFT SHOULDER: Mild osteoarthritis affects the acromioclavicular joint. No fracture or malalignment is present. | Mild AC joint osteoarthritis, without fracture or malalignment. |
Generate impression based on findings. | Status post right total hip arthroplasty One view of the pelvis and one view of the right hip demonstrates a right total hip arthroplasty device situated in anatomic alignment, without radiographic evidence of hardware complication.Mild osteoarthritis affects the left hip, as seen on the single frontal view. | Postoperative changes of a right total hip arthroplasty. |
Generate impression based on findings. | Patient with multiple myeloma. Sternal pain. Concern for sternal fracture. A portion of the cortex of the distal sternum, approximately 5 cm from its caudal tip, appears discontinuous, which may represent a fracture given the clinical history. No discrete myelomatous lesions are seen, however, a pathological fracture cannot be excluded. | Possible fracture of the distal sternum. Pathological fracture cannot be excluded. If further evaluation is clinically warranted, CT is recommended.Findings discussed with APN Dimeglio at 4:00pm on 2/26/15 |
Generate impression based on findings. | Swelling and pain An oblique fracture traverses the distal fibula, without displacement or angulation of the distal fracture fragment. The tibiotalar articulation is anatomic. Extensive soft tissue swelling is noted over the lateral malleolus.Orthopedic screws are noted in the first metatarsal, likely from a prior hallux valgus correction. | Distal fibular fracture. |
Generate impression based on findings. | on heparin infusion, cerebrovascular accident Re demonstration of multifocal low attenuations on bilateral hemispheres.No evidence of significant interval changes.No evidence of hemorrhage.Again additional imaging investigations such as brain MRI with and without contrast enhancement are recommended.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, midline shift. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | Multifocal bihemispheric low attenuation lesions as described above.No change since prior exam.Brain MRI with and without contrast is recommended for further evaluation. |
Generate impression based on findings. | HTN and Alzheimer's dementia now with left-sided weakness. There is no evidence of acute intracranial hemorrhage or mass. There is mild patchy cerebral white matter hypoattenuation. There is diffuse mild prominence of the ventricles and sulci, but more pronounced in the medial temporal lobes. 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. There are bilateral lens implants. | 1. Mild patchy cerebral white matter hypoattenuation likely represent small vessel ischemic disease of indeterminate age, but no evidence of acute intracranial hemorrhage or mass, or cerebral edema. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.2. Cerebral volume loss that is most pronounced in the medial temporal lobes is suggestive of Alzheimer's disease. |
Generate impression based on findings. | Evaluate pain into right shoulder and right hip for metastatic disease. Abnormal increased activity is noted within the left eighth rib, consistent with a bone metastasis. This corresponds with a permeative lesion seen on CT which may also involve a pathologic fracture.A medium-sized focus of abnormal activity is seen in the right supralateral acetabulum, very suspicious for an additional bone metastasis.A faint linear focus in a right upper rib likely represents old trauma. | Osseous metastasis in the left lateral eighth rib and also likely the right acetabulum. |
Generate impression based on findings. | Back pain. There is a posterior stabilization device with screws entering the L5 and S1 vertebrae. I see no hardware complications. There is an intervertebral spacer device at L5/S1 containing bone graft with intervertebral bony bridging of L5 and S1. Mild to moderate degenerative disk disease affects L1/2. I see no frank instability between the flexion, neutral, and extension views. Vertebral body heights are preserved. | Postoperative changes of lumbosacral fusion and degenerative disk disease as above without evidence of instability. |
Generate impression based on findings. | Osteoarthritis. Pain. The bones appear slightly demineralized, suggesting osteopenia. Mild osteoarthritis affects the acromioclavicular joint and glenohumeral joint, essentially within normal limits for age. There is a compression fracture of T9 that appears similar to that seen on a chest radiograph from September 5, 2014. Right lung findings also appear similar to those described in the report of the chest radiograph from September. | Mild osteoarthritis. |
Generate impression based on findings. | Patient with right ankle pain and swelling after injury 3 months ago. Evaluate for residual injury/fracture. I see no fracture or other specific findings to account for the patient's pain. | Normal-appearing ankle, without fracture or other specific findings to account for the patient's pain. |
Generate impression based on findings. | Status post fall, severe pain with standing, swelling and lower leg medially then lower down tender to palpation on medial malleolus. Fracture? Three views of the left ankle are provided. There is perhaps mild soft tissue swelling, but I see no fracture or malalignment. I otherwise see no specific findings to account for the patient's pain.Two views of the left tibia/fibula are provided. I see no fracture or other specific findings to account for the patient's pain. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | Seizure-like episode with desaturation to 20-30s requiring bagging, posturing, eye movement, bradycardia. There is hyperattenuating material along the posterior falx cerebri and cerebelli that measures up to 8 mm in width. There may also be trace subarachnoid hyperattenuation in the right parieto-occipital region versus artifact. There is slight diastasis of an accessory intraoccipital suture near the midline. There is no midline shift or herniation. The brain parenchyma is grossly unremarkable. The ventricles are normal in size and configuration. There are mildly prominent extra-axial CSF spaces anterior to the bilateral temporal lobes, which may represent a developmental variant. The imaged paranasal sinuses and mastoid air cells are clear. There is a partially-imaged enteric tube. | Slight diastasis of an accessory intraoccipital suture with acute subdural hemorrhage the posterior falx cerebri and cerebelli that measures up to 8 mm in width, but no midline shift or herniation. Possible trace subarachnoid hemorrhage in the right parieto-occipital region versus artifact. Discussed with Dr. Weiss at 4:15 PM on 2/26/15. |
Generate impression based on findings. | acute SAH NONCONTRAST CT HEADThere are diffuse acute SAH with IVH as well as mild ventriculomegaly (Fischer grade 4 acute SAH).No parenchymal hemorrhage is seen.No evidence of acute ischemic lesion.The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is relatively wide neck right distal ICA (most likely right pcom artery) aneurysm which is measured about 2mm x 3mm with about 1mm sized daughter sac indicating possible origin of current acute SAH.There is also 2mm x 1mm sized blister type of aneurysmal lesion just beside above described aneurysm. This lesion could represent another blister type of aneurysm or could represent adjacent atherosclerotic plaque with minimal ulceration.There is no evidence of vascular luminal narrowing or irregularity.There is no other aneurysm was seen.Bilateral Pcom arteries are patent and Acom artery is also patent.There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through left ICA, MCA and ACA. Vertebrobasilar system appears to be normal.No evidence of significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. Diffuse acute SAH, IVH with ventriculomegaly2. Right distal ICA aneurysm (3mm x 2mm) with suspicious adjacent blister like aneurysm (2mm x 1mm).Comment: discussed with Neurosurgery team (Dr.Awad) and planning for EVD before the angiography and subsequent angiography with planning for endovascular treatment under general anesthesia at the time of this dictation. |
Generate impression based on findings. | Status post right revision total hip arthroplasty The AP view of the right hip shows components of a total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of complication. A drain and foci of gas density in the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the right. Components of a left total hip arthroplasty device are situated in near anatomic alignment, although the distal extent of the prosthesis is not included on the field of view of this study. | Total hip arthroplasty as above. |
Generate impression based on findings. | Status post right total knee arthroplasty Components of a right total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density in the anterior soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty as above. |
Generate impression based on findings. | Patient with ankle pain and swelling. Please evaluate for fracture. There is mild soft tissue swelling about the ankle. I see no fracture or malalignment. The mid diaphysis of the fibula is absent, presumably due to prior surgery. | Presumed postoperative changes of the right fibula. I see no fracture. |
Generate impression based on findings. | Right knee pain status post mechanical fall. Evaluate for fracture. Mild osteoarthritis affects the knee. There is a small joint effusion. I see no fracture or malalignment. Note is made of arterial calcifications in the soft tissues as well as a stent in the femoral artery that extends off of the field of view of this study. | Osteoarthritis and small joint effusion without fracture evident. |
Generate impression based on findings. | congestive heart failure, intracerebral hemorrhage. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are metallic artifacts on the right distal ICA area indicating previously coiled aneurysm.Underlying brain shows patchy low attenuations on bilateral white matter suggesting non specific small vessel disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Small vessel ischemic disease. |
Generate impression based on findings. | acute SAH NONCONTRAST CT HEADThere are diffuse acute SAH with IVH as well as mild ventriculomegaly (Fischer grade 4 acute SAH).No parenchymal hemorrhage is seen.No evidence of acute ischemic lesion.The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is relatively wide neck right distal ICA (most likely right pcom artery) aneurysm which is measured about 2mm x 3mm with about 1mm sized daughter sac indicating possible origin of current acute SAH.There is also 2mm x 1mm sized blister type of aneurysmal lesion just beside above described aneurysm. This lesion could represent another blister type of aneurysm or could represent adjacent atherosclerotic plaque with minimal ulceration.There is no evidence of vascular luminal narrowing or irregularity.There is no other aneurysm was seen.Bilateral Pcom arteries are patent and Acom artery is also patent.There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through left ICA, MCA and ACA. Vertebrobasilar system appears to be normal.No evidence of significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. Diffuse acute SAH, IVH with ventriculomegaly2. Right distal ICA aneurysm (3mm x 2mm) with suspicious adjacent blister like aneurysm (2mm x 1mm).Comment: discussed with Neurosurgery team (Dr.Awad) and planning for EVD before the angiography and subsequent angiography with planning for endovascular treatment under general anesthesia at the time of this dictation. |
Generate impression based on findings. | seizure No evidence of acute ischemic or hemorrhagic lesion.Non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Non specific small vessel disease. |
Generate impression based on findings. | Swollen tender left lower extremity. Rule-out osteomyelitis or necrotizing fasciitis There is diffuse soft tissue swelling with reticulation of the subcutaneous fat. I see no gas density within the soft tissues. I see no radiographic evidence of osteomyelitis. Moderate osteoarthritis affects the knee. | Diffuse soft tissue swelling without specific radiographic features of osteomyelitis or necrotizing fasciitis. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Swelling. Is there a fracture? There is soft tissue swelling, particularly along the lateral aspect of the ankle. I see no underlying fracture. There may be a tibiotalar joint effusion, but this is equivocal. Small spurs are noted along the posterior and plantar aspects of the calcaneus which may not be of any clinical significance. | Soft tissue swelling without fracture evident. |
Generate impression based on findings. | Isolated tenderness to palpation of patella, mild effusion, no instability of the knee. Patella fracture? I see no fracture or malalignment. There is mild anterior soft tissue swelling and perhaps a small joint effusion. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | Laceration of the fifth finger. Evaluate for fracture of fifth metacarpal. There is perhaps mild soft tissue swelling along the 5th metacarpal, but I see no underlying fracture or malalignment. | No fracture evident. |
Generate impression based on findings. | 41 years, Female, Reason: Evaluate for lymphadenopathy in chest or abdomen, masses or intra-abdominal or pelvic abscess History: Fever of unknown origin. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Mildly prominent precarinal node.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes there isBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent right inguinal lobe.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount free fluid in the pelvis, likely physiologic. | No significant lymphadenopathy. |
Generate impression based on findings. | Pain over ulnar side of hand for one month after punching wall.VIEWS: Right hand PA/lateral/oblique (3 views) 02/26/15 No healing fracture is identified. The bones are normal in appearance. The capitate and hamate are fused, normal variant anatomy. The soft tissues of the hypo-thenar eminence are slightly thickened. | No healing fracture. |
Generate impression based on findings. | 53 years, Male. Reason: is Dobbhoff in correct place to use for tube feeds tonight History: malnutrition Enteric feeding tube tip projects over the distal gastric body. Surgical clip noted over the left upper quadrant. Nonobstructive bowel gas pattern. Spinal catheter tip projects over the T9 vertebral body. The lower portion of the pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the distal gastric body. |
Generate impression based on findings. | Shortness of breath, Question of pulmonary embolism PULMONARY ARTERIES: The quality of this examination is diagnostic for the evaluation of pulmonary embolism. No pulmonary embolus. Normal size of the main pulmonary artery.LUNGS AND PLEURA: Subsegmental atelectasis involving the inferior aspect of the right upper lobe. Scattered pulmonary micronodules. Calcified granuloma right lower lobe. Dependent debris within the left mainstem bronchus favor aspirated secretions. Minimal bronchial wall thickening and debris within right upper lobe bronchioles (series 8 image 57). The findings raise a question of reactive airway disease.MEDIASTINUM AND HILA: Heart size is normal no pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Low density lesion of the left adrenal gland with macroscopic fat most likely adrenal adenoma which measures approximately 9 by 10 mm. | No evidence of pulmonary embolus. Minimal bronchial wall thickening with debris and several bronchioles which raise a question of reactive airway disease.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Jaw pain. Evaluate for jaw dislocation. The Panorex radiograph of the mandible shows no fracture. Temporomandibular joint alignment is within normal limits. I see no specific findings to account for the patient's pain. | No fracture, dislocation or other specific findings to account for the patient's pain are evident. |
Generate impression based on findings. | 66 year old male with new axillary lymphadenopathy, concern for PTLD in stem cell transplant patient. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: CHEST:LUNGS AND PLEURA: Basilar consolidation increased from 2/19/2015. Peripheral left upper lobe opacity with solid rim and ground glass center (series 3, image 38) measures 3.6 x 3.7 cm, new from 2/19/2015 and highly suspicious for pulmonary infarct. MEDIASTINUM AND HILA: Right-sided central venous catheter with tip at the SVC atrial junction. Mild cardiomegaly. Severe coronary calcifications. No hilar or mediastinal lymphadenopathy.CHEST WALL: There is redemonstration of bilateral axillary lymphadenopathy, not significantly changed since 2/19/2015 exam but increased compared to 9/20/2013 exam.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral low-attenuation renal lesions some of which have intermediate density which appear grossly similar to 2013 exam but are incompletely evaluated.RETROPERITONEUM, LYMPH NODES: There are several mildly prominent retroperitoneal lymph nodes increased in size from the 2013 exam. For example, left para-aortic lymph node (series 3, image 126) measures 1.0 x 1.4 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia. New anasarca. OTHER: There is moderate abdominal ascites which was present on the 2/19/2015 exam but new from the 9/20/2013 exam.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There is bilateral iliac and inguinal lymphadenopathy, new compared to the 2013 exam. A left inguinal lymph node (series 3, image 180) measures 1.6 x 2.0 cm. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: New anasarca. OTHER: No significant abnormality noted | 1.New left upper lobe opacity with configuration highly suspicious for pulmonary infarct. Recommend evaluation for pulmonary embolism with CT chest PE protocol or VQ scan. 2.Increasing basilar consolidation consistent with infection.3.Axillary lymphadenopathy stable compared to 2/19/2015 exam but new from 2013. 4.New retroperitoneal and pelvic lymphadenopathy.5.Moderate abdominal ascites and anasarca similar to 2/19/2015 exam but new from 2013. 6.Indeterminant renal lesions grossly similar to 2013 but incompletely characterized. Findings communicated with Melissa A Nietert at 10:10 a.m. on 2/27/2015. |
Generate impression based on findings. | 15 year old female ventilator dependentVIEW: Chest AP (one view) 2/26/2015 16:01 ET tube tip below thoracic inlet. Feeding tube tip likely in the gastric antrum. Right upper extremity PICC tip in the right atrium.Spinal fusion instrumentation extends from T2 to L1.Near complete opacification of the left hemithorax with mediastinal shift to the left likely a combination of pneumonia and atelectasis. The left hemidiaphragm and left heart border are silhouetted. Streaky opacities in the right lung base are unchanged. No pneumothorax. | Near complete opacification of the left hemithorax with ipsilateral mediastinal shift likely a combination of pneumonia and atelectasis. |
Generate impression based on findings. | Knee swelling, pain. Dislocation or fractures? There is a small joint effusion with a 1 cm round focus of calcification in the suprapatellar pouch that likely represents a loose body, but I see no acute fracture. Moderate to severe osteoarthritis affects the knee. There is chondrocalcinosis of the menisci. | Osteoarthritis without fracture or dislocation. |
Generate impression based on findings. | 4-year-old male, rule out acute chestVIEWS: Chest AP/lateral (two views) 2/26/15 16:44 The cardiothymic silhouette is upper limits of normal. Low lung volumes and retrocardiac atelectasis without evidence of pneumonia or acute chest. | Low lung volumes without evidence of pneumonia or acute chest. |
Generate impression based on findings. | 54 year old male with history of esophageal cancer, evaluate extent of malignancy. CHEST:LUNGS AND PLEURA: Dependent atelectasis without suspicious nodules or masses. No pleural effusionsMEDIASTINUM AND HILA: There is diffuse circumferential esophageal wall thickening and mild paraesophageal soft tissue thickening compatible with patient's stated history of esophageal cancer. No discrete mediastinal lymphadenopathy is identified. Moderate coronary calcifications are present.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy by size criteria. BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Interval placement of percutaneous jejunostomy tube with moderate pneumoperitoneum presumably related to laparoscopic procedure.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall including expected small foci of air. Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above. BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1.Interval postsurgical changes of recent laparoscopic jejunostomy tube placement including moderate pneumoperitoneum.2.Esophageal and paraesophageal soft tissue thickening compatible with patient's stated history of esophageal cancer without discretely measurable lymphadenopathy. |
Generate impression based on findings. | Frequent vomiting. Rule out pyloric stenosis.EXAMINATION: Interpretation of outside exam 02/27/15upper GI 01/22/15 performed at Methodist Hospital, Merrillville, Indiana 01/22/15 The scout radiograph of the abdomen excludes most of the pelvis. The bowel gas pattern is slightly disorganized.Fluoroscopy of the esophagus was performed in the lateral projection and the esophagus is normal in appearance. An unknown amount of contrast was consumed and the stomach was very distended. The ligament of Treitz cannot be evaluated due to technique. According to the radiologist's report, gastric emptying was significantly delayed. | Malrotation cannot be excluded. Gastric distention. |
Generate impression based on findings. | 19 day old male status post PDA ligation with hypotension and tachycardiaVIEW: Chest AP (one view) 2/27/15 2:44 Centra venous catheter tip in the SVC. Enteric tube side port at the EG junction. ETT at the thoracic inlet. PDA ligation clip is again noted.Patchy bilateral air space opacities are improved from the prior exam. Subcutaneous gas along the left lateral chest wall and left third rib deformity from recent surgery. Cardiac silhouette size is upper limits of normal. | Patchy bilateral air space opacities are improved from the prior exam. |
Generate impression based on findings. | Reason: s/p EVD removal History: s/p EVD removal There are foci of encephalomalacia present involving the left inferior frontal gyrus and part of the left superior temporal gyrus extending into the left supramarginal gyrus. There is associated enlargement of the left lateral ventricle. Foci of encephalomalacia is also present along the inferior medial aspects of the frontal lobes bilaterally. Subarachnoid and intraventricular blood products have dissipated since the prior exam a small amount of blood is present in the right lateral ventricle.The patient is teslas recent ventriculostomy tube removal. Biventricular diameter on coronal imaging at the level of the entry point of the ventriculostomy tube is currently 46 mm and previously was the same.There is a radiopaque stent present along the distal left internal carotid artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | Status post recent ventriculostomy tube removal. The lateral ventricles are enlarged but remain stable when compared to prior exam. |
Generate impression based on findings. | Reason: pulmonary infiltrate seen on CXR, volume overload or infectious process? History: edema, ascites, cough, SOB LUNGS AND PLEURA: Scattered patchy areas of groundglass opacity, with an upper lobe predominance.No significant septal thickening. No pleural effusions.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is enlarged. Small pericardial effusion. Moderate coronary artery calcification. Hypoattenuation of the blood pool suggestive of anemia. Atrial septal occluder device.Scattered mildly enlarged mediastinal lymph nodes are nonspecific. A tracheoesophageal lymph node measures 11mm (series 3, image 11).CHEST WALL: Soft tissue edema in the subcutaneous tissue upper abdomen, left breast, with skin thickening of the left breast. Healed left rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post TIPS. Small amount of ascites partially visualized.A 5-cm hypodense lesion in the right hepatic lobe is stable from prior CT imaging dated 10/2013, likely a cyst. | 1. Scattered patchy upper-lobe-predominant areas of groundglass most likely represents viral pneumonia. Atypical edema and pulmonary hemorrhage are considered less likely.2. Subcutaneous edema/fluid and skin thickening involving the left breast may be due to patient positioning or an occluded left chest wall vein, however given the asymmetry, non-benign process cannot be excluded by CT. |
Generate impression based on findings. | 6-month-old male with PICC placement, feeding intolerance. VIEWS: Chest and abdomen AP (two views) 2/26/2015 16:31 Interval placement of left upper extremity PICC with tip at the confluence of the brachiocephalic veins. Tracheostomy tube in place. NG-tube tip in the stomach within the giant omphalocele. Right lower extremity PICC tip in the right external iliac vein. The omphalocele overlies the right lung and a portion of the left lung. No pulmonary opacities are noted. No pleural effusion or pneumothorax. Cardiothymic silhouette is normal. Shape of the thorax remains long and narrowed related to the omphalocele.Dilated bowel loops are noted within the omphalocele. Radiopaque material along the omphalocele wall is again seen likely mesh material as noted on CT. | 1. Left upper extremity PICC tip at the confluence of the brachiocephalic veins. 2. Dilated bowel loops are noted within the omphalocele. |
Generate impression based on findings. | Female 63 years old Reason: 63yo F with history of SLE presenting with hip pain and fevers, concern for abscess. History: hip pain, fever 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: Subcentimeter hypodense lesions bilaterally which are too small to characterize but likely represent cysts. Mild scarring of the inferior pole of the left kidney. RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta.BOWEL, MESENTERY: Large, right lateral abdominal wall hernia is seen with thinning of the internal/external obliques and transverse abdominis muscles. The hernia sac contains unobstructed small bowel, ascending colon, mesenteric fat, lower pole of the kidney and the inferior aspect of the right lobe of the liver. No significant fat stranding, free fluid or bowel obstruction. No intraperitoneal free air. Findings are similar to prior exam.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is enlarged and bulky with calcified ill-defined fibroids. These findings are grossly unchanged compared to the prior study. BLADDER: No significant abnormality notedLYMPH NODES: Prominent but unchanged pelvic lymphadenopathy, including common iliac, external iliac and inguinal nodes. BOWEL, MESENTERY: Large right lateral abdominal wall hernia as above.BONES, SOFT TISSUES: No findings to explain patient's hip pain. No evidence of abscess. Grade 1 anterolisthesis of L4 and L5. Age-indeterminate anterior wedging of the T12 vertebral body.OTHER: No significant abnormality noted | 1.No findings to explain patient's hip pain. No evidence of abscess. 2.Stable, large right lateral abdominal wall hernia without evidence of bowel obstruction. |
Generate impression based on findings. | 60 year old female with abdominal pain and fever, rule out acute process. ABDOMEN:LUNG BASES: Mild basilar atelectasis/consolidation. Calcified granuloma in the left lung base and calcified hilar lymph nodes compatible with prior granulomatous disease. Cardiomegaly and enlarged right atrium.LIVER, BILIARY TRACT: Hepatic steatosis. Reflux of contrast into IVC and enlarged hepatic veins suggest right heart failure. Cholelithiasis.SPLEEN: Splenic granulomata. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: The IVC and its tributaries are significantly enlarged.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix is visualized and unremarkable.BONES, SOFT TISSUES: Severe degenerative changes of the visualized thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix is visualized and unremarkable.BONES, SOFT TISSUES: Severe degenerative changes of the visualized thoracolumbar spine. OTHER: No significant abnormality noted | 1.Bilateral mild basilar atelectasis/consolidation which could be related to aspiration and/or infection. 2.No acute abdominal findings to account for the patient's abdominal pain.3.Hepatic steatosis.4.Findings compatible with right heart failure including reflux of contrast into an enlarged IVC and tributaries.5.Cholelithiasis. 6.Mild anasarca. |
Generate impression based on findings. | 47 years, Male. Reason: abdominal pain, r/o obstruction History: abdominal pain Interval removal of Swan-Ganz catheter, enteric feeding tube, and surgical drains. LVAD, sternotomy hardware, and AICD unchanged. Nonobstructive bowel gas pattern with moderate stool burden in the colon. Bilateral air space opacities are better evaluated on chest radiograph performed on 2/27/2015. | Nonobstructive bowel gas pattern with moderate stool burden. |
Generate impression based on findings. | 19 day old male, assess lung expansion after PDA ligationVIEW: Chest AP (one view) 2/26/15 18:19 ETT tip at the thoracic inlet. Right central venous catheter tip in the SVC. Enteric tube side port at the EG junction. New PDA ligation clip. Extensive bilateral airspace opacities with interval improved aeration in the left lung. Large lung volumes and scattered round lucencies that may represent interstitial emphysema are again noted. No pneumothorax. Cardiac silhouette size is upper limits of normal.Subcutaneous emphysema along the left lateral chest wall and third rib deformity from PDA ligation surgery. | Interval PDA ligation with slight improvement in left pulmonary opacities. No pneumothorax. |
Generate impression based on findings. | 79 year old male with abdominal pain, evaluate for obstruction. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Minimal basilar atelectasisLIVER, 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: A suture line is present in the right mid abdomen indicating prior bowel surgery. There is a C-shaped loop of small bowel dilated up to 3.6 cm in the right midabdomen. Small bowel feces sign is present within this loop. The loop appears to converge into two transition points and an area of swirling mesentery (series 3, image 62) highly concerning for closed loop obstruction. The distal small bowel is collapsed. No intraperitoneal free air, portal venous gas, or pneumatosis. There is a small amount of free fluid in the pelvis. 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: A suture line is present in the right mid abdomen indicating prior bowel surgery. There is a C-shaped loop of small bowel dilated up to 3.6 cm in the right midabdomen. Small bowel feces sign is present within this loop. The loop appears to converge into two transition points and an area of swirling mesentery (series 3, image 62) highly concerning for closed loop obstruction. The distal small bowel is collapsed. No intraperitoneal free air, portal venous gas, or pneumatosis. There is a small amount of free fluid in the pelvis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings highly concerning for closed loop small bowel obstruction. No associated intraperitoneal free air. Small amount of pelvic free fluid is present.Findings communicated by on-call resident to ER physician Dr. Turner at 12:22 a.m. on 2/27/2015. |
Generate impression based on findings. | 56 years, Female, Reason: kidney stone History: left flank pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter right renal hypodensity is too small to characterize and unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. Ovoid region of low attenuation with peripheral calcifications it is slightly increased in size measuring 2.1 x 1.1 cm (3/65), previously 1.5 x 8.6 cm with increased adjacent parenchymal loss. Nonobstructing right lower pole stone is minimally increased. No obstructing ureteral stones. Large left lower pole stone seen on prior exam is longer evident.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No hydronephrosis or obstructing renal stones.2.Ovoid region of hypoattenuation in the left kidney with peripheral calcifications is more prominent than the prior exam. While this could represent a minimally complex cyst, calcifications in the setting of caliectasis and scarring is favored. |
Generate impression based on findings. | 15 year-old male with tenderness status post traumaVIEWS: Right clavicle, AP and axial (two views) 2/26/15 19:18, Right shoulder, internal and external rotation (two views), 2/26/1519:17 Alignment is anatomic. The humeral head articulates normally with the glenoid fossa. The clavicle is intact. | Normal examination. |
Generate impression based on findings. | 66 years, Male. Reason: Eval colon distention History: Dilated colon, distention Persistent, but improved gas filled loops of small and large bowel compatible with ileus type pattern. Right pleural effusion is again noted. Gastrostomy tube projects over the gastric body. Prosthetic mitral valve again noted. | Persistent, but improved gas filled loops of small and large bowel compatible with ileus type pattern. |
Generate impression based on findings. | 9-year-old female with medial malleolus pain, everting foot with ambulation.VIEWS: Right ankle AP/lateral/oblique (3 views), left ankle AP/lateral/oblique (3 views) 2/26/2015 Normal alignment. No soft tissue swelling or joint effusion. No fracture or dislocation. | Normal examinations. |
Generate impression based on findings. | Left foot pain/swelling. Evaluate for fracture. Three views of the left ankle are provided. There is mild soft tissue swelling and perhaps a small tibiotalar joint effusion. I see no fracture or malalignment.Three views of the left foot are provided. There is mild diffuse soft tissue swelling. I see no fracture. There is a moderate hallux valgus deformity. A small round lucency in the first metatarsal head probably represents a cyst. Lucencies within the intermediate cuneiforms and the neck of the talus may also represent cysts, although I cannot entirely the possibility of chronic erosions. | Soft tissue swelling and arthritic changes as described above, without fracture evident. |
Generate impression based on findings. | 66 years, Male. Reason: ileus, r/o obstruction History: bowel dilation Persistent mild gaseous distension of small and large bowel compatible with ileus type pattern. No pneumoperitoneum on upright imaging. Right pleural effusion is again noted. Gastrostomy tube projects over the gastric body. Prosthetic mitral valve again noted. | Mild gaseous distension of small and large bowel compatible with ileus type pattern. |
Generate impression based on findings. | 7-month-old female with respiratory distressVIEW: Chest AP (one view) 2/26/1519:40 The cardiothymic silhouette is normal. Right upper lobe perihilar atelectasis. No pleural effusions or pneumothorax. | Right upper lobe atelectasis without pleural effusions or pneumothorax. |
Generate impression based on findings. | Lung cancer staging with suspicious SCV lymph node. CHEST:LUNGS AND PLEURA: The dominant hypermetabolic left upper lobe mass measures slightly smaller when compared to recent previous CT from 1/28/15. For example, using similar measurement, this is 3.6 x 3.7 cm (6/35), as compared to 3.5 x 4.2 cm. It has slightly reduced in transverse dimension by 2 mm when compared to the CT component of the recent PET.The second spiculated solid component that surrounds the left upper lobe bronchus and proximal branches has become less nodular, measuring 11 mm transverse, as compared to 20 mm on the previous CT (6/39).The left major fissural and lateral pleural thickening remains stable.No new pulmonary nodules. Peripheral right upper lobe nodule (6/47) is stable at 3 mm. Resolution of previous left pleural effusion. Centrilobular paraseptal emphysema with scattered cysts unchanged.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy is better delineated with contrast. The degree of soft tissue from lymphadenopathy surrounding the proximal left subclavian artery has not significantly changed. The left subclavian artery, left brachiocephalic vein and central subclavian veins are patent. There is a degree of contrast noted within the right subclavian artery; no specific intraluminal thrombus is identified. No significant change in the right cardiophrenic lymph node. Aortopulmonary lymphadenopathy which is hypermetabolic on the recent PET measures 16 mm transverse (4/40) as compared to 12 mm on the prior noncontrast CT. Bulky left perihilar lymphadenopathy surrounds the distal left main pulmonary artery and branches as well as the central left superior and inferior pulmonary veins. This does appear to be stable in overall size when compared to the previous noncontrast images. These also demonstrate increased metabolic activity on the recent PET.No interval right paratracheal or right hilar lymphadenopathy.The heart size remains stable. Stable pericardial thickening, most prominent at the lateral wall which may be related to radiation. No significant pericardial effusion is present. Aortic valvular calcification remains stable.CHEST WALL: Stable low left cervical lymphadenopathy. No significant axillary or subpectoral lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Dependent sludge layers within the gallbladder.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | The dominant hypermetabolic left upper lobe mass compatible with malignancy measures slightly smaller 3.6 x 3.7cm, as compared to 3.5 x 4.2 cm. The second spiculated solid component that surrounds the left upper lobe bronchus and proximal branches has become less nodular, measuring 11 mm transverse, as compared to 20 mm.Resolution of left pleural effusion.Aortopulmonary hypermetabolic lymphadenopathy measures 16 mm transverse (4/40) as compared to 12 mm on the prior noncontrast CT. Stable, bulky left perihilar lymphadenopathy surrounds the distal left main pulmonary artery and branches as well as the central left superior and inferior pulmonary veins. No new pulmonary nodule or lymphadenopathy. |
Generate impression based on findings. | Female, 76 years old.Surgery greater than 8 hours and multiple surgical teams. No unexpected radiopaque foreign objects. Enteric feeding tube tip projects over the distal gastric body. Surgical drain projects over the left upper quadrant. Surgical sutures are noted in the left upper quadrant. Nonobstructive bowel gas pattern. Expected post surgical pneumoperitoneum. AICD leads noted. | No unexpected radiopaque foreign objects.Findings discussed with the attending surgeon, Dr. Lengyel, via telephone at 18:19 hours on 2/26/2015 by Dr. Alexander. |
Generate impression based on findings. | Pain status post fall. Rule out fracture. I see no fracture or malalignment. The wrist appears normal for age. | No fracture or other specific findings to account for the patient's pain are evident. |
Generate impression based on findings. | Shoulder pain The distal clavicle appears slightly elevated relative to the acromion process on the AP view, but this may simply reflect normal anatomy for this patient. The remainder of the shoulder is normal. | Slight elevation of the distal clavicle of uncertain clinical significance. The shoulder otherwise appears normal. |
Generate impression based on findings. | Female 80 years old Reason: 80yo F with L hand swelling, leukocytosis, and pain out of proportion to exam; concern for necrotizing fasciitis. History: swelling, pain, leukocytosis. There is replacement of the subcutaneous fat along the dorsum of the hand with soft tissue density compatible with edema. This edema extends through the dorsal and ulnar subcutaneous fat of the forearm and elbow. Although this edema is confluent, we see no rim enhancing lesions to suggest an abscess. The underlying musculature is unremarkable without evidence of fluid collection or gas. We see no radiographic evidence of osteomyelitis. Degenerative arthritic changes affect the wrist and there is also osteoarthritis of the elbow. Prominent vascular structure in the anterior aspect of the elbow presumably represents a dialysis graft/fistula, and is incompletely imaged on this study. Note is made of a small lipoma in the proximal musculature of the forearm. | Superficial soft tissue edema without specific radiographic features of necrotizing fasciitis. |
Generate impression based on findings. | 61 years, Male. Reason: patient with emesis, assess for ileus History: emesis Nonobstructive bowel gas pattern with air filled loops of small bowel in the midabdomen. Moderate to large stool burden in the colon. Air space opacities are better evaluated on chest radiograph performed 2/26/2015. | Nonobstructive bowel gas pattern with air filled loops of small bowel in the midabdomen. Moderate to large stool burden in the colon. |
Generate impression based on findings. | Female 37 years old Reason: eval for stone, eval appendix History: R flank pain, hematuria ABDOMEN: Limited exam secondary to lack of oral and intravenous contrast. Lack of intravenous contrast makes evaluation of solid organ and vascular pathology suboptimal. Lack of oral contrast makes evaluation of bowel pathology suboptimal. Within these limitations, the following observations are made:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or hydroureter. No perinephric fat stranding. There is a small 1-2-mm hyperdense focus just superior to the expected location of the right ureterovesicular junction best seen on coronal images (series 80220, image 36). This may represent a very small ureteral calculus or a phlebolith, however, it would be unlikely to cause gross hematuria. RETROPERITONEUM, LYMPH NODES: Well defined, hypoattenuating collection centered in the right paracolic gutter measuring 9.2 x 6.4 x 10.7 cm (series 3, image 81 and series 80220, image 52). The fluid collection has no apparent nodular component or septations, however, the exam is limited without intravenous contrast. The collection could be intraperitoneal or retroperitoneal. The lesion abuts the ascending colon but does not appear to be arising from the right kidney or the ascending colon. The fluid collection is likely benign cystic lesions such as a lymphangioma, lymphocele, duplication cyst or mesenteric cyst such as a mesothelial/epithelial cyst. The fluid collection is unlikely to be the cause of the patient's gross hematuria.BOWEL, MESENTERY: Normal appendix. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Limited exam with lack of intravenous contrast making evaluation of solid organ pathology suboptimal. Within these limitations, there is a large well-defined, hypoattenuating fluid collection centered in the right paracolic gutter which likely represents a benign cystic lesions such as a lymphangioma, lymphocele, duplication cyst or mesenteric cyst such as a mesothelial/epithelial cyst. 2.No convincing findings to explain patient's reported gross hematuria. Recommend dedicated, contrast enhanced renal CT with cortical nephrogram and delayed phases. Findings, including the need for a dedicated renal CT, were discussed with the emergency medicine resident, Dr. Tripp, at 8:40 a.m. on 2/27/2015. |
Generate impression based on findings. | 68 years, Male. Reason: abdominal distention, obstruction? History: abd distension, constipation Examination is limited by patient body habitus. Mildly distended gas filled colon with paucity of gas in the rectum may represent colonic ileus versus colonic obstruction. Cholecystectomy clips noted in the right quadrant. | Mildly distended gas filled colon may represent colonic ileus versus colonic obstruction. |
Generate impression based on findings. | Spine trauma. Kyphosis AP and lateral views of the spine were obtained, per spinal survey technique. Please note that this technique is not optimal for evaluation of spine trauma. There are deformities of the L1 and L4 vertebral bodies which likely represent old fractures as seen on prior imaging studies. Multiple thoracic vertebral compression deformities appear similar to the chest radiograph in 2013.There is approximately 40 degrees of thoracic kyphosis measured from what we believe to be the superior endplate of T5 to the superior endplate of T12. There is approximately 40 degrees of dextroscoliosis as measured from the the superior endplate of T3 to the inferior end plate of T11. There is approximately 3 cm of positive sagittal balance. The coronal balance is within normal limits.There is multilevel degenerative disk disease; facet joint osteoarthritis affects the lower lumbar spine.A cardiac pacing device is noted, appearing similar to prior. | Chronic appearing vertebral body fractures, kyphoscoliosis, and degenerative changes as described above. If there is clinical concern for acute spine trauma, CT should be considered. |
Generate impression based on findings. | Female 76 years old, surgery with greater than 8 hours. Multiple surgical teams. The upper abdomen is excluded from the field-of-view. No unexpected radiopaque foreign objects. Partially imaged surgical drain projects over the left upper quadrant. Suture material projects over the mid pelvis. Expected post surgical pneumoperitoneum. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign objects.These findings were discussed by the radiology resident on call via telephone with Dr. Lengyel, the attending surgeon, on 2/26/2015 at 18:19 hours by Dr. Alexander. |
Generate impression based on findings. | Reason: left lung nodule, s/p bilateral lung transplant History: as noted above LUNGS AND PLEURA: Status post bilateral lung transplant.Moderate linear scarring throughout the lungs.Small pleural effusions bilaterally, with adjacent small areas of subpleural atelectasis at the bilateral bases.A calcified pleural plaque anterolaterally in the left hemithorax corresponds with the nodular density seen on recent chest radiograph.Scattered benign-appearing nodules, some calcified. No suspicious pulmonary nodules or masses.Mild pleural thickening with scattered focal calcifications bilaterally.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification. Scattered small mediastinal and hilar lymph nodes, some calcified. No lymphadenopathy.Surgical changes of a bilateral lung transplant.CHEST WALL: Degenerative disease of the thoracic spine.Healed left rib fractures.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered splenic calcifications. Atherosclerotic calcification of the abdominal aorta and its branches. | 1. No suspicious pulmonary nodules or masses. A calcified pleural plaque anterolaterally in the left hemithorax corresponds with the nodular density seen on recent chest radiograph.2. Moderate linear scarring, pleural thickening, very mild bronchiectasis and small pleural effusions bilaterally, improved from outside CT dated 3/14. |
Generate impression based on findings. | 3-year-old male with pain and swellingVIEWS: Right hand, PA, oblique, and lateral (3 views) 2/26/15 22:58 Minimally displaced fracture of the distal tuft of the ring finger with overlying soft tissue swelling. The remaining osseous structures are intact. | Minimally displaced fracture of the distal tuft of the ring finger. |
Generate impression based on findings. | Central line placementVIEW: Chest AP and abdomen AP NG tube tip in the stomach. The umbilical venous catheter tip in the SVC. Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | The umbilical venous catheter tip in the SVC. |
Generate impression based on findings. | 34-year-old female with history of swelling, evaluate for SVC syndrome. History of bilateral internal jugular vein thrombosis. There is marked attenuation of bilateral inferior internal jugular veins. Bilateral upper internal jugular veins are patient and non-dilated to suggest a significant obstruction. No obvious edema in the visualized facial and neck soft tissues. The main pulmonary artery is enlarged measuring up to 3.7 cm suggesting pulmonary hypertension. The bilateral brachiocephalic veins and proximal SVC are patent without evidence of filling defect. The left parotid gland is atrophic when compared to the right. The remaining salivary and thyroid glands are unremarkable. There are scattered mildly enlarged lymph nodes however there is no pathologic enlargement by CT size criteria. The airway is patent. There is mild mucosal thickening of the maxillary and ethmoid sinuses. The mastoid air cells are clear. The orbits are unremarkable. The visualized intracranial structures are normal. | 1. Marked attenuation of inferior bilateral internal jugular veins which is compatible with patient's history of chronic bilateral internal jugular vein thrombosis. Upper internal jugular veins are patent without dilatation. Bilateral brachiocephalic veins and visualized SVC are also patent. 3. Enlarged main pulmonary artery suggestive of pulmonary artery hypertension.4. A mild allergic-like reaction occurred to IV contrast material for which premedication with steroids is recommended prior to any future contrast administration. See details in the technique section of this report. |
Generate impression based on findings. | Cardiac surgeryVIEW: Chest AP 2/27/15 Right central line with tip in the right atrium. Cardiomegaly unchanged. Midline sternal wires again noted. Patchy atelectasis bilaterally increased from prior study. No pleural effusion or pneumothorax. | Bilateral patchy atelectasis increased from prior study. |
Generate impression based on findings. | 44 years, Male. Reason: picc line placement History: as above Support lines overlie the patient. Peripherally inserted central catheter tip is located above the upper aspect of the image and is not seen. Radiodensity projected over the right iliac crest and additional incompletely evaluated radiodensities project over the right upper thorax may represent bullet fragments. Nonobstructive bowel gas pattern. The pelvis is incompletely imaged. | PICC tip is located above the upper aspect of the radiograph and is not seen. Chest/neck radiograph should be obtained for visualization |
Generate impression based on findings. | Ms. Brooks is a 71 year old female with biopsy proven malignancy within the right superior breast. She presents today for wire localization prior to surgery. On review of the prior studies, the target is irregular, hypoechoic mass measuring 1.7 x 0.9 x 1.4 cm, located in the right breast in the superior region located posteriorly at 12 o’clock. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was skin was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially. Using aseptic technique, continuous ultrasound guidance and a mediolateral approach, a 7 cm Kopans needle was placed through the lesion. Using ultrasound guidance, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Two view orthogonal mammograms reveal the spring wire to be in adequate position. The mammogram was annotated and reviewed with Dr. Chhablani prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sheth performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass, clip and spring wire to be within the specimen. | Successful needle localization of the right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Cardiac surgeryVIEW: Chest AP 2/26/15 Midline sternal wires again noted. Right central line with tip in the right atrium. Cardiomegaly unchanged. Bilateral diffuse patchy atelectasis not significantly changed. There is a small right apical pneumothorax. | Bilateral patchy atelectasis and small right apical pneumothorax unchanged. |
Generate impression based on findings. | 6-year-old male with cough and fever, evaluate for pneumoniaVIEWS: Chest AP/lateral (two views) 2/27/15 2:25 Mild bronchial wall thickening and large lung volumes without evidence of pneumonia. Mild basilar atelectasis. The cardiac apex, aortic arch and stomach are left-sided.The cardiothymic silhouette is normal. | Bronchiolitis or reactive airway disease without evidence of pneumonia. |
Generate impression based on findings. | 1-day-old male on cooling protocol, esophageal temperature probe placementVIEW: Chest AP, abdomen, AP (two views) 2/27/15 4:04 Esophageal temperature probe tip in the distal thoracic esophagus. UVC catheter tip in the right atrium.The cardiothymic silhouette is normal. The cardiac apex, aortic arch and stomach are left-sided. Bronchial wall thickening and subsegmental basilar atelectasis. Normal bowel gas pattern. | Esophageal temperature probe tip in the distal thoracic esophagus. |
Generate impression based on findings. | Respiratory distressVIEW: Chest AP 2/27/15 Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette normal. Patchy atelectasis in the right lower lobe and left lower lobe minimally improved. No pleural effusion or pneumothorax. | Bilateral patchy atelectasis improved from prior study. |
Generate impression based on findings. | Evaluate foreign bodyVIEW: Abdomen AP 2/27/15 Gastrostomy tube in place. Metallic hardware at the left iliac bone and left proximal femur. There is a radiopaque foreign body projected over the stomach. Moderate amount of fecal burden at the descending colon and rectosigmoid region. Disorganized nonobstructive bowel gas pattern. No evidence of pneumoperitoneum. | Radiopaque foreign body projected over the stomach. |
Generate impression based on findings. | 41 years, Female. Reason: 41 F with abdominal pain, no bowel movements History: abdominal pain Nonobstructive bowel gas pattern. Average stool burden. | Nonobstructive bowel gas pattern. Average stool burden. |
Generate impression based on findings. | NSCLC initial staging. Head: There is no evidence of intracranial mass or abnormal enhancement. There is a punctate area of hypoattenuation in the left thalamus. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Neck: There is a partially imaged right lung mass. There is a cluster of enlarged and hyperenhancing lymph nodes in the left lower neck. For example, a left level 4 lymph node measures 17 x 13 mm. The thyroid and major salivary glands are unremarkable. There is a retropharyngeal course of the bilateral internal carotid arteries. There is multilevel degenerative spondylosis. The airways are patent. | 1. Left lower neck lymphadenopathy is compatible with metastatic disease. 2. No evidence of intracranial metastases.3. Partially imaged right lung mass. Please refer to the separate chest CT report for additional details.4. An area of hypoattenuation in the left thalamus may represent a lacunar infarct of indeterminate age. |
Generate impression based on findings. | 59 year old woman with history of left breast mass seen on screening mammogram. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is an oval, circumscribed mass in the left upper outer breast measuring 5mm in length which persists on spot compression. No additional dominant mass, suspicious microcalcifications, or areas of architectural distortion are seen in the left breast. SONOGRAPHIC | Benign-appearing mass, likely a fibroadenoma, in the left breast. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Abdominal distention and rectal decompression tube.VIEW: Abdomen AP (one view) 02/27/15, 0809 and 0810 Feeding tube is coiled upon itself in the stomach. Tracheostomy and gastrostomy tubes are present. A rectal tube has been placed. Left thoracolumbar curve is present. Bilateral developmental hip dysplasia is noted.There appears to be contrast material at the hepatic flexure of the colon and in the rectum. This appears much more dense than on yesterday's exam. The caliber of the colon has decreased. Bowel gas pattern remains disorganized and multiple mildly dilated loops are seen. | Decrease in caliber of bowel after placement of rectal tube. |
Generate impression based on findings. | 9-year-old male with history of Wilms tumor status-post right nephrectomy. 36 months off therapy. CHEST:LUNGS AND PLEURA: Left upper lobe micronodule is unchanged. No new suspicious micronodules are seen. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal. No mediastinal or hilar lymphadenopathy is present.CHEST WALL: Normal appearance. No axillary lymphadenopathy is present.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal with no evidence of intra-or extrahepatic biliary ductal dilatation. Solitary gallstone is again seen in the gallbladder with no evidence of cholecystitis.SPLEEN: Spleen is normal.PANCREAS: Pancreas is normal with no evidence of pancreatic ductal dilatation.ADRENAL GLANDS: Right adrenal gland is not seen. Left adrenal gland is normal.KIDNEYS, URETERS: Right kidney has been resected. No evidence of recurrence in the right renal fossa. Left kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: Multiple surgical clips are again seen. BOWEL, MESENTERY: Normal caliber with no evidence of bowel wall thickening, abnormal enhancement or obstruction. Few mesenteric lymph nodes are seen and appear unchanged.BONES, SOFT TISSUES: Normal in appearance. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Tiny urachal remnant is again seen, normal variant anatomy.LYMPH NODES: Right iliac lymph node is unchanged. BOWEL, MESENTERY: Normal caliber with no evidence of bowel wall thickening, abnormal enhancement or obstruction. BONES, SOFT TISSUES: Normal in appearance. OTHER: No significant abnormality noted | No evidence of disease recurrence or metastases. |
Generate impression based on findings. | 54-year-old male with history of heart transplant and recurrent upper respiratory symptoms. Please evaluate for sinus pathology. There is minimal mucosal thickening of scattered anterior ethmoid air cells. The remaining paranasal sinuses are clear. No air fluid levels are present. There is a chronic deformity of the right medial orbital wall with some herniation of fat likely sequela of prior trauma. The orbits are otherwise unremarkable. There is minimal rightward nasal septal deviation with a prominent right nasal septal spur. | 1. No significant paranasal sinus disease. There is minimal scattered ethmoid mucosal thickening but sinuses are otherwise well aerated. 2. Chronic right medial orbital wall fracture. |
Generate impression based on findings. | 41 year old woman with history of multiple breast cysts. History of paternal grandmother and great aunt with breast cancer. 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. There are multiple, bilateral, partially obscured masses with radiolucent halos which are stable in size and appearance. No new suspicious mass, suspicious microcalcifications, or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | Stable, bilateral, benign appearing masses seen to be cysts on the prior ultrasound. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
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