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Generate impression based on findings. | Female 31 years old Reason: ankle fx History: above. Possible degenerative changes of the lateral process of the talus, without definite fracture. Overlying soft tissue swelling has decreased when compared to the prior exam. | No definite fracture. Interval decrease in overlying soft tissue swelling. |
Generate impression based on findings. | 63 year old female with recent open repair of incarcerated umbilical hernia now with leukocytosis, evaluate for infectious process or fluid collection. ABDOMEN:LUNG BASES: Basilar atelectasis/consolidation and small pleural effusions, slightly increased. Cardiomegaly. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small peripheral wedge-shaped areas of low attenuation in the spleen compatible with infarcts, increased from prior.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are focally dilated loops of small bowel in the pelvis measuring up to 4 cm, slightly increased in diameter from prior. The small bowel proximally and more distally is not dilated. This pattern is thought to represent a focal ileus. No intraperitoneal free air. No drainable fluid collections.BONES, SOFT TISSUES: Postoperative changes from ventral hernia repair with a subcutaneous drain and skin staples. There is soft tissue induration and small foci of gas adjacent to the incision site without drainable fluid collections.PELVIS:UTERUS, ADNEXA: There has been interval placement of a pessary. The uterus is now located in the pelvis and demonstrates a heterogenous appearance.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the visualized spine.OTHER: No significant abnormality noted | 1.Focally dilated loops of small bowel in the pelvis likely representing postoperative ileus, slightly increased in size.2.Postoperative changes of recent ventral hernia repair without drainable fluid collections.3.Interval placement of pessary and replacement of ureters into the pelvis. The uterus has a heterogenous appearance and malignancy cannot be excluded.4.Basilar atelectasis/consolidation and small pleural effusions, slightly increased.5.Small splenic infarcts, increased. |
Generate impression based on findings. | Evaluate for hemorrhage and abnormality of the larynx after right sided head injury, now with severe headache; persistent throat pain and dysphagia. Head: There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. There is a left cerebellar hemisphere developmental venous anomaly. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is mild scattered paranasal sinus opacification. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is a right lens implant. Neck: The larynx appears to be intact. The airways are patent. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is mild plaque at the carotid bifurcations. There is multilevel degenerative spondylosis with prominent anterior cervical osteophytes. There are degenerative changes in the left temporomandibular joint. There is torus palatinus. The imaged portions of the lungs are clear. | 1. No evidence of acute intracranial hemorrhage or mass.2. No evidence of laryngeal disruption or airway stenosis.3. Prominent anterior cervical osteophytes. 4. Degenerative changes in the left temporomandibular joint. |
Generate impression based on findings. | PICC placement. Respiratory failure.VIEW: Chest AP (one view) 02/27/15, 1112 Right upper extremity PICC tip is at junction of right atrium and inferior vena cava. Endotracheal tube tip is at carina with tip directed toward right mainstem bronchus. There appears to be a zipper tab in the gastric fundus. A gastrostomy tube is present.Cardiac silhouette size is normal. Airspace disease on the right and left lower lobe opacity persist.Right thoracic curve is again seen. | Right PICC tip at junction of right atrium and inferior vena cava. Endotracheal tube tip at carina with tip directed into right mainstem bronchus. Bilateral lung opacities. |
Generate impression based on findings. | Reason: h/o oral mandibular/alveolus ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered benign-appearing nodules and calcified granulomas appear similar to the prior scan. No new suspicious pulmonary nodules or masses.No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.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. | No evidence of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 78 years old Reason: metastatic bladder cancer. needs restaging exam History: metastatic bladder cancer to lungs Within the limits of a non IV contrast enhanced examination which limits ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: CHEST:LUNGS AND PLEURA: Interval resolution of bilateral pleural effusions and the previously seen bilateral pulmonary nodules with cavitation. These nodules likely represent a now resolved infectious process. Other scattered calcified and noncalcified micronodules are unchanged. Left upper lobe 4-mm micronodule is unchanged (series 4, image 52). Centrilobular and paraseptal emphysema. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Calcified mediastinal and left hilar lymph nodes again seen. There is severe coronary arterial calcifications. The heart size is normal without pericardial effusion. Right chest wall port with catheter tip at the cavoatrial junction.CHEST WALL: Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: No hepatic steatosis. Punctate calcifications in liver.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large hypoattenuating lesion in the superior pole of the left kidney, unchanged and consistent with a simple renal cyst. Left percutaneous nephrostomy tube, unchanged in position. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: The previously referenced left periaortic lymph node now measures 1.6 x 1.4 cm (series 3, image 113), previously 1.4 x 1.1 cm. The second index left periaortic lymph node now measures 0.7 x 0.7 cm (series 3, image 131), previously 0.9 x 0.7 cm. Heavy atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Status post ileal conduit. No evidence of bowel obstruction.BONES, SOFT TISSUES: Small fat-containing ventral abdominal wall stomal hernia. Degenerative changes of the thoracolumbar spine with a rightward curvature of the lower thoracic spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: Reference right external iliac chain node is increased in size and now measures 2.7 x 5.3 cm (series 3, image 165), previously 2.8 x 4.4 cm. Additional reference lesion is increased in size and now measures 4.3 x 5.0 cm (series 3, image 173), previously measuring 3.5 x 3.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval resolution of bilateral pleural effusions and multiple nodules thought to be related to metastatic disease. These likely represent a now resolved infectious process.2.Significant interval increase in size of the patient's pelvic lymphadenopathy, likely representing progression of disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Scattered benign calcifications, including arterial calcifications, are present in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of lung cancer, diagnosed at the age of 50. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the central left breast is stable when compared to prior exams. Scattered benign calcifications are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign lymph nodes project over the axillae. | Stable focal asymmetry in central left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 79 year old man with aortic valve mass referred for evaluation of coronary anatomy prior to surgery.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 severe stenoses present in the left main. There is a <20% partially calcified stenosis in the distal left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. Minimal calcification in the proximal LAD. LCx: The left circumflex coronary artery is 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 small and arises normally from the right sinus of Valsalva. It is non-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 ventricle is normal in sizeRight Ventricle: The right ventricle is mild to moderately dilated. 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 atrial volume appears to be mild to moderately dilated. 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. There is a small mass (5x7x8mm) on the non-coronary cusp of the aortic valve. Its appearance is consistent with the patient's known papillary fibroelastoma.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1.There are no significant coronary artery stenoses present. 2.Mild coronary stenosis in the left main. 3.Small papillary fibroelastoma noted on aortic valve. 4.Mild to moderate dilation of the right ventricle and right atrium. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Male 59 years old; Reason: eval for collection History: tender scrotum, abscess on CT pelvis RIGHT TESTIS: Measures 4.6 x 2.4 x 2.9 cm. There is extensive microlithiasis. No suspicious lesion is identified. Normal, symmetric vascular flow.LEFT TESTIS: Measures 5.0 x 2.8 to 2.8 cm. There is extensive microlithiasis. No suspicious lesion is identified. Normal, symmetric vascular flow.RIGHT EPIDIDYMIS: Measures 3.6 x 0.8 x 1.1 cm with a normal ultrasound appearance.LEFT EPIDIDYMIS: Measures 4.8 x 1.1 x 0.4 cm with a normal ultrasound appearance.OTHER: There is a large, complex fluid collection in the left groin containing foci of gas. This measures 6.4 x 2.0 x 4.9 cm.Moderate left hydrocele and thickening of the left scrotal wall. | 1.Large, complex fluid collection with foci of gas in left groin.. Foci of air may be related to the recently removed surgical drains.2.Moderate simple appearing left hydrocele and thickening of the scrotal wall, likely reactive.3.Extensive bilateral testicular microlithiasis. |
Generate impression based on findings. | NECK: There are postoperative findings related to thyroidectomy. There is interval increase in size of the necrotic right paratracheal lymph node, which measures 26 x 37 mm, previously 13 x 27 mm. The lesion is inseparable from the tracheal wall. There is also interval increase in size of a necrotic right level 4 lymph node, which measures 12 x 15 mm, previously 7 x 9 mm. There is hyperattenuation within the bilateral vocal cords that represents laryngoplasty filler material. There are otherwise unchanged findings related to right vocal cord augmentation. The major salivary glands are unremarkable. There is mild plaque at the carotid bifurcations. The osseous structures are unchanged. The airways are patent. However, there are secretions within the trachea. The imaged portions of the lungs, with a few micronodules. There are also emphysematous changes in the lungs.HEAD: There is no intracranial mass or abnormal enhancement. There is unchanged minimal cerebral white matter hypoattenuation that may represent small vessel ischemic disease. There is encephalomalacia in the left cerebellar hemisphere. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unchanged. | 1.Interval increase in size of the metastatic right paratracheal and right level 4 lymphadenopathy.2.No evidence of intracranial metastasis.3.Pulmonary micronodules. Please refer to the separate chest CT report for additional details.4. Secretions within the trachea may be due to aspiration. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of right cyst aspiration. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Male, 40 days old, with possible seizures in a neonate. The cerebral and cerebellar hemispheres and brainstem are normal for age in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid is seen. There is no evidence of mass effect or parenchymal edema. The ventricular system is normal in size and morphology. The bones of the calvarium and skull base are intact. | No acute intracranial abnormality and no findings to account for the patient's possible seizures. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in mother, diagnosed at the age of 63. Two standard digital views of both breasts with additional right CC view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Patchy focal asymmetries in the left breast are stable when compared to prior exams. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 84 years old Reason: mediastinal and hilar LAD with smoldering myeloma and IgM MGUS, r/o lymphoma (Waldenstroms or other B cell) History: none CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heterogeneous thyroid gland.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Nonspecific, hypodense lesion near the splenic hilum which may represent a hemangioma (series 3, image 100).PANCREAS: No significant abnormality notedADRENAL GLANDS: Lesion in the left adrenal measuring 2.2 x 1.8 cm (series 3, image 105) which is hypodense on the noncontrast CT from PET imaging. Favor benign adenoma.KIDNEYS, URETERS: Multiple bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Marked degenerative changes of the visualized spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked degenerative changes of the visualized spine.OTHER: No significant abnormality noted | No lymphadenopathy or other evidence of metastatic disease. |
Generate impression based on findings. | Dedicated images through the sella demonstrate a normal height of the pituitary gland. The suspected area of differential enhancement seen on the prior study is not well appreciated on this study. No other discrete lesion is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is an unchanged punctate focus of abnormal T2 hyperintensity within the left insula, which is non-specific. There is no diffusion abnormality. No extra-axial fluid collection is identified. An incidental subcentimeter pineal cystic lesion is unchanged.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a small mucous retention cyst in the left maxillary sinus. | 1. Suspected area of differential enhancement seen on the prior study is not well appreciated on this study. No other discrete lesion is seen within the pituitary gland. 2. Stable incidental findings in the brain. |
Generate impression based on findings. | - 50 year old male with renal transplant and abnormal function. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Peak systolic velocity in the adjacent iliac artery of 134 cm/sec. Peak systolic velocity adjacent to the anastomosis in the transplant renal artery of 109 cm/sec with highest velocity in the midportion at 164 cm/sec. Transplant renal vein is patent. Parenchymal resistive index averages 0.7. Slight, non-specific parvus tardus.OTHER: No significant abnormality noted | No hydronephrosis. No renal artery stenosis. |
Generate impression based on findings. | Female 80 years old Reason: gastric cancer, carcinomatosis restaging CT. Exam is not sensitive for detecting lesions in the solid organs vasculature due to lack of intravenous contrast. Given those limitations following Osler's;CHEST:LUNGS AND PLEURA: Previously seen small left pleural effusion is resolved.Fibrotic interstitial changes right middle lobe, radiation changes left upper lobe, and atelectasis right lower lobe. Few scattered micronodules unchanged. No suspicious lesions for metastasis.MEDIASTINUM AND HILA: Port-A-Cath terminates in the right atrium. Moderate atherosclerosis aortic root and coronary artery. Very small pericardial effusion.CHEST WALL: Soft tissue nodule left breast series image 51, 1.3 x 1.2 cm. Previously, series image 47, 1.7 x 1 cm.ABDOMEN:LIVER, BILIARY TRACT: Hepatic cyst right lobe, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Presumed cyst right kidney, unchangedRETROPERITONEUM, LYMPH NODES: Atherosclerotic changes aorta, no evidence of aneurysm. No pathologic sized retroperitoneal nodes.BOWEL, MESENTERY: Gastric wall thickening circumferential involving the gastric body and antrum, average thickness of 1.6-cm as measured on series 2 image 100. This is probably unchanged. Small perigastric nodes the index node on series image 91 measuring 0.9 x 0.8 cm previously 1 x 0.8 cm.Nodes in gastrohepatic ligament unchanged. No evidence of ascites. The previously described subtle nodularity in the upper abdominal mesentery omentum is unchanged. Other than the small measurable perigastric nodes there is no measurable solid carcinomatosis however. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXAE: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of ascites or carcinomatosis.BONES, SOFT TISSUES: Degenerative changes.OTHER: No significant abnormality noted. | Roughly stable disease. Index measurements as above. Persistent but slightly decreased pleural effusions. |
Generate impression based on findings. | 51-year-old male with tenderness at site of transplanted kidney. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplanted kidney measures 13.9 cm in length. There is very mild prominence of the renal collecting system and proximal ureter.COLLECTING SYSTEM/URETER: There is very mild dilatation of the renal collecting system.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Peak systolic velocity in the adjacent iliac artery is 80 cm/sec. The peak systolic velocity in the transplant renal artery at the anastomosis of 130 cm/sec. Parenchymal tracings demonstrate average resistive index of 0.58. No parvus tardis. Transplant renal vein is patent. On today's study, there is suggestion of linear, echogenic material within the adjacent iliac artery and I cannot exclude a small amount of calcified thrombus. This was not noted on prior exams.OTHER: No significant abnormality noted | Mild dilatation of the renal collecting system.Patent vasculature.Question small amount of linear calcification in the adjacent iliac artery. |
Generate impression based on findings. | Male 61 years old; Reason: metastatic prostate cancer with rising PSA. needs reeval. outside lab creat 12/26/14 0.9 History: metastatic prostate cancer ABDOMEN:LUNGS BASES: Micronodule right middle lobe series 4 image 5 and image 9. This could be followed.LIVER, BILIARY TRACT: About 10 hypodense lesions in the liver consistent with metastases. Baseline purposes index lesion measurements provided as follows:Segment 4, series image 40/161, 2.6 x 2.1 cm.Segment 5, series 2 image 50, 2.5 x 2.2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous punctate calcifications throughout both kidneys consistent with nonobstructive nephrolithiasis. No evidence of Hydronephrosis or hydroureter. No calcifications seen along the course of the ureters however.Several small cysts.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of evidence of aneurysm. Small shotty retroperitoneal nodes. The left para-aortic nodes are borderline significance by clustering.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Asymmetric mass in the region of the right lobe of the prostate abutting bladder and seminal vesicle, see coronal image 51 axial image 138-142. No surgical clips are seen, correlate with surgical historyBLADDER: Bladder wall thickening. 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.Multifocal hypodense lesions in the liver consistent with metastases. Portal and significant retroperitoneal nodes.2.Soft tissue mass the region of the right lobe of the prostate inseparable from bladder and seminal vesicle.3.Bilateral nephrolithiasis.4.Nonspecific micronodules lung base.5.No visible osseous lesions. |
Generate impression based on findings. | Bilateral hip pain. Limited walking. Two views of the right hip are provided. Mild osteoarthritis affects the hip appearing similar to that seen on the prior study.Two views of the left hip are provided. Mild osteoarthritis affects the hip.Scattered arterial calcifications are seen within the pelvis and proximal thighs. Additional calcifications in the pelvis may represent uterine fibroids. | Mild osteoarthritis. |
Generate impression based on findings. | 65-year-old male with solitary right kidney and acute renal failure. RIGHT KIDNEY: The right kidney measures 12.4 cm in length. Echotexture appears normal and the parenchyma is well-preserved. There is a 1.2 cm cyst in the lower pole. No hydronephrosis, shadowing calculus or solid massLEFT KIDNEY: Post nephrectomyURINARY BLADDER: NondistendedOTHER: Echogenic liver, presumably due to fatty infiltration. | No change in right kidney. No hydronephrosis. |
Generate impression based on findings. | Redemonstrated are multiple small T1 hyperintense, mildly enhancing lesions with associated susceptibility effect, some of which are stable in size and some of which are slightly increased in size. These include the lesions in the right paracentral lobule measuring 8 mm, previously 7 mm, and in the right inferior frontal gyrus measuring 8 mm, previously 7 mm. There is no definite new lesion. Additional lesions include those in the left precentral gyrus, left thalamus, left middle frontal gyrus, left occipital lobe, and left cerebellar hemisphere. There is no significant associated vasogenic edema or mass effect. There are a few unchanged mild non-enhancing cerebral white matter lesions. There is no evidence of acute infarction. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. | Slight interval increase in size of some of the multiple lesions along the cortical surfaces with intrinsic T1 hyperintensity, which may represent metastases with blood product. |
Generate impression based on findings. | Female 46 years old Reason: re-evaluation of extent of metastatic disease in patient with cholangiocarcinoma History: obstructive jaundice ABDOMEN:LUNG BASES: New right retrocaval lymph node series 2 image 85.LIVER, BILIARY TRACT: Previously seen biliary dilatation is resolved. There are new, numerous small hypodense lesions scattered in liver consistent with metastasis.Previously seen lesion flow of segment IVb is no longer present and may have been resected.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple procedure. New cystic nodes seen around superior mesenteric artery mesenteric root and retroperitoneum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: New extensive cystic aortic and pericaval adenopathy. For baseline purposes a left para-aortic node is measured on series 2 image 112, 3 x 2-cm.BOWEL, MESENTERY: Expected postsurgical changes. Mesenteric node with heterogeneous architecture in the midline is measured on series 2 image 119, 1.8 x 1.1 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Subtotal colectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Progression of disease with new adenopathy and liver lesions. |
Generate impression based on findings. | Lumbago. Evaluate for DDD, spondylolisthesis. For the sake of consistency with the prior study, I will designate 5 lumbar vertebrae with hypoplastic ribs at L1. Again seen is a bilateral spondylolysis of L4 with a grade 2 anterolisthesis of L4 that appears to have progressed when compared with the prior study. Moderate to severe degenerative disk disease at L4/5 also appears to have progressed when compared with the prior study. There is a minimal retrolisthesis of L5 relative to S1, with mild degenerative disk disease at L5/S1. Mild to moderate degenerative disk disease at L1/2 appears similar to that seen on the prior study accounting for positional differences. | L4 spondylolysis with progression of spondylolisthesis and degenerative disk disease as described above. |
Generate impression based on findings. | 68-year-old male with history of rectal cancer status post colorectal anastomosis and ileostomy takedown. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Low-attenuation segment 8 hepatic lesion measures 6 mm (series 3, image 35), unchanged since 2013.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter low attenuation renal lesions too small to characterize but likely benign.RETROPERITONEUM, LYMPH NODES: Mild ectasia of the infrarenal abdominal aorta and common iliac arteries, unchanged.BOWEL, MESENTERY: There has been interval takedown of the right lower quadrant ostomy. Normal caliber small and large bowel without evidence of obstruction. Postoperative changes are present involving the rectosigmoid with presacral fluid appearing similar to prior. Small mesenteric lymph nodes are present which are not pathologically enlarged by size criteria.BONES, SOFT TISSUES: Degenerative disk disease affects the visualized thoracolumbar spine. Postsurgical changes to the anterior abdominal wall. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly prominent right common and external iliac nodes not significantly changed. BOWEL, MESENTERY: There has been interval takedown of the right lower quadrant ostomy. Normal caliber small and large bowel without evidence of obstruction. Postoperative changes are present involving the rectosigmoid with presacral fluid appearing similar to prior.BONES, SOFT TISSUES: Degenerative disk disease affects the visualized thoracolumbar spine. OTHER: No significant abnormality noted | 1.Interval takedown of right lower quadrant ileostomy without evidence of complication.2.Postsurgical changes to the rectum and presacral space appearing similar to prior.3.Mildly prominent right common and external iliac nodes not significantly changed. |
Generate impression based on findings. | Reason: stem cell transplant patient with recent xray concerning for new LUL opacity. Want CT to rule out fungal pneumonia History: N/A LUNGS AND PLEURA: Scattered micronodules are unchanged. A previously visualized nodular pleural-based opacity in the right lower lobe within an area of scarring is no longer seen, now only with focal residual scarring. Several small sided endobronchial debris and associated ground glass opacity in the right upper lobe suspicious for aspiration or retained secretions.Basilar scarring/subsegmental atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy. A previously described right hilar lymph node measures 11 mm (series 3, image 40), unchanged.CHEST WALL: Degenerative disease of the thoracic spine, with an unchanged compression deformity of the T7 vertebral body, and stable sclerosis at the inferior endplate of T9 vertebral body.Right chest port, tip at the cavoatrial junction. A punctate focus of air and a small amount of fluid surround the port (series 3, image 1).UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No suspicious pulmonary nodules or masses. No evidence of fungal pneumonia.2. A punctate focus of air and a small amount of fluid surrounding the right chest port may be signs of infection if the port was not placed recently.3. Mild bronchiolitis, likely related to microaspiration. |
Generate impression based on findings. | Right breast cancer -12.8 mm. Needs lymphoscintigraphy for surgery scheduled 2-27-15 at 1pm in dCAM wt=170 1bs.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.52 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the right axilla. |
Generate impression based on findings. | Female 53 years old Reason: RA History: same Right hand: There is narrowing of the radial carpal joint, with sclerosis and subchondral cysts, which is unchanged from the prior exam. There may be increased narrowing of the distal radioulnar joint, which may be, in part, due to patient positioning. Again seen is a lucency with sclerotic edges at the base of the second proximal phalanx, which is unchanged from prior exam, and likely represents a subchondral cyst rather than an erosion. There may be a questionable erosion of the ulnar styloid, but this is equivocal and unchanged from the prior exam. Otherwise, no definite erosions or specific radiographic findings for inflammatory arthritis are seen.Left hand: There is narrowing and sclerosis at the radiocarpal joint with underlying subchondral cysts, which appears less prominent than those seen on the right hand, and are unchanged from the prior study. No erosions or specific radiographic findings for inflammatory arthritis are seen.Right foot: There is mild hallux valgus angulation and small osteophytes of the interphalangeal joints of the first great toe, which have not progressed when compared to the prior exam. Additional small osteophytes are noted at the distal interphalangeal joints of the second third and fourth toes. Which do not appear to have progressed when compared to the prior exam. Note is made of a calcaneal spur. There are no erosions or other specific radiographic findings of inflammatory arthritis.Left foot: There is mild hallux valgus angulation and minimal osteophytes of the interphalangeal joints of the first toe, which are unchanged from the prior exam. Additional minimal degenerative changes affect the mid foot. Note is made of a calcaneal spur. There are no erosions or other specific radiographic findings of inflammatory arthritis. | 1. Lucency in ulnar styloid may represent a small erosion, but this is equivocal.2. Degenerative changes more pronounced in the right wrist then in the left wrist, appearing similar to the prior study. 3. Additional degenerative changes involving the feet are unchanged from prior exam. |
Generate impression based on findings. | Female 54 years old Reason: fall History: same. We have 3 views of the left wrist. Various swelling along the dorsal aspect of the wrist. A small fragment within the dorsum of the wrist is compatible with a triquetral fracture fragment. | Triquetral fracture as described above. |
Generate impression based on findings. | Newly diagnosed ascending colon cancer. Had initial staging CT Scan on 2/11/15 here with a round superior mediastinal mass with CEA over 25ng/ml. Needs PET Scan for initial staging.RADIOPHARMACEUTICAL: 10.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 109 mg/dL. Today's CT portion grossly demonstrates a region of focal thickening in the ascending colon. A soft tissue density is noted in pre-cardiac space and there are coronary artery calcifications. Today's PET examination demonstrates a focal region of increased activity in the lesser curvature of the stomach with an SUVmax of 17.6 and is suspicious for possible malignancy. Abnormal hypermetabolic FDG avid activity is also noted within a focal region of thickening in the ascending colon which corresponds with the finding on the recent diagnostic CT. This has an SUVmax of 26.8, corresponding to a colonic malignancy. An upper pre-vascular space lymph node has an SUVmax of 3.5. A right mediastinal pre-vascular lymph node has mildly increased activity with an SUVmax of 3.8. Normal sized lymph nodes in the axillary regions is likely reactive. A right external iliac and bilateral inguinal region lymph nodes are noted with an SUVmax in the right inguinal region is 3.9. Foci of increased activity in the interspinous ligaments of lumbar region likely represent inflammation possibly from ligamentous injury. | 1.Ascending colon lesion with significantly abnormal FDG avid activity, compatible with colonic malignancy. 2.Significantly abnormal FDG avid activity in the fundus of the stomach may be due to gastric cancer, an upper endoscopy may provide further information.3.Activity within lymph nodes in the mediastinum, external iliac and inguinal regions are nonspecific but more likely inflammatory. |
Generate impression based on findings. | Female 65 years old Reason: fx f/u History: pain. Left shoulder and left clavicle: Hardware components of a left shoulder hemiarthroplasty device are situated in near anatomic alignment. Again seen is chronic erosive remodeling of the glenoid, which has not significantly progressed from the prior exam. Distal clavicular fracture is again demonstrated with increased dissociation of the distal fracture fragment . There is increased sclerosis along the clavicular fracture edges. | Left shoulder hemiarthroplasty and distal clavicular fracture as described above. |
Generate impression based on findings. | Nausea and vomiting. Question of gastroparesis. Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 71 % of peak activity (normal >70 %)1 hour: 65 % of peak activity (normal 30-90 %) 2 hours: 47 % of peak activity (normal <60 %) 4 hours: 4 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | Male 69 years old; Reason: cirrhosis, PVT and SMVT - follow up on thromboses History: hypercoagulable state ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cirrhotic morphology with associated chronic portal, splenic and superior mesenteric vein thrombosis with extensive collateral formation. Calcifications seen in the left lobe. No lesion suspicious for hepatocellular carcinoma.Hepatic veins enhance normally. Cholelithiasis without biliary dilatation.SPLEEN: Marked splenomegaly 20.2-cm cephalocaudad. Large peri-splenic varices.PANCREAS: Small cystic lesion in the pancreatic head well-characterized on MR. Please refer to that report.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes aorta and branch vessels. Mild bulge in the mid abdominal aorta does not meet criteria for aneurysm with maximal dimension of 2.5-cm is seen on coronal image 56/99 on the venous phase.Small nodes in the porta hepatis and gastric likely retroperitoneum not pathologic in size probably related to cirrhosis.BOWEL, MESENTERY: Thickening right colon consistent with right-sided portal colapathy Some fat stranding in the mesenteric area.Varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites in dependent portion of the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild atherosclerotic changes. | 1.Diffuse portal splenic and superior mesenteric vein thrombosis with collateral formation. Small amount of ascites. 2.Mark splenomegaly. 3.Right-sided clonic wall thickening consistent with portal hypertension effect. 4.Gallstones.5.Left renal cyst come atherosclerotic disease with mild bulging the abdominal aorta.6.Stable appearance of the pancreas. |
Generate impression based on findings. | History of diabetes type II, now with persistent Nausea/Vomiting, concern for gastric gastroparesis History: h/o DM2, now with persistent Nausea/Vomiting, concern for gastric gastroparesis Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 75 % of peak activity (normal >70 %)1 hour: 60 % of peak activity (normal 30-90 %) 2 hours: 5.6 % of peak activity (normal <60 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | Reason: s/p coiling History: same The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the previous examination a ventriculostomy tube is in place in the right frontal bone into the right lateral ventricle. There is a small amount of intraparenchymal blood surrounding the ventriculostomy site within the right frontal lobe.Biventricular diameter at the level of the entry of the ventriculostomy tube is currently 38 mm and previously was approximately the same. The temporal horns of the lateral ventricles show little change.There is remonstration of subarachnoid hemorrhage which is stable compared to prior exam. The blood vessels are currently opacified. There is metal artifact present at the location of the recent aneurysm coiling.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. | 1.Since the prior exam the patient has undergone right-sided ventriculostomy and aneurysm coil placement for the right posterior communicating artery aneurysm. 2.The ventricles remain stable. 3.A small focal hemorrhage is developed in the right frontal lobe. |
Generate impression based on findings. | History of prostate cancer. Evaluate for progression. Abnormal foci of uptake are again noted in the left anterior ribs, right posterior ribs, calvarium, and distal right humerus. New focus of uptake within the lateral right 7th rib corresponds to a healing fracture on CT from the same date. Degenerative uptake is noted in the cervical spine, shoulders, and knees. | No significant change in size or number of osseous metastatic lesions. |
Generate impression based on findings. | High oxygen requirements, chest pain evaluate for PE. Mesothelioma. PULMONARY ARTERIES: Technically adequate contrast infusion without evidence of pulmonary embolus to the distal segment level. Exam is limited by motion artifact. LUNGS AND PLEURA: Subpleural pneumatoceles in the right lung most likely reflect chest tube tracts; the posterior tract also contains fluid. Small pleural effusions right greater than left. Groundglass opacity and atelectasis in the upper lobes bilaterally suggestive of atypical edema. Within the right lower lobe, there is extensive consolidation, this is seen to a lesser extent in the right middle lobe. The right lower lobe bronchus and its branches are intermittently occluded. A small air and fluid collection is noted in the major fissure. Subpleural edema on the left.MEDIASTINUM AND HILA: Mild cardiomegaly. Soft tissue opacity in the right lateral aspect of the mediastinum extends from the level of the aortic arch (10/65) to the lung bases along the cardiac border. Although this may be postoperative, assessment for disease is limited as infiltrative tumor may have this radiographic appearance. Soft tissue thickening surrounds the right hilum and mild lymphadenopathy is present measuring up to 15-mm (10/118).CHEST WALL: Subcutaneous emphysema right chest wall. Surgical anchors from neo-diaphragm right chest wall. Subcutaneous fat stranding, fluid and postoperative blood products limit assessment for tumor in the chest wall. Right 6th rib displaced surgical fracture.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Right diaphragmatic mesh with right upper quadrant positioning suggestive of phrenic nerve paralysis. Foci of enhancement in the deep costophrenic sulcus nonspecific in the postoperative setting; residual disease cannot be excluded. Small amount of air and fluid along the right hepatic margin. | No evidence of pulmonary embolus to the distal segmental level. Postoperative changes from recent thoracotomy and decortication limit sensitivity for detection of residual tumor which may have a similar radiographic appearance to postoperative blood products. Pulmonary edema. Right lower and middle lobe post operative contusion and atelectasis with a disproportionate degree of consolidation in the right posterior base suspicious for pneumonia.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: r/o PE History: chest pain, (+) d dimer The bilateral inferior most posterior costophrenic angles are not included on this exam.PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism or other acute abnormality to account for patient's symptoms.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Check lytic lesions. Patient with right rib and hip pain. Patient with myeloma Diffuse demineralization limits sensitivitySKULL: No discrete myelomatous deposits. Small lucencies likely represent venous lakes.CERVICAL SPINE: Multilevel degenerative changes including a grade 1 retrolisthesis of C4 on 5, unchanged. No discrete myelomatous lesionsTHORACIC SPINE: Scattered moderate degenerative changes again scattered or significantly involving the lower thoracic spine. Mild wedge deformities are observed including what appears to be T6 and T11. These changes are unchanged. No discrete myelomatous lesionsLUMBAR SPINE: Moderate degenerative changes again observed throughout the lower lumbar spine without discrete myelomatous involvement. Grade 2 anterolisthesis of L4 on 5 unchangedRIBS: No discrete focal rib abnormalities, specific attention was placed on the right chest wallPELVIS: Bilateral osteoarthritic changes of the SI joints and hips. Calcified uterine fibroids. No suspicious myelomatous lesions given demineralization. Specific attention was placed in the same area previously described is concerning including the left ischium.UPPER EXTREMITY: Postsurgical changes involving both wrists unchanged without discrete superimposed new lytic myelomatous lesions LOWER EXTREMITY: Scattered degenerative changes without discrete superimposed focal suspicious myelomatous lesions. Particular attention is placed in the proximal left femur with a previous the described lucency not clearly observed currently. No evidence of cortical bone loss and superimposed structures an artifact may account for prior description. | Unchanged appearance without discrete myelomatous lesions. Particular attention was placed in the area of the left ischium and femur previously identified. Please see specific detail provided above |
Generate impression based on findings. | Female 49 years old Reason: patient s/p roux-en-y gastric bypass asses jejuno-jejunal anastomosis History: nausea and vomiting, . Omnipaque 350 was orally ingested and flowed without holdup through the esophago-jejunal anastomosis and opacified the proximal small bowel. Contrast passed through the two anastomoses without evidence of leak or obstruction. Gaseous distention of small and large bowel loops consistent with ileus pattern.Fluoroscopically monitored palpation was not performed due to patient tenderness. Fluoroscopy time 5 minutes and 56 seconds. | Status post Roux-en-Y gastric bypass with jejuno-jejunal anastomosis. No evidence of leak or obstruction. |
Generate impression based on findings. | Frontal sinus: The frontal sinuses are clear. There is trace mucosal thickening in both frontal ethmoidal recesses.Anterior ethmoids: There is mild-moderate patchy opacification and mucosal thickening within the anterior ethmoid air cells.Maxillary sinuses: There is mild mucosal thickening in the maxillary sinuses. The ostiomeatal units are opacified bilaterally.Posterior ethmoids: There is mild mucosal thickening in the posterior ethmoid air cells are clear.Sphenoid sinus: There is mucosal thickening and aerated secretions in the left sphenoid sinus. There is a tiny mucosal retention cyst in the right sphenoid sinus, with opacification along the right sphenoethmoidal recess.There is mild leftward nasal septal deviation with a leftward directed bony spur measuring 5 mm. The nasal turbinate morphology is within normal limits. There is opacification in the right middle meatus with debris in the left inferior meatus.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric.Incidental note is made of ventricular and sulcal prominence somewhat disproportionate to age which may relate to focal volume loss. | 1. Overall, mild-moderate scattered sinus inflammatory changes with opacification of both ostiomeatal units in the left sphenoethmoidal recess. Minimal aerated secretions in the left sphenoid sinus which can be seen with acute sinusitis.2. Mild leftward nasoseptal deviation with small bony spur. |
Generate impression based on findings. | Pain. Preoperative. Moderate osteoarthritis affects the left knee, with 4 degrees of genu varus. Mild osteoarthritis affects the left hip. | Osteoarthritis. |
Generate impression based on findings. | Reason: metastatic head and neck restaging History: as above CHEST:LUNGS AND PLEURA: Moderate apical predominant centrilobular and paraseptal emphysema, with apical bullae, unchanged.A right lower lobe solid nodule measures 22 x 17 mm (series 5, image 249), previously 17 x 14 mm. Additional scattered micronodules, some calcified, are unchanged. No new suspicious pulmonary nodules or masses.New groundglass and nodular consolidation in the right lower lobe, with bronchial wall thickening and debris within the trachea, right mainstem bronchus, and lower lobe branches (series 6, image 73).No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. Mild coronary artery calcifications.A right upper paratracheal lymph node measures 23 mm (series 4, image 21), previously 15 mm.A low right paratracheal lymph node measures 9 mm (series 4, image 45), previously 6 mm.Reference right hilar lymph node measures 13 mm (series 4, image 55), previously 10 mm.Right inferior interlobar lymphadenopathy is new (series 4, image 68).CHEST WALL: Degenerative disease of the thoracic spine. Hypodensity in the T8 vertebral body is stable and likely degenerative.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Probable cyst in the left hepatic lobe are unchanged. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine. OTHER: No significant abnormality noted. | 1. Increasing mediastinal lymphadenopathy is suspicious for metastatic disease. Right hilar lymphadenopathy nonspecific and could be postinfectious or metastatic.2. Right lower lobe nodule slightly larger.3. New nodular consolidation in the right lower lobe which may represent aspiration pneumonia however is isoattenuating to disease elsewhere and underlying endobronchial metastases with post obstructive infection cannot be excluded. Suggest short-term CT follow-up in 4 to 6 weeks if further characterization would alter clinical management of the patient.. |
Generate impression based on findings. | History of right tonsil T1N0SCCA. The study was performed for restaging.RADIOPHARMACEUTICAL:13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 108 mg/dL. Today's CT portion grossly demonstrates post-surgical changes in the right neck. Hepatic steatosis is noted. A single kidney is seen on the right. A tubular soft tissue density in the left retroperitoneal region is unchanged from the prior exam. Today's PET examination demonstrates mild bilateral axillary lymph node activity. A right axillary lymph node for reference has an SUVmax of 2.1. The lymph node activity bilaterally is stable and likely reactive. Increased right sided superficial axillary skin activity represents benign inflammatory process. The tubular soft tissue lesion in the left retroperitoneal region demonstrates no activity and may represent a hypoplastic kidney. | 1.No evidence of FDG avid tumor. 2.Bilateral axillary lymph node activity is likely reactive. 3.Increased skin activity in the right upper chest is likely inflammatory in etiology. |
Generate impression based on findings. | 68 years, Male. Reason: assess NG tube placement History: s/p NG placement Note that patient body habitus and motion artifact limits evaluation. Enteric feeding tube tip projects over the fundus and sidehole is immediately proximal to the gastroesophageal junction. No significant interval change in gaseous colonic distention that may represent colonic ileus versus colonic obstruction. Cholecystectomy clips again noted.The lower portion of the pelvis is excluded from the field of view. | Enteric feeding tube tip projects over the fundus and sidehole is immediately proximal to the gastroesophageal junction. |
Generate impression based on findings. | Evaluate OA - evaluate for unicompartmental arthroplasty MAKO protocol History: pain Mild osteoarthritis affects the left hip. Irregularity at the left hamstring insertion likely reflects old injury. Moderate osteoarthritis affects the left knee. | Osteoarthritis. |
Generate impression based on findings. | History of PTLD, greater than 2.5 years status post allogeneic SCT.RADIOPHARMACEUTICAL: 4.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 130 mg/dL. Today's CT portion grossly demonstrates mucosal thickening of the bilateral ethmoid, sphenoid, and maxillary sinuses. There multiple prominent to enlarged level II-IV, supraclavicular, and mediastinal lymph nodules, including the right paratracheal, precarinal, subcarinal, and prevascular lymph node stations. There is suture material in the left lower lobe and right middle lobe atelectasis/scarring. The gallbladder and spleen are absent. There are scattered prominent mesenteric lymph nodes. There are scattered enlarged retroperitoneal, pelvic, and inguinal lymph nodes. Today's PET examination demonstrates slight interval decrease in number of hypermetabolic lymph nodes within the neck. A right level II lymph node measures max SUV of 6.2, previously 6.1. A left supraclavicular lymph node measures max SUV of 4.6, previously 5.0. Increased activity within the pharyngeal tonsils is unchanged and likely due to adenoid tissue in a person of this age.Benign activity within the thymus is again noted and similar to the prior examination. No FDG avid lesions are identified in the mediastinum or hila.Within the upper abdomen, there is a similar number, size, and metabolic activity of gastrohepatic, mesenteric, and retroperitoneal lymph nodes.In the pelvis, there has been a slight decrease in the number of hypermetabolic lymph nodes in the iliac lymph node stations. There is no significant change in number or activity of bilateral inguinal nodes. A right inguinal lymph node measures max SUV of 4.5, previously 3.4. | Slight interval improvement with decreased number of hypermetabolic lymph nodes in the neck and pelvis. No new FDG avid lesion is identified. |
Generate impression based on findings. | Pain Knee: Severe and marked osteoarthritic changes observed in both knees greater on the left and more pronounced in the lateral compartments. Changes have significantly progressed since 2013. Small effusion with a questionable loose body projected behind the knee. Heavy atherosclerotic disease.Leg length: 16 degrees of valgus angulation is observed with additional minimal osteoarthritic changes of the proximal hip and distal ankle. | Severe osteoarthritic the left knee with valgus angulation |
Generate impression based on findings. | 55 years, Male. Reason: corpak placement History: corpak Enteric feeding tube is looped in the gastric fundus with tip projecting over the gastric body. Nonobstructive bowel gas pattern. | Enteric feeding tube is looped in the gastric fundus with tip projecting over the gastric body. |
Generate impression based on findings. | 55-year-old male history of metastatic prostate cancer and shortness of breath, compare to previous scans. CHEST:LUNGS AND PLEURA: No suspicious nodules or masses. No focal consolidation or pleural effusion. MEDIASTINUM AND HILA: Small right thyroid nodule is unchanged. Enlarged AP window lymph node (series 3, image 42) measures 1.3 x 1.8 cm, previously 1.3 x 1.8 cm. Additional small mediastinal nodes are unchanged. Mild cardiomegaly without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Sclerotic lesions compatible with metastases are present in the bilateral ribs and thoracic spine, similar to prior. ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly. No focal hepatic lesions are identified. SPLEEN: No significant abnormality notedPANCREAS: Minimal peripancreatic fat stranding appearing similar to prior.ADRENAL GLANDS: Left adrenal nodule measures 2.2 x 2.2 cm (series 3, image 103), previously 2.2 x 2.2 cm. Right adrenal nodule measures 2.0 x 2.0 cm (series 3, image 104), previously 2.0 x 2.0 cm. Superior exophytic nodularity from the right adrenal is stable.KIDNEYS, URETERS: Bilateral perinephric stranding is nonspecific and unchanged. Bilateral renal lesions appear similar to prior and likely represent hemorrhagic cysts, better characterized on the prior MRI.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastases involve the thoracolumbar spine and pelvis appearing similar to prior.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Prostate radiation fiducial markers.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged right inguinal lymph node measures 2.1 x 1.6 cm (series 3, image 218), previously 2.1 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic metastases involve the thoracolumbar spine and pelvis appearing similar to prior.OTHER: No significant abnormality noted. | 1.Overall stable exam without significant change in bilateral adrenal nodules, inguinal and mediastinal lymphadenopathy, and sclerotic osseous metastases. Please note that nuclear medicine bone scan is more sensitive in assessing osseous metastases. 2.Mild peripancreatic stranding likely related to prior pancreatitis, similar to prior.3.Bilateral hyperdense renal lesions likely represent hemorrhagic cysts similar to prior, better characterized on prior MRI. |
Generate impression based on findings. | 90 years, Female. Reason: eval obstruction, ileus History: ileus Residual enteric contrast is now noted in the rectum, indicating slow bowel transit. There is interval removal of the enteric feeding tube. There is interval improvement in multiple dilated loops of small bowel compatible with small bowel obstruction. No pneumoperitoneum. | Improving small bowel dilatation compatible with small bowel obstruction. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (1/7/15, 11/10/14), ultrasound images of left breast (1/7/15, 11/10/14) performed at Veterans Affairs Medical Center. For comparison, digital mammographic images (3/25/14) are available. DIGITAL MAMMOGRAPHIC IMAGES OF LEFT BREAST (1/7/15, 11/10/14):A BB marker is placed at posterior lateral left breast, denoting the site of palpable lesion. A large palpable round mass, measuring 55 mm, is present at posterior 3 o'clock position. The mass is significantly increased in size when compared to the prior study (11/10/14). On the prior study, the mass measures 34 mm. In addition, increase in parenchymal engorgement is seen in the left breast at lateral aspect. Multiple enlarged left axillary lymph nodes, which are larger than ones on prior study, are present.ULTRASOUND IMAGES OF LEFT BREAST (11/10/14):Irregularly shaped hypoechoic with ill-defined margins measuring 23 x 21 mm at the "area of swelling". Mixed hypo and anechoic components are present in the lesion.ULTRASOUND IMAGES OF LEFT BREAST (1/7/15):The lesion seen on the prior study (11/10/14) in the left breast becomes significantly larger, measuring 49 x 35 mm. The lesion becomes predominantly anechoic, suggesting necrosis. The lesion is reported to be malignant.DIGITAL MAMMOGRAPHIC IMAGES (3/25/14):The breast parenchyma is heterogeneously dense.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. | Rapidly enlarging malignant mass in the left breast with multiple enlarged left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Lung cancer. CHEST:LUNGS AND PLEURA: Left upper lobe cystic and solid mass measures 3.6 x 5 cm (4/33), previously 3.7 x 5 cm. Small clustered nodules associated with the mass are similar in appearance.Numerous nodules elsewhere in the left upper lobe are similar in size and number.Solid left lower lobe mass has decreased in size, 4.1 x 3.5 cm (4/72), previously 4.2 x 4.1 cm ( though if the prior study is remeasured its prior maximal transaxial dimensions were 4.9 x 4.6 cm on series 5 image 72).Right pneumonectomy.MEDIASTINUM AND HILA: Rightward mediastinal shift. Severe atherosclerotic disease of the aorta and its branches including the coronary arteries which are heavily calcified. No pericardial fluid. Nonindex subaortic lymph node not significantly changed (3/40). Other small lymph nodes in the mediastinum are similar to previous.CHEST WALL: The right chest wall deformity. Degenerative changes of the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Granulomas.ADRENAL GLANDS: Nodular thickening in of the left adrenal gland not appreciably changed.KIDNEYS, URETERS: Bilateral renal cysts and subcentimeter lesions use to accurately characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: An aortoiliac bypass is partially visualized.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval decrease in size of the left lower lobe mass.2. No significant change in left upper lobe mass, small mediastinal lymph nodes or numerous left upper lobe pulmonary nodules. |
Generate impression based on findings. | Prostate cancer with bone mets. There is redemonstration of multiple osseous metastatic lesions within the axial and appendicular skeleton. Some lesions appear to have increased radiotracer uptake and size while others have slightly decreased. However, no new lesions are identified. | Overall, stable distribution of multiple osseous metastatic lesions without new lesion. |
Generate impression based on findings. | 23-year-old male patient with history of Crohn's disease status post terminal ileum resection and narrowing at the ileocolonic anastomosis seen on colonoscopy. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 45 minutes. Fluoroscopic evaluation showed fixed narrowing of a 8 cm segment of neoterminal ileum. This portion of ileum demonstrated a cobblestoning appearance and separation of the loop compatible with fibrofatty proliferation. The narrowest portion of this segment measures 3 mm in diameter and is in the distal portion. The patient complained of pain in this area. The remaining small bowel appeared normal without ulcers, sinus tracts, fistulae, or adhesions. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 3:01 minutes | Severely narrowed long segment fibrostenotic disease at the neoterminal ileum compatible with active on chronic Crohn's disease. |
Generate impression based on findings. | Left shoulder and elbow pain. Three views of the left shoulder demonstrate no fracture or malalignment. No specific findings to account for the patient's symptoms are present.Four views of the left elbow demonstrate minimal osteoarthritis. No fracture or malalignment is present. | No acute findings to account for the patient's symptoms. |
Generate impression based on findings. | 37-year-old male patient status post total gastrectomy on 2/23/2015. Evaluate for leak. Scout radiograph of the lower chest and upper abdomen demonstrated postsurgical free air under the diaphragm, suture material and surgical staples in the right up quadrant, and a partially visualized percutaneous jejunostomy tube. Mildly distended loops of small and large bowel are compatible with postsurgical ileus. Air space opacity in the retrocardiac area may represent atelectasis versus consolidation.There is rapid flow of enteric contrast from the esophagus into the jejunum with a side-to-end anastomosis noted. Five minute delayed radiograph was taken. There is no leak evident.TOTAL FLUOROSCOPY TIME: 1:32 minutes. | Post surgical changes from total gastrectomy without evidence of leak. |
Generate impression based on findings. | Male 54 years old Reason: History of Hodgkin's lymphoma History: NOne Exam is limited secondary to lack of intravenous contrast. Evaluation of solid organs and vascular pathology is suboptimal. Within these limitations, the following observations are made:CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Prominent mildly enlarged left level 3/4 cervical lymph nodes again noted. Left chest wall port with catheter tip at the cavoatrial junction. CHEST WALL: Stable size of several right axillary lymph nodes. There is interval placement of surgical clips at the site of the largest axillary lymph node consistent with interval lymph node biopsy. The referenced right retropectoral lymph node now measures 0.8 x 0.6 cm (series 3, image 26), previously 0.9 x 0.7 cm. Left chest wall port in place.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cysts.RETROPERITONEUM, LYMPH NODES: Stable normal size retroperitoneal lymph nodes. The referenced left para-aortic lymph node measures 0.7 x 0.5 cm (series 3, image 96), previously 0.7 x 0.4 cm.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Stable fat-containing umbilical hernia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable right axillary lymphadenopathy and prominent mildly enlarged left cervical level 3/4 lymph nodes. No new sites of lymphadenopathy. |
Generate impression based on findings. | Injury There is a transverse fracture through the mid diaphysis of the fifth metacarpal, with volar angulation and full-width dorsal displacement of the distal fracture fragment. | Fifth metacarpal fracture, as above. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There are no areas of abnormal attenuation or pathological enhancement. There is redemonstration of a left cerebellar developmental venous anomaly. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is redemonstration of paucity of subcutaneous fat along the left paramedian frontal scalp, without evidence of focal skin or soft tissue thickening.NECK | No evidence of metastatic disease. Stable left frontal scalp postoperative changes. |
Generate impression based on findings. | Metastatic prostate cancer. Re-evaluation. No abnormal osseous foci are identified to indicate metastatic disease. Degenerative uptake noted in the shoulders, knees, cervical spine, and lower lumbar spine. | No evidence of bone metastases. |
Generate impression based on findings. | 56 years, Male. Reason: confirm ogt placement History: see above Enteric feeding tube tip projects over the distal gastric body. Common bile duct stent is again noted. Nonobstructive bowel gas pattern. Central venous catheter tip at the cavoatrial junction. Pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the distal gastric body. |
Generate impression based on findings. | 48 years, Male. Reason: s/p renal transplant stent removed in Urology History: confirm removal Nonobstructive bowel gas pattern with moderate to large stool burden in the colon. Interval nephrostomy stent removal. Postsurgical changes project over the left hemipelvis. | Interval nephrostomy stent removal. |
Generate impression based on findings. | Left knee pain Severe osteoarthritis affects the left knee, with medial joint space narrowing and varus angulation. This has minimally progressed since 2012.The right total knee arthroplasty device appears in near-anatomic alignment, as seen on frontal views. | Severe left knee osteoarthritis, minimally progressed. |
Generate impression based on findings. | 14-week-old former 27 week gestational age patient with increased work of breathing. Chest tube dislodged.VIEW: Chest AP (one view) 02/27/15, 1251 Left chest tube is no longer visualized. Right internal jugular line tip is at junction of right atrium and inferior vena cava. Feeding tube tip is distal to proximal body of stomach and not included on image.Left pneumothorax has increased in the interval and is small in size. Small left pleural effusion is identified. Cardiac silhouette size is normal. Hazy lung opacities are present bilaterally. | Increase in size of left pneumothorax after chest tube removal. |
Generate impression based on findings. | Bilateral knee pain RIGHT KNEE: Near severe osteoarthritis affects the right knee, with medial compartment narrowing and tricompartmental osteophytes. A moderate sized joint effusion is present.LEFT KNEE: Near severe osteoarthritis affects the left knee, with medial compartment narrowing and tricompartmental osteophytes. A moderate sized joint effusion is present. | Osteoarthritis, as above. |
Generate impression based on findings. | Ms. Cole is a 63 year old female presenting for routine mammogram. Per patient, she has radiating pain down the right shoulder and arm. She has no specific breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. Patient's right shoulder/arm pain should be managed clinically. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Neurosarcoidosis, chronic sinusitis, smoker and cough. LUNGS AND PLEURA: Faint new basilar and peribronchial ground glass opacities in the lower lobes and lingula, left greater than right. No signs of pulmonary edema. Mild emphysema. Mild left lower lobe bronchiectasis.MEDIASTINUM AND HILA: Normal heart size. No visible coronary artery calcifications. Significant improvement in previously seen lymphadenopathy in the chest, with mild left hilar lymphadenopathy remaining.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Nonspecific hypoattenuating lesion in the anterior liver unchanged, possibly a cyst, less likely sarcoidosis based on chronicity. Cholecystectomy clips. | Significant improvement in mediastinal and hilar lymphadenopathy since previous examination. On the current study, there are scattered groundglass opacities which are nonspecific in appearance at this time but could represent an early manifestation of alveolar sarcoidosis in the absence of clinical signs of infection. Suggest follow up ILD protocol CT in 6 months. |
Generate impression based on findings. | Reason: life long non smoker with 2 months cough, CXR demonstrating a RUL cavitary lesion History: cough LUNGS AND PLEURA: Scattered benign-appearing micronodules. No suspicious pulmonary nodules or masses.Minimal scattered ground glass opacity and nodularity through the dependent right upper and right middle lobes. Mild bronchiectasis, diffuse basilar ground glass density, and mild basal subpleural reticulation.No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Moderate coronary artery calcification. The main pulmonary artery is upper normal in caliber.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No suspicious pulmonary nodules or masses. No evidence of cavitary lesion.2. Mild patchy ground glass opacity may be postinflammatory in origin, including prior aspiration or infection. 3. Mild bronchiectasis, diffuse basilar ground glass density and reticulation may represent early pulmonary fibrosis. Recommend followup CT imaging with dedicated ILD protocol for further evaluation when feasible. |
Generate impression based on findings. | 62-year-old male patient status post reconstruction of esophagus with transverse cervical flap with history of fistula status post repair. Evaluate for leak/patency. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Enteric feeding tube extends beyond the inferior margin of the image. Surgical clips project over the neck and upper thorax. Bibasilar scarring noted.Single contrast evaluation of the cervical esophagus demonstrated a persistent connection between the anterior wall of the esophagus in the posterior wall of the trachea at the level of the laryngeal tube that measures up to 6 mm in craniocaudal dimension.TOTAL FLUOROSCOPY TIME: 1:05 minutes. | Persistent connection between the anterior wall of the esophagus the posterior wall of the trachea, measuring up to 6 mm in craniocaudal dimension. |
Generate impression based on findings. | 39-year-old male with epigastric and mid abdominal pain in the area of previous wound. 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: Very small left renal cyst.RETROPERITONEUM, LYMPH NODES: There is mild to moderate adenopathy seen in the suprapancreatic region, at the level of the gastrohepatic ligament and inferior to the main portal vein. The largest of these inferior the portal vein and anterior to the inferior cava measures approximately 1.7 x 3.8 cm on image 47/172. Small nodes are seen more caudally in the retroperitoneum.BOWEL, MESENTERY: Sigmoid colon and stomach are decompressed and wall cannot be adequately evaluated. There is no gross bowel wall abnormality.BONES, SOFT TISSUES: Multiple healed rib fractures and presumed sternal fracture from prior traumaOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid colon and stomach are decompressed and wall cannot be adequately evaluated. There is no gross bowel wall abnormality.BONES, SOFT TISSUES: Multiple healed rib fractures and presumed sternal fracture from prior traumaOTHER: No significant abnormality noted | Unusual pattern of adenopathy in the peripancreatic region of unknown significance.Posttraumatic bony changes as noted above. |
Generate impression based on findings. | There is a calculus that measures up to 35 mm in the superior aspect of the right submandibular gland with associated right intraglandular ductal dilatation. These findings are grossly similar to the CT cervical spine exam from 2007. There is no associated soft tissue stranding or edema. There is no significant cervical lymphadenopathy. The thyroid and other salivary glands are otherwise unremarkable. There are mild atherosclerotic calcifications of the carotid bifurcations. The major cervical vessels are otherwise patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is trace right maxillary sinus mucosal thickening. There is unchanged moderate right-sided uncovertebral hypertrophy at C3-4, C4-5, C5-6 with right neural foraminal stenosis at these levels. There are paraseptal emphysematous changes in the lung apices. There are numerous dental caries, some of which are associated with periodontal lucencies. There is extensive torus mandibularis. | 1. Large right submandibular sialolith with intraglandular ductal dilatation, but no associated inflammatory changes.2. Extensive dental disease. |
Generate impression based on findings. | 79-year-old male with remote history of bladder cancer now with irritative voiding symptoms. ABDOMEN:LUNG BASES: Minimal basilar atelectasis. Previously referenced left hilar lymph node is not included in the field of view.LIVER, BILIARY TRACT: Diffuse low-attenuation of the liver compatible with hepatic steatosis. The liver also demonstrates a nodular contour with widening of the fissures and atrophy of the right lobe consistent with cirrhotic morphology.There is redemonstration of indeterminate lesions in segment 7 of the liver. Two poorly defined hyperenhancing lesions are present superiorly (series 7, image 23) which demonstrate some washout and appear to have increased in size. The larger, more medial lesion (series 7, image 23) measures approximately 4.1 x 4.6 cm, previously 2.9 x 3.3 cm. A third hypoattenuating lesion is present just inferior to the other two lesions which appears similar in size. Given the background evidence of cirrhosis these lesions are concerning for possible HCC.Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The previously described right adrenal nodule is unchanged in size now measuring 1.5 x 2.0 cm (series 7, image 35) and previously measured 1.5 x 2.0 cm. Given the stability in size since 2004, a benign adrenal adenoma is favored.KIDNEYS, URETERS: Previously seen right-sided hydronephrosis has resolved. A round fluid density lesion is again seen in the right kidney consistent with a simple cyst. The previously described subcentimeter high attenuation lesion in the left anterior kidney is stable in size since the prior examination and likely represents a hemorrhagic cyst.The kidneys excrete contrast symmetrically. No filling defects are identified in the collecting systems. The distal ureters are again slightly dilated with a focal narrowing in the right distal ureter (series 9, image 100), similar to prior. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are again noted and appear stable since the prior examination. Aortocaval lymph node measures 1.1 x 1.0 cm (series 7, image 62), previously 1.1 x 1.0 cm. Retroperitoneal lymph node on the left measures 0.9 x 1.3 cm (series 7, image 64), previously 0.9 x 1.3 cm. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple enlarged pelvic lymph nodes are again noted and appear stable since the prior examination. Reference right external iliac lymph node now measures 0.9 X 1.5 cm (series 7, image 113), previously 0.9 X 1.5 cm. Left external iliac lymph node now measures 0.9 x 1.2 cm (series 7, image 118); previously 0.9 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine including compression deformity of L1 appearing similar to prior. OTHER: No significant abnormality noted | 1.Cirrhotic appearing liver with two enhancing lesions which appear to have increased in size and remain concerning for possible HCC. Dedicated MR of the liver should be considered in the appropriate clinical setting.2.Stable retroperitoneal and pelvic reference lymph nodes.3.Stable adrenal nodule likely representing adrenal adenoma.4.Interval improvement of right-sided hydronephrosis. |
Generate impression based on findings. | There are punctate foci of diffusion restriction in the left centrum semiovale and in the left paramedian cerebellum. There is corresponding T2/FLAIR hyperintensity in these locations. There is punctate enhancement associated with the left paramedian inferior cerebellar focus of diffusion restriction. There is mild diffusion hyperintensity along the cortex of the lateral aspect of the left superior frontal gyrus with cortical FLAIR hyperintensity. Punctate enhancement is seen with subtle FLAIR hyperintensity along the medial aspect of the left middle frontal gyrus. There are also areas of gyral thickening and sulcal effacement with extensive T2/FLAIR hyperintensity and gyriform enhancement within predominantly the right precentral and post central gyrus as well as more posteriorly in the right parietal occipital lobes. There are scattered foci of susceptibility within the cerebral hemispheres and cerebellum bilaterally consistent with chronic hemosiderin deposition, possibly relating to amyloid angiopathy.Incidental note is made of mild diffuse dural thickening and enhancement along the floor of the right middle cranial fossa with invasion of the right cavernous sinus by slightly heterogeneously enhancing soft tissue. There is resultant asymmetry in the contour of the sella. Meckel's cave is not well delineated in the right due to the encroachment of soft tissue along its superior margin. Exact measurement of this mass is difficult due to its configuration, although it measures approximately 1.1 cm transverse by 3.0-cm AP by 2.0 cm CC. There is dural extension along the right paramedian prepontine cistern. There is encasement of the cavernous right internal carotid artery although without narrowing. There is also questioned mild expansion of the anterior aspect of the left cavernous sinus. In addition, there is a small extra-axial dural based enhancing mass measuring 8 x 9 mm on 1201/348 just above the left central sulcus.The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. Intracranial vessels are somewhat dolichoectatic, especially The midline structures and craniocervical junction are within normal limits. There are prominent mucosal retention cysts in the maxillary sinuses the sphenoid sinuses, with a small amount of aerated secretions in the left sphenoid sinus. There is severe left and moderate-severe right mastoid air cell and middle ear fluid opacification. There is also fluid likely within a pneumatized left greater than right petrous apex. There is fluid dependently in the naso- and oropharynx.Incidental note is made of more focal oval areas of fat signal intensity in the posterior lateral subcutaneous fat of the neck, and possibility of focal lipomas cannot be excluded. | 1. Multiple scattered evolving infarcts, including punctate acute infarcts in the left centrum semiovale. Subacute infarcts are seen involving the right frontal, parietal, and occipital lobes, with smaller areas in the left frontal and parietal lobes, as well as the left cerebellum.2. Numerous foci of scattered susceptibility within the brain parenchyma consistent with chronic hemosiderin deposition, with distribution suggestive of amyloid angiopathy.3. Right cavernous sinus expansile mass with encroachment if not invasion of the right Meckel's cave, most suggestive of meningioma. Mild dural thickening and enhancement extending along the adjacent floor of the right middle cranial fossa. Questioned additional mild expansion of the anterior left cavernous sinus which may be related to the same process.4. Additional left parietal convexity enhancing subcentimeter extra-axial mass also consistent with meningioma.5. Extensive mastoid air cell and middle ear opacification bilaterally, as well as scattered paranasal sinus inflammatory changes. Please correlate clinically. |
Generate impression based on findings. | Bilateral vesicoureteral reflux. Please evaluate for renal scarring. Sequential DMSA renal images show the kidneys to be of normal size, morphology,and position. Both kidneys demonstrate prompt homogenous diffuse cortical uptake with nofocal defects evident.The estimated contribution of the right kidney to total renal function is 52% and that ofthe left kidney is 48%. | Normal examination. No focal renal cortical defects. |
Generate impression based on findings. | Severe emphysema, Alpha I deficiency, severe S.O.B. and weight loss. Cough. LUNGS AND PLEURA: Severe emphysema with hyperexpansion of the right lung. Abrupt angulation of the right upper lobe bronchus is noted, though it remains patent. The anterior segmental bronchus of the right upper lobe is patent. The posterior segmental bronchus is narrowed with atelectasis of subsegments posteromedially. Bronchus intermedius is narrowed in the AP dimension measuring 6-mm (6/52).MEDIASTINUM AND HILA: Atherosclerotic calcification of the aorta and its branches. Normal heart size. Moderate coronary artery calcifications. Main pulmonary artery appears enlarged, measuring 2.9-cm in transverse dimension. No lymphadenopathy. The intrathoracic trachea is dilated.CHEST WALL: Compression fracture of T12 and L1 vertebral bodies. Demineralization of the skeletal structures. Thoracic kyphosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the aorta and its branches. | Severe emphysema. Collapse of the right upper lobe posterior segment with smooth borders, most consistent with atelectasis; a proximally obstructing lesion or a lesion within the collapsed lung cannot be excluded by CT. If there is clinical suspicion for malignancy, consider further assessment with FDG- PET scan. The main pulmonary artery appears enlarged, suspicious for pulmonary hypertension. Coronary artery disease. |
Generate impression based on findings. | Reason: r/o intracranial bleed History: s/p total artificial heart, neuro exam altered Examination performed on the portable CT scanner which provides lower contrast resolution and then a conventional CT scanner furthermore there are metal wires surround the patient's head and create artifacts.There are no early stigmata of cerebral infarction appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 6-mm subdural hyperdense focus adjacent to the right medial parietal lobe at the level of the precuneus extending inferiorly along the right occipital lobe. The visualized portions of the paranasal sinuses demonstrate partial opacification of the paranasal sinuses status post intubation.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.There is a small subdural hematoma adjacent to the right parietal lobe extending down to the right occipital lobe.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Examination was performed on a portable scanner as well as associated with artifacts. As a result subtle abnormalities may not be as readily apparent.4.Findings reported to Dr. Levin by Dr. Wu at the time of the exam. |
Generate impression based on findings. | Chronic sinusitis. There are postoperative findings related to endoscopic sinonasal surgery with bilateral uncinectomy and medial upper antrostomy, partial ethmoidectomy, and inferior turbinectomy. There are persistent bilateral maxillary sinus retention cysts, partial opacification of the right neo-infundibulum and mild opacification of the remaining ethmoid air cells. The nasal cavity is clear. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, and orbits structures appear to be unremarkable. There are postoperative findings with encephalomalacia in the right temporal lobe. | Postoperative findings related to endoscopic sinonasal surgery with scattered paranasal sinus opacification including persistent bilateral maxillary sinus retention cysts. Of note, the absence of the bilateral inferior turbinates can predispose to empty nose syndrome. |
Generate impression based on findings. | Female 72 years old Reason: Shoulder pain History: Pain. Left shoulder: The bones appear demineralized. There are moderate to severe degenerative arthritic changes of the glenohumeral and acromioclavicular joints with sclerosis and joint space narrowing, osteophyte formation, and subchondral cysts. There is no acute fracture or dislocation. Note is made of a partially imaged ICD device.Right Shoulder: Severe degenerative arthritic changes affect the glenohumeral and acromioclavicular joints with sclerosis and joint space narrowing, osteophyte formation and subchondral cysts. There is no acute fracture or dislocation. Note is made of a partially imaged plate and screws device affixing the distal humerus and partially imaged ICD lead. | Moderate to severe osteoarthritis of the left shoulder joint and severe osteoarthritis of the right shoulder joint. |
Generate impression based on findings. | Reason: signs of infection History: neutropenic fever LUNGS AND PLEURA: Multifocal areas of peribronchovascular groundglass opacity. Prominent septal lines. Small bilateral pleural effusions, with minimal dependent atelectasis.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is normal in size, with a new small circumferential pericardial fluid collection. Mild coronary artery calcification. Hypoattenuation of the blood pool, suggestive of anemia.Scattered mediastinal lymph nodes, increased in size from the prior exam. A right paratracheal lymph node measures 9 mm (series 3, image 26). Mild hilar lymph node enlargement.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatosplenomegaly. | 1. Mild patchy areas of groundglass opacity nonspecific and may represent edema given the presence of septal thickening and new pleural and pericardial fluid. Infectious process is a differential consideration in a neutropenic patient, including viral pneumonia; pneumocystis pneumonia is possible, but considered less likely.2. New mild mediastinal and hilar lymphadenopathy. |
Generate impression based on findings. | 18 month status post left lower lobe lung resection. LUNGS AND PLEURA: Nodule containing an air bronchogram in the posterior right upper lobe abutting the fissure (5/42) has enlarged, measuring 5 x 9 mm, previously 4-mm in diameter, now suspicious for a metastasis.Severe emphysema. Bronchial wall thickening and ended bronchiolitis, chronic. Postsurgical volume loss on left. Pleural thickening on the left not significantly changed. Loculated small pleural fluid collection on the right decreased in volume although thickening of both the visceral and parietal pleural surfaces remain.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aorta and its branches. Leftward mediastinal shift. Severe coronary artery calcification. No visible lymphadenopathy.CHEST WALL: Small left internal mammary chain lymph nodes, not normally visible, present previously and not significantly changed.. Thoracic kyphosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic calcification aorta and its branches. | Interval enlargement of a right upper lobe pulmonary nodule, now suspicious for a metastasis. No signs of localized recurrence at the resection site. Slight decrease in volume of loculated pleural fluid on the right with chronic thickening of the visceral and parietal pleural surfaces . |
Generate impression based on findings. | Reason: is there evidence stroke History: speech difficulty yesterday - resolved after 20 minutes (occurred yest am 830) The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses redemonstrated mucus retention cyst in left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. These have progressed when compared to the 2005 exam. |
Generate impression based on findings. | Female 66 years old Reason: SLE/RA overlap with recurrent pain at L trochanteric bursa and hip - rule out bony lesion History: SLE/RA overlap with recurrent pain at L trochanteric bursa and hip - rule out bony lesion Mild degenerative arthritic changes affect the left hip joint with enthesophyte formation at the anterior superior iliac spine. | Degenerative arthritic changes of the left hip joint with enthesophyte formation at the anterior superior iliac spine. |
Generate impression based on findings. | Again demonstrated is a vascular right thigh mass of homogeneous echogenicity measuring 8.3 x 4.8 x 5.9, not significantly changed compared with the prior exam, although there were differences in measuring technique. Multiple feeding vessels and draining veins are again noted.DOPPLER | Vascular right thigh mass consistent with the history of Kaposiform hemangioendothelioma, not significantly changed from the prior exam. |
Generate impression based on findings. | Asbestos exposure weight loss rule out malignancy. LUNGS AND PLEURA: Bilateral nodular pleural plaques and calcification consistent with prior asbestos exposure. Linear scarring at the right lung base. No pulmonary masses or suspicious nodules.MEDIASTINUM AND HILA: Mild cardiomegaly. Calcification involving the aortic valve. Faint coronary artery calcifications. No pericardial fluid. Pulmonary artery appears normal in caliber.Within the left anterior mediastinum, there is a 10 x 20 mm soft tissue density nodule which may represent a lymph node or a small thymoma, partially visualized on the 2003 scan (series 2 image 29) and probably benign, though it may have been slightly smaller.CHEST WALL: Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Nonspecific subcentimeter area of hypoattenuation in the posterior right hepatic lobe (3/113), incompletely characterized but unchanged, probably benign. A previously seen hypoattenuating lesion also in the right hepatic lobe on the 2003 scan is not visible on the current study, possibly due to technique. | Emphysema, signs of asbestos exposure and mild coronary artery disease, but no suspicious findings to suggest the presence of pulmonary malignancy. Small anterior mediastinal soft tissue nodule is probably benign given its chronicity can be conservatively followed with CT in 4 months unless there is a high enough level of clinical suspicion to warrant a PET scan.Aortic valve calcification may be further assessed with echocardiography to exclude stenosis if required. |
Generate impression based on findings. | Female 43 years old Reason: fx f/u History: pain. Three views of the left wrist show a minimally laterally displaced transverse fracture of the radial styloid extending to the articular surface of the radiocarpal joint. The fracture line appears somewhat indistinct indicating partial healing. A fracture of the ulnar styloid is also demonstrated in near-anatomic alignment, with became somewhat indistinct fracture line indicating partial healing. Overall, the bones appear slightly demineralized possibly due to disuse. | Partial healing of intra-articular radial and ulnar styloid fractures. |
Generate impression based on findings. | Female 71 years old Reason: r/o fracture History: swelling, pain. Two views of the right humerus show a comminuted transverse fracture of the surgical neck of the right humerus with mild medial displacement of the distal fracture fragment. | Comminuted fracture of the surgical neck of the humerus as described above. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (9/12/14) performed at St. Anthony Hospital. For comparison, digital mammographic images (5/7/13, 10/1/10, 1/6/09, 8/14/07) are available. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable intramammary lymph nodes are present in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 1 - NegativeRECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 45 years old Reason: r/o foriegn body History: laceration. There is diffuse soft tissue swelling about the hand. No acute fracture or dislocation is present. No radio opaque foreign body is evident. | No radiopaque foreign body is evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Prior benign biopsies bilaterally. 3 sisters with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Numerous benign morphology calcifications are scattered bilaterally, left greater than right. Biopsy clips in the right upper outer and left upper inner breast noted. Local architectural distortion at the sites of biopsy is stable.No suspicious masses or microcalcifications are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Suspicion of shaken baby syndrome and a subdural hematoma and underwent removal and then replacement of cranioplasty bone in October of 2014. History of brain injury and trauma. Evaluate skull fracture healing. There interval absence of the right parietal bone flap, with a skull defect that measures up to approximately 6 cm. There is fluid subjacent to the scalp flap measuring up to 8 mm in thickness. There is increase in size of the cystic components of the right parietal lobe encephalomalacia, which protrudes slightly through the skull defect. Smaller areas of encephalomalacia in the bilateral occipital lobes are otherwise not significantly changed. There is associated ex vacuo dilation of the right lateral ventricle. There is no evidence of acute intracranial hemorrhage. There is no midline shift. The imaged paranasal sinuses and mastoid air cells are clear. | Interval resorption of the right parietal bone flap with a skull defect that measures up to 6 cm and increase in size of the cystic components of the right parietal lobe encephalomalacia, which is perhaps in proportion to interval head growth, but it protrudes slightly through the skull defect. Smaller areas of encephalomalacia in the bilateral occipital lobes are otherwise not significantly changed. |
Generate impression based on findings. | 12-year-old female with history of LP shunt with difficulty reprogramming, continued headache.EXAMINATION: Fluoroscopic guidance for reprogramming of Codman Hakim programmable valve 02/27/15 Fluoroscopic guidance was provided for reprogramming of Codman Hakim programmable valve. Reprogramming was performed by nurse practitioner Paula Zakrzewski. Codman Hakim programmable valve was changed from 200 mm of water to 70 mm of water. 29 seconds of fluoroscopy was used. | Fluoroscopic guidance provided for reprogramming of Codman Hakim programmable valve which is now set at 70 mm of water. |
Generate impression based on findings. | Female 68 years old Reason: Pt presented to OSH with Painless jaundice was stented by ERCP. Bile duct mass. Pt had imaging at OSH no definitive pancreas mass with with CBD dilatation. Needs pancreas protocol Ct Scan History: none ABDOMEN:LUNG BASES: Small bilateral pleural effusions, left greater than right, with interval improvement compared to prior exam. .LIVER, BILIARY TRACT: Expected pneumobilia which is likely iatrogenic in etiology. Metallic common bile duct stent is in place with distal end in the duodenum. No definitive common bile duct mass is seen as the common bile duct stent may obscure visualization. No focal hepatic mass is noted. There is debris in the distal portion of the stent. Interval improvement in abdominopelvic ascites seen on prior exam.Hepatic vasculature is patent. There is no variant anatomy of the vasculature.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypodense lesion in the right kidney is too small to characterize but likely represents a cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval resolution of previously seen anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Marked degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1.No definitive visualization of a bile duct or pancreatic mass.2.Interval improvement in pleural effusions and ascites. |
Generate impression based on findings. | 18-month-old female with history of trauma. Evaluate for intracranial hemorrhage or fracture. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or calvarial fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of benign right breast MR guided biopsy and a history of bilateral breast reduction. Strong family history of breast cancer, including mother, maternal aunt, maternal cousin, and paternal grandmother. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy mark clip identified in the right lateral breast, at site of prior benign breast biopsy. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
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