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Generate impression based on findings. | 16 month old female with history of head injury. There is a large right occipital subgaleal hematoma without underlying calvarial fracture. No evidence of acute intracranial hemorrhage. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. The gray-white differentiation is maintained. No extra-axial collections. The ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Large right occipital subgaleal hematoma without underlying calvarial fracture or intracranial hemorrhage. |
Generate impression based on findings. | 12-year-old male with respiratory insufficiency.VIEW: Chest AP (one view) 2/28/2015 3:27 Right PICC tip in the SVC. Gastrostomy tube is noted. Cardiothymic silhouette is unchanged. Patchy right middle lobe opacities are improved. Slight improvement in linear left upper lobe linear opacities most likely atelectasis. Thoracolumbar dextroscoliosis is again noted. Right upper quadrant surgical clips. | Decreased right middle lobe opacity. |
Generate impression based on findings. | Female 28 years old Reason: assess for splenomegaly, diverticulitis, or other cause of LLQ abdominal pain History: LLQ abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific mild periportal edema. Prominent liver measuring up to 20 cm in length (coronal images series 8038, image 43). No focal hepatic mass or ascites. No biliary ductal dilatation. No ascites.SPLEEN: No evidence of splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Ill-defined, wedge-shaped hypoechoic foci extending to the periphery are present within the kidneys bilaterally. These findings are suspicious for bilateral pyelonephritis. Right lower pole hypoechoic focus best seen on coronal image (series 803, image 32). Left upper pole hypoechoic foci best seen on coronal images (series 803, image 25 and 30). Ischemic disease may also have this imaging appearance, however is considered less likely. No radioopaque nephrolithiasis or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large stool burden. No evidence of bowel obstruction or intraperitoneal free air.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: No evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted | 1.Focal ill-defined, wedge-shaped hypoechoic areas within the renal parenchyma suspicious for bilateral pyelonephritis. 2.Large stool burden. Correlate with patient for history of constipation. 3.No evidence of splenomegaly or diverticulitis as clinically questioned.Findings were discussed with the clinical service Dr. Benes at 8:45 a.m. on 2/28/2015. |
Generate impression based on findings. | 10-year-old female with history of CSF leak after LP now complaining of headaches and blurry vision. There is no evidence of acute intracranial hemorrhage. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. The gray-white differentiation is maintained. No evidence of extra-axial collections. The ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The cerebellar tonsils extend approximately 9 mm below the foramen magnum compatible with Chiari I malformation. There are postsurgical changes from suboccipital craniectomy. | 1. No intracranial hemorrhage or extra-axial collections. No obvious CT evidence of intracranial hypotension.2. Postoperative changes of suboccipital craniectomy for Chiari 1 decompression. |
Generate impression based on findings. | Evaluate Dobbhoff tube Enteric tube seen coiled in stomach with tip located in proximal gastric body, tube is kinked approximately 12 cm from tip in distal gastric body. Nonobstructive bowel gas pattern. Compared to prior study, interval improvement in spinal alignment, previously described scoliosis is likely positional. | Enteric tube as above, repositioning should be considered if tube does not seem to be functioning appropriately, may be secondary to kinking of tube as described. |
Generate impression based on findings. | Enteric tube placement Suboptimal study due to patient motion artifact. Enteric tube seen with distal portion kinked at expected region of side-port, tip directed upward/retrograde and located in distal esophagus, repositioning recommended. Left basilar/retrocardiac consolidation. Please note that right hemithorax not included in entirety on submitted image. | Enteric tube as above, repositioning recommended. |
Generate impression based on findings. | 60-year-old male with history of unsteadiness. There is no evidence of acute intracranial hemorrhage. There is mild global parenchymal volume loss. The ventricles are slightly prominent for the degree of volume loss and minimally progressed since 2012. There are calcifications of the visualized distal vertebral and internal carotid arteries. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. The gray-white differentiation is maintained. No evidence of extra-axial collections. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues are within normal limits. | 1. No intracranial hemorrhage, mass, or mass effect.2. Prominence of the ventricular system which is favored to be due to volume loss. However, correlate with clinical findings for possible component of communicating hydrocephalus/NPH. |
Generate impression based on findings. | Evaluate enteric tube, recently advanced Suboptimal study due to patient's body habitus. Status post sternotomy. Enteric tube seen with tip approximately 4 cm beyond the gastroesophageal junction, side-port appears to be at the level of the gastroesophageal junction, further advancing by approximately 4 cm recommended. Basilar atelectasis. Right upper quadrant surgical clips. Incompletely imaged gas containing bowel, not well assessed on this nondedicated study. | Enteric tube as above, further advancing recommended. |
Generate impression based on findings. | Female 68 years old Reason: eval fusion History: s/p L1-5 XLIF. Interval placement of bone grafts at L1/L2, L2/L3, L3/L4, L4/L5, and L5/S1. There is marked scoliosis of the lower lumbar spine, unchanged from the prior exam. Moderate to severe degenerative changes including multilevel anterior vertebral body osteophytes neuroforaminal narrowing are better evaluated on recent CT. | Postoperative changes of the lower lumbar spine as described above. |
Generate impression based on findings. | Dobbhoff tube placement, assess positioning Dobbhoff tube seen with tip in gastric fundus. Residual contrast seen in right colon. Incompletely imaged bowel demonstrates gaseous distention, may reflect diffuse ileus. Postsurgical sequela seen in lower abdomen. Please refer to recent CT chest imaging for additional findings. Spinal degenerative disease. | Enteric tube as above. |
Generate impression based on findings. | 32 year old female with history of MS and unwitnessed fall. Evaluate for hemorrhage. There is no evidence of acute intracranial hemorrhage or calvarial fracture. Extensive areas of hypoattenuation in the white matter are compatible with patient's history of advanced multiple sclerosis. There is advanced parenchymal volume loss. The gray white differentiation is preserved. Ventricular configuration is stable with no evidence of hydrocephalus. No midline shift or mass-effect. The visualized paranasal sinuses, mastoid air cells, and orbits are within normal limits. The soft tissues of the scalp are normal. | 1. No evidence of acute intracranial hemorrhage or calvarial fracture.2. Marked white matter disease and volume loss compatible with patient's history of multiple sclerosis and better evaluated on recent MRI. |
Generate impression based on findings. | Generalized abdominal pain Above average stool burden. No evidence of bowel obstruction. Mediastinal shift towards right, reflecting volume loss, incompletely imaged postsurgical scarring. Please note that multiple bilateral pulmonary metastases seen on earlier CT chest imaging not well delineated on this nondedicated radiographic exam, please refer to January 6, 2015 CT chest exam for additional findings. | Large stool burden, correlate clinically for constipation. No bowel obstruction. |
Generate impression based on findings. | Nausea and vomiting No free air seen on submitted erect view. Incompletely imaged mild gaseous distention of colon (pelvis excluded on submitted image), stable to minimally improved from prior study. Basilar atelectasis/airspace disease, particularly on left. Subcentimeter radiodensity in right humeral head, may be sclerotic focus versus iatrogenic. | No free air.Incompletely imaged bowel without significant change, see above. |
Generate impression based on findings. | 48 year-old male with history of fall. Evaluate for hemorrhage. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No midline shift or mass effect. No extra axial fluid collections are identified. The ventricles are within normal limits without evidence of hydrocephalus. There is a small fat containing ovoid lesion within the left parietal scalp at the vertex compatible with a lipoma. The visualized paranasal sinuses, mastoid air cells, and orbits are unremarkable. | 1. No evidence of acute intracranial hemorrhage or calvarial fracture.2. Small lipoma within the left parietal scalp similar to 2006. |
Generate impression based on findings. | 0-day-old male (32 week gestational age patient) with increasing respiratory distress, increasing O2 requirement. Evaluate UVC tip placementVIEWS: Chest and abdomen AP (two views) 2/28/2015 8:30 Umbilical venous catheter tip in the right atrium.Left sided aortic arch, cardiac apex and stomach. Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax.Disorganized nonobstructive bowel gas pattern. | UVC tip in the right atrium. |
Generate impression based on findings. | HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns 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 extracranial soft tissues are unremarkable. NECK: There are postoperative changes of total thyroidectomy with persistent ill-defined soft tissue prominence inferior to the thyroidectomy bed on the left and medially which is stable from 5/9/2014. No significant change in subcentimeter bilateral cervical lymph nodes. There is an unchanged low attenuation focus in the left parotid gland measuring up to 14 mm. The osseous structures show no focal lesion. There are stable multilevel cervical degenerative changes with small disk osteophyte complexes at C3-4, C4-5 and C5-6. There is stable 2-mm retrolisthesis of C5 on C6. There is stable loss of disk height at multiple levels in the cervical spine. There are atherosclerotic calcifications of the bilateral carotid bifurcations. Right inferior internal jugular vein is occluded and unchanged. The major cervical vessels are otherwise patent. There is a stable small lipoma in the left lower posterior neck soft tissues. The airways are patent. The imaged portions of the lungs show multiple nodules; please refer to dedicated accompanying CT chest report for further details. There are unchanged nonspecific bilateral cheek and right forehead skin nodules. | 1.No significant change in nonspecific ill-defined soft tissue prominence inferior to the thyroidectomy bed which may represent postsurgical change. An ultrasound of this region may be useful for further characterization. No new or enlarging neck mass or significant cervical lymphadenopathy is seen. 2.Left parotid fluid attenuating cystic lesion which may represent cyst, cystic neoplasm or focal ductal dilatation. While it is stable from 5/9/2014, it has mildly enlarged from 10/18/2012. 3.Please refer to dedicated accompanying CT chest report for further details regarding multiple lung metastases.4.No CT evidence of intracranial metastatic disease. MRI would more sensitive and can be considered if clinically indicated.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Colonic distention Percutaneous gastrostomy tube, tube projects over region of gastric body. Moderate gastric gaseous distention. Air containing small and large bowel. Appearance suggestive of diffuse ileus.Lumbosacral degenerative disease.Please refer to concomitant chest radiography from same day for additional findings. | Moderate gastric gaseous distention, for which continued follow-up suggested. Air containing small and large bowel, appearance suggestive of diffuse ileus. |
Generate impression based on findings. | Assess stool burden, history of abdominal pain and constipation Mildly below average stool burden. No bowel obstruction. Right-sided postsurgical spinal hardware including transpedicular screws/rod device again seen. Hip degenerative disease. | No bowel obstruction. |
Generate impression based on findings. | 14-week-old female with increased work of breathing. Evaluate for pneumothorax and size of pleural effusion.VIEW: Chest AP (one view) 2/28/2015 7:48 Right central venous catheter tip in the right atrium. Feeding tube with the side port at the GE junction. Cardiothymic silhouette is normal. Hazy lung opacities are seen bilaterally, increased on the left with likely increase in size of left pleural effusion. Left-sided pneumothorax is no longer seen. No right pneumothorax. | Bilateral hazy pulmonary opacities, increased on the left with likely increased left pleural effusion. Left pneumothorax no longer seen. |
Generate impression based on findings. | Abdominal pain status post ERCP Residual contrast in portions of colon, particularly hepatic flexure. Nonobstructive bowel gas pattern. Common bile duct stent. Please note that evaluation for free air suboptimal as only supine imaging was performed.Incompletely imaged sternotomy and additional left mediastinal/hilar radiodensities, may reflect iatrogenic material but nonspecific. Mild basilar atelectasis. Multiple left mediastinal clips.Diffuse decreased osseous mineralization. Degenerative disease of spine and scoliosis. Calcified soft tissue granulomata. | Nonobstructive bowel gas pattern. If there is concern for free air, please note that this would be better assessed with dedicated upright or decubitus radiographic imaging or CT. |
Generate impression based on findings. | Female 41 years old Reason: Persistent fevers, neutropenic patient, assess for infectious source History: Persistent fevers, history of lymphoma. Exam is limited secondary to lack of oral and intravenous contrast. Lack of intravenous contrast makes the evaluation of solid organ and vascular pathology suboptimal. Lack of oral contrast makes evaluation of bowel pathology suboptimal. Within these limitations the following observations can be made:CHEST:LUNGS AND PLEURA: Left basilar atelectasis. No suspicious nodule. MEDIASTINUM AND HILA: Right chest port and left-sided central venous catheter with catheter tips at the SVC-atrial junction. No hilar or mediastinal lymphadenopathy. Interval placement of enteric tube with tip beyond the pylorus. Beam hardening artifact makes evaluation of the antropyloric region suboptimal.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hydropic gallbladder measuring up to 5.0 cm (series 5, image 125), nonspecific. No focal hepatic lesion or biliary ductal dilatation.SPLEEN: Mild splenomegaly appearing similar to prior.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes consistent with prior bilateral tubal ligation and Essure placement.BLADDER: No significant abnormality noted.noted.BONES, SOFT TISSUES: Nonspecific small pelvic ascites which may be physiological in etiology. | Limited exam secondary to lack of oral and intravenous contrast. Within these limitations, a hydropic gallbladder is seen, nonspecific. The patient had a recent abdominal ultrasound exam on 2/23/2015, which showed no evidence of gallstones or acute cholecystitis. Ultrasound imaging may be repeated or nuclear medicine study obtained if strong clinical concern for acute cholecystitis remains. |
Generate impression based on findings. | Abdominal distention/constipation Moderate stool burden, greater than on prior study. No bowel obstruction. Hepatomegaly. Bilateral hip dysplasia present. | Nonobstructive bowel gas pattern, moderate stool burden. |
Generate impression based on findings. | J-tube placement, assess for ileus or obstruction Left-sided percutaneous enteric tube, seen in left mid abdomen medially, projecting over bowel measuring up to 5.3 cm, uncertain whether stomach or dilated jejunum. Please note that more accurate determination of exact location of tube could be achieved with imaging following instillation of contrast via tube. Upper abdominal surgical clips. Very large stool burden. No bowel obstruction. Left inguinal surgical clips. Incompletely imaged right-sided chest tubes, please refer to recent dedicated chest radiography for additional findings, previously seen right subpulmonic pneumothorax not as well assessed on this nondedicated study, right basilar atelectasis/effusion. | Very large stool burden, likely reflecting constipation. Additionally, prominent bowel seen in abdomen centrally at location of percutaneous enteric tube as described, uncertain whether reflects stomach or dilated small bowel, correlation with patient's clinical history and continued follow up recommended. |
Generate impression based on findings. | Male 61 years old Reason: cause of abdominal pain, mid epigastric, supraumbilical, assess for mass History: Abdominal pain ABDOMEN:LUNG BASES: Mild centrilobular emphysema with mild bronchial wall thickening.LIVER, BILIARY TRACT: No focal hepatic mass or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Portions of small bowel are not well distended however there is enhancement of some small bowel loops and adjacent mesentery which may suggest infectious/inflammatory process such as enteritis. No small bowel dilatation to suggest obstruction. Within the pelvis, there are multiple loops of fluid-containing bowel which appear to have a tethered appearance (series 3, image 77). Nonobstructing underlying adhesive disease cannot be excluded.BONES, SOFT TISSUES: No evidence of supraumbilical mass.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with dystrophic calcifications.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine. | 1.Focal enhancement of the small bowel and adjacent mesentery suggestive of infectious/inflammatory process such as enteritis. Follow up to resolution. 2.Possible rectal wall thickening versus underdistention. This could represent an infectious, inflammatory, or malignant process, however correlation with direct visualization and/or colonoscopy is recommended.3.No evidence of supraumbilical mass. |
Generate impression based on findings. | Assess for residual stone fragments in right ureter following right percutaneous nephrolithotomy Suboptimal study due to patient motion artifact and body habitus. Right-sided percutaneous catheter in right mid abdomen. Moderate to large stool burden, particularly in right abdomen, no bowel obstruction. No radiopaque density seen in expected region of right urinary tract but evaluation suboptimal due to overlying stool. Amorphous radiodensity seen in left abdomen, corresponding to left-sided staghorn calculi seen on prior CT imaging from February 6, 2015. Bilateral tubal ligation. | Suboptimal assessment for radiopaque right-sided urolithiasis due to overlying stool, no definite radiodensity seen on right side. If there is continued clinical concern, imaging with CT recommended.Left-sided staghorn calculi. |
Generate impression based on findings. | NG tube placement Enteric tube seen with side-port at level of gastric body. Nonobstructive bowel gas pattern. Vascular calcifications.Please refer to concomitant chest radiography from same day for additional findings. | Enteric tube as above. |
Generate impression based on findings. | Flatulence, pain Suboptimal exam due to patient's body habitus, lateralmost aspects of abdomen excluded. Side-port of the enteric tube seen approximately 5 cm beyond gastroesophageal junction. Degree of bowel dilatation, primarily colon, stable to mildly increased, for example, in left abdomen, bowel measures up to 9.4 cm, previously 8.3 cm. Right upper quadrant surgical clips.Status post sternotomy. Low lung volumes, basilar atelectasis/air space disease. | Enteric tube as above.Stable to mild increase in degree of colonic dilatation, findings may again reflect colonic ileus versus colonic obstruction. |
Generate impression based on findings. | Male 59 years old Reason: assess for traumatic injury History: pain Exam is limited secondary to lack of intravenous contrast. Lack of intravenous contrast makes the evaluation of solid organ and vascular pathology suboptimal. Exam is also limited by motion artifact. Within these limitations the following observations can be made:ABDOMEN:LUNG BASES: Left basilar atelectasis with mild interlobular septal thickening.LIVER, BILIARY TRACT: Perihepatic fluid is present, some of which is minimally complex and measures up to 18 Hounsfield units. Micronodular contour of the liver is noted which could represent some element of chronic liver disease.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys.RETROPERITONEUM, LYMPH NODES: Scattered areas of lymphadenopathy including peripancreatic, periceliac, and periaortic lymph node chains. Reference left periaortic lymph node measures 1.8 x 1.0 cm (series 4, image 83).BOWEL, MESENTERY: Bowel and fat containing ventral abdominal hernia without evidence of obstruction. The hernia measures up to 1.5 cm in length with a neck of 0.8 cm (series 4, image 93). No intraperitoneal free air.BONES, SOFT TISSUES: Mild degenerative changes of the thoracic spine.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered pelvic lymphadenopathy including the external iliac and inguinal chains. Reference left inguinal lymph node measures 2.1 x 1.8 cm (series 4, image 24). BONES, SOFT TISSUES: No significant abnormality noted | 1. Small perihepatic ascites. Evaluation of solid organs suboptimal without intravenous contrast and solid organ injury cannot be entirely excluded on the basis of this exam. If there is continued clinical concern for intraabdominal injury, repeat evaluation with a contrast-enhanced CT imaging is recommended.2. Scattered nonspecific retroperitoneal and pelvic lymphadenopathy. |
Generate impression based on findings. | Reason: h/o met pap thyroid ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Redemonstration of numerous pulmonary metastases, several of which appear slightly smaller compared to the prior exam, some with new cavitary component (series 4, image 54).Reference left upper lobe nodule measures 14 x 11 mm (series 4, image 24), previously 16 x 14 mm.Reference right middle lobe nodule measures 11 x 7 mm (series 4, image 30), previously 14 x 9 mm.Reference left lower lobe nodule measures 6 x 6 mm (series 4, image 35), unchanged.Several other non-reference nodules are mildly decreased from prior.No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.Mediastinal and hilar lymph nodes appear similar to the prior exam.Reference low right paratracheal lymph node measures 10 mm (series 3, image 25), unchanged.Reference right cardiophrenic lymph node measures 8 mm (series 3, image 54), unchanged.Reference precardiac lymph node measures 10 mm (series 3, image 21), unchanged.Surgical clips in the thyroid bed.CHEST WALL: Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered subcentimeter hepatic hypodensities, likely cysts.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. Large number of pulmonary metastases, several of which have slightly decreased in size and some with new cavitary component. Findings suggest response to therapy.2. Stable mild prominence of multiple mediastinal lymph nodes. |
Generate impression based on findings. | Female 45 years old Reason: 45yo with necrotizing pancreatitis w/pseudocyst c/b R pleural effusion. Recent procedures R thora 2/23, IR embolization of L gastric artery 2/24, ERCP/EUS 2/25 with cystogastrostomy tube placement R chest tube placed 2/26th. Now with fevers, hypotension History: evaluate for abscess/perforation, other pathology, hgb stable CHEST:LUNGS AND PLEURA: Small right pneumothorax. Right chest tube in place terminating toward the right upper lobe. Intralobular septal thickening and air space opacities likely representing pulmonary edema. Bilateral loculated pleural effusions with overlying compressive atelectasis. Left upper lobe ground glass opacity suggestive of superimposed infection or atelectasis.MEDIASTINUM AND HILA: Enteric tube with tip in the mid abdomen past the ligament of Treitz.CHEST WALL: Foci of subcutaneous air along the tract of the right chest tube likely iatrogenic in etiology.ABDOMEN:LIVER, BILIARY TRACT: Hypodense focus along the ligamentum teres most likely represents focal fatty infiltration. Portal vein, splenic vein, and SMV are patent.SPLEEN: No significant abnormality noted.PANCREAS: Multiple peripancreatic fluid collections, are again seen and appear decreased in size. Previously described collection adjacent to the spleen (series 3, image 96) measures 2.0 x 5.6 cm, previously 3.7 x 7.1 cm. Additional rim enhancing fluid collection seen in left posterior perinephric/posterior pararenal region has nearly resolved (series 3, image 110) and measures 0.8 x 1.8 cm, previously 2.7 x 4.2 cm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral kidneys have symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Celiac artery has with proximally narrowed appearance with poststenotic dilatation but remains patent.BOWEL, MESENTERY: Interval placement of cyst gastrostomy tube. Abdominal ascites is mildly increased.BONES, SOFT TISSUES: Anasarca appears unchanged.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter in place. Compressed bladder is suboptimally evaluated. Small foci of air appears to be present in the anterior lumen of the bladder.BONES, SOFT TISSUES: No significant abnormality noted. | 1.Multiple peripancreatic fluid collections are again seen and decreased in size status post cyst gastrostomy.2.Intralobular septal thickening and air space opacities likely representing pulmonary edema. Additional left upper lobe ground glass opacity may suggest superimposed infection or atelectasis.3.Bilateral loculated pleural effusions. 4.Small right pneumothorax status post chest tube placement. |
Generate impression based on findings. | There has been significant interval reduction of mucosal thickening within the left maxillary sinus with only trace mucosal thickening now present in the bilateral maxillary sinuses. There is mild new scattered ethmoid with trace frontal and sphenoid sinus mucosal thickening. The mastoid air cells remain clear. There is deviation of the nasal septum to the left with a large bony septal spur and unchanged.There is persistent loculated bony lucency surrounding the ADA tooth 15 which is incompletely imaged on current exam but grossly unchanged. | 1.Significant interval improvement in left maxillary sinus mucosal thickening compared to 12/1/2014.2.Mild new scattered bilateral ethmoid and frontal sinus mucosal thickening.3.Persistent periapical lucency surrounding the ADA tooth 15, incompletely imaged, and may represent periapical abscess.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: metastatic Prostate cancer. Please provide bi-dimentional measurements per RECIST 1.1 criteria History: metastatic Prostate cancer CHEST:LUNGS AND PLEURA: A subpleural nodular opacity in the right lower lobe is increased from the prior exam, now measuring 15 x 9 mm (series 7, image 56), suspicious for malignancy. Mild basilar subsegmental atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Status post CABG. Severe coronary artery calcification.Mildly prominent right hilar lymph nodes, measuring up to 11 mm (series 5, image 55), similar to the prior exam. No mediastinal lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine. Mild scoliosis.Poorly defined sclerotic foci in the left third rib. See same-day nuclear medicine bone scan for additional details.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the 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 lumbar spine.OTHER: No significant abnormality noted. | 1. A 1.5 cm right lower lobe nodule is increased from prior, with right hilar lymphadenopathy, suspicious for malignancy including primary lung neoplasm or metastasis. 2. See same-day nuclear medicine bone scan for additional details regarding osseous metastases. |
Generate impression based on findings. | 62 year old female with history of incontinence. Evaluate for NPH or acute process. There is no evidence of acute intracranial hemorrhage. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. The gray-white differentiation is maintained. No evidence of extra-axial collections. The ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues are within normal limits. | No acute intracranial hemorrhage, mass, mass effect or evidence of hydrocephalus. |
Generate impression based on findings. | Finger back during dodgeball 1.5 weeks ago. Paronychia. Rule-out fracture.VIEWS: Left hand PA, left middle finger oblique/lateral (3 views) 02/28/15 Soft tissue swelling is seen around the distal phalanx of the middle finger. The bones are normal in appearance. No fracture is identified. | Soft tissue swelling around distal phalanx of middle finger. |
Generate impression based on findings. | 91-year-old female with history of fall. Head: There is a resolving right parietal subgaleal hematoma. There is no evidence of intracranial hemorrhage. There is extensive periventricular and subcortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. A small lacunar infarct is present in the left thalamus. The gray-white differentiation is preserved. The ventricles and sulci are prominent, but symmetric. There is no midline shift or mass effect. The basal cisterns are patent. The visualized paranasal sinuses, mastoid air cells, and orbits are unremarkable. The right lens has been replaced.Cervical Spine: There is no evidence of acute cervical spine fracture or subluxation. There is a grade 1 retrolisthesis of C3 on C4 and minimal retrolisthesis of C4 on C5 and C5 on C6 appearing similar to prior. Vertebral body heights are preserved. Moderate to severe degenerative changes are noted throughout the cervical spine with loss of intervertebral disc spaces and vacuum phenomenon at multiple levels. Prominent disc osteophyte complexes are noted especially at C3-4 and C4-5 resulting in at least moderate spinal canal stenosis. The prevertebral soft tissues are within normal limits. The airway is intact. The thyroid is heterogeneous. There are scattered mildly enlarged cervical lymph nodes. | 1. No evidence of acute intracranial hemorrhage or calvarial fracture.2. Extensive small vessel ischemic disease appearing similar to prior.3. No acute cervical spine fracture or subluxation.4. Moderate to severe degenerative disease of the cervical spine worse at C3-4 and C4-5 resulting in at least moderate spinal canal stenosis. |
Generate impression based on findings. | Female 57 years old Reason: evaluate esophageal ulcer, GIST tumor History: planning for surgical resection of GIST ABDOMEN:LUNG BASES: Small right pleural effusion. Right upper lobe predominant airspace consolidation with extension into the lingula is suspicious for pneumonia. Incompletely imaged right middle lobe nodule is similar in size to prior study and measures 1.0 cm (series 8, image 1).LIVER, BILIARY TRACT: No biliary ductal dilatation or focal hepatic mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Markedly atrophic left kidney which may be secondary to a vascular etiology as the lumen of the left renal artery is diminutive.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Esophageal stent in place in the distal esophagus. There is dilatation of the contrast-filled proximal esophagus. The proximal component of the esophageal stent is not well visualized and there appears to be debris in the distal portion. Contrast opacifies the stent throughout otherwise. Contrast is present in the distal bowel indicating patency. There appears to be contrast extending lateral to the stent, left greater than right, indicative of a defect or ulceration (coronal images series 80596, image 5 and axial images series 7, image 25). No evidence of perforation. Ill-defined surrounding soft tissue mass around the stent is consistent with a the patient's known GIST tumor. No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Esophageal stent is patent with an ulcer/defect as described above. 2.Ill-defined surrounding soft tissue mass around the stent consistent with the patient's known GIST tumor. 3.Left upper lobe airspace consolidation is suspicious for pneumonia. |
Generate impression based on findings. | 3-year-old female with history of penetrating trauma. Evaluate for carotid sheath injury. There is a common origin of the left common carotid and brachiocephalic trunk which is a normal variant. The vasculature of the neck is within normal limits. There are tiny foci of apparent outpouching in the oropharyngeal airway of uncertain significance and favored to be developmental. No hematoma in the parapharyngeal soft tissues. There is no evidence of carotid artery injury or contrast extravasation. The salivary and thyroid glands are normal. The airway is intact. The visualized intracranial structures are unremarkable. There is mucosal thickening of the maxillary sinuses and ethmoid air cells. | No evidence of cervical vascular injury. |
Generate impression based on findings. | There has been resolution of minimal pneumocephalus seen on the prior examination status post placement of right transfrontal ventriculostomy shunt catheter, which terminates at the foramen of Monro. There is no significant soft tissue stranding, air or fluid collection along the imaged catheter tract. The ventricles are stable with the temporal horns not significantly dilated.There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.No acute intracranial hemorrhage, mass effect or change in ventricular caliber. 2.Expected postsurgical changes with unchanged right transfrontal ventricular catheter position. No significant inflammatory changes or air or fluid collection along the imaged ventricular catheter tract. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 13-year-old male with seizures.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 2/28/2015 VP shunt tip is to the right of midline in the inferior portion of the middle cranial fossa. Shunt tubing exits the right parietal bone, courses along the right head and neck, right anterior chest wall, and abdomen with tip looped in the right upper quadrant. No evidence of kinking or disconnection is seen.The calvarium is thickened and small with narrow transverse diameter and flattening of the left parietal bone. Cardiothymic silhouette is normal. No focal pulmonary opacity. No pleural effusion or pneumothorax.Moderate fecal burden with a nonobstructive bowel gas pattern. | No evidence of shunt malfunction. |
Generate impression based on findings. | Female 43 years old Reason: 43 y/o F with metastatic neuroendocrine tumor with symptoms of SBO, please evaluate. History: abdominal pain, nausea, vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hepatic lesions consistent with metastatic disease are again noted. The previously seen arterial enhancing lesions are not well visualized on the current study due to portal venous phase contrast timing. Several predominantly hypoattenuating hepatic lesions are noted and are also consistent with metastatic disease. Reference segment IVb lesion measures 2.7 x 2.3 cm (series 3, image 58), previously measuring 2.7 x 2.3 cm. Reference segment 5/6 lesion measures 1.4 x 1.2 cm (series 3, image 56), previously measuring 1.4 x 1.2 cm. Reference segment two lesion measures 1.3 x 1.0 cm (series 3, image 24), previously measuring 1.3 x 1.0 cm. No significant interval change in multiple smaller ill-defined hypoattenuating lesions. No new hypodense lesions are seen. Cholelithiasis without evidence of acute cholecystitis. Nonspecific slight interval increase in size of the common bile duct. The common bile duct measuring up to 7 mm, previously 5 mm, but continues to taper distally. No radiopaque obstructing stone is present.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Unchanged subcentimeter retroperitoneal/left paraaortic lymph nodes.BOWEL, MESENTERY: There is marked thickening of a long segment of the terminal ileum and cecum and is likely the site of the patient's primary tumor. The cecal mass appears to be larger in size measuring 4.4 x 4.2 cm (series 3, image 23), however, cannot be definitively compared due to differences in distention and orientation on the previous exam. The length of terminal ileum thickening appears similar to prior exam. There is mild prominence of the upstream small bowel with decrease in the passage of contrast distally into the colon. While this may be secondary to timing, partial small bowel obstruction cannot be excluded. No free air.BONES, SOFT TISSUES: Subcutaneous emphysema is noted just right of the anterior midline abdomen and likely secondary to medicinal injection.PELVIS:UTERUS, ADNEXA: Fibroid uterus again seen.BLADDER: No significant abnormality notedLYMPH NODES: Stable, nonspecific soft tissue nodular focus within the pelvis (series 3, image 135). BOWEL, MESENTERY: Right lower quadrant findings as detailed above. Mild increase in the pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted | 1.Marked wall thickening of the terminal ileum and cecum is again seen with mild increase in degree of the cecal wall thickening. There is mild prominence of the upstream small bowel with decrease in the passage of contrast distally into the colon. While this may be secondary to timing, partial small bowel obstruction cannot be excluded. 2.Stable hepatic metastatic disease. |
Generate impression based on findings. | 56 year old female with history of headache, neck pain, and subjective fever. ? meningitis, mass, on immunosuppression. There is no evidence of acute intracranial hemorrhage. There is moderate periventricular and subcortical white matter hypoattenuation, which is nonspecific, but compatible with age indeterminate small vessel ischemic disease. The gray-white differentiation is preserved. The basal cisterns are patent. There is no midline shift or mass effect. There is moderate scattered mucosal thickening of the maxillary, ethmoid, and sphenoid sinuses. There is a small amount of fluid within the dependent aspect of the left maxillary and sphenoid sinuses. The mastoid air cells are clear. The orbits are unremarkable. | 1. No intracranial hemorrhage or mass effect. No noncontrast CT evidence of abscess or empyema. If clinically indicated, MRI and LP can be considered. 2. Moderate periventricular and subcortical white matter hypoattenuation which is nonspecific and may represent advanced chronic small vessel ischemic disease. Treatment related white matter changes is also a possibility.3. Paranasal sinus mucosal thickening as above including fluid-levels in the left maxillary and sphenoid sinuses which can be seen with acute sinus disease. |
Generate impression based on findings. | Female, 28 years old, pregnant and BMI greater than 50, assess for RFO Suboptimal exam due to patient's body habitus and portions of upper abdomen and left greater than right lateralmost abdomen having been excluded on submitted image. Epidural catheter seen. No unexpected radiopaque foreign body delineated within the limitations of exam. Mildly prominent small and large bowel, may reflect ileus type pattern. Possible Foley catheter. Findings discussed with Dr. Nunes by on call radiology resident at 10:07 a.m. on 2/28/15. | No unexpected radiopaque foreign body seen within limitations of exam, as above. |
Generate impression based on findings. | Reason: hx of head and neck cancer, compare to previous with measurements. History: as above CHEST:LUNGS AND PLEURA: Multiple pulmonary metastases are similar in appearance the prior exam. Reference right lower lobe nodule measures 8 mm (series 6, image 81), unchanged. No new pulmonary nodules identified.Mild subsegmental scarring/atelectasis. No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: Right thyroid bed soft tissue densities are incompletely evaluated. See same day CT soft tissue neck for additional details.The heart is normal in size, with a pericardial effusion. Moderate coronary artery calcification. Mediastinal and hilar lymphadenopathy, similar to the prior exam. Reference right paratracheal lymph node measures 20 mm (series 4, image 42), unchanged.Reference right hilar lymph node measures 21 mm (series 4, image 55), unchanged.CHEST WALL: Degenerative disease of the thoracic spine. Diffuse skeletal metastases, including a destructive lesion in the left glenoid, similar in appearance to the prior exam.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Presumed hemangioma at the dome of the liver (series 4, image 89), unchanged. Scattered calcified granulomas, stable.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.Reference upper abdominal lymph node measures 9 mm (series 4, image 102), unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Diffuse skeletal metastases, unchanged.OTHER: No significant abnormality noted. | Stable metastatic disease, including multiple pulmonary nodules, mediastinal and hilar lymphadenopathy, and extensive bony metastases, all similar in appearance to the prior exam. Reference measurements as above. The mass in the neck is incompletely evaluated. See same day CT neck report for additional details. |
Generate impression based on findings. | Reason: h/o tonsil ca and CRT, compare to previous, measurements plan History: none CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules, unchanged. A small left upper lobe ground glass nodule (series 4, image 23) is decreased in prominence from the prior exam, may be infectious/inflammatory in etiology. No new suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.Status post right thyroidectomy.CHEST WALL: Degenerative disease of the thoracic spine, with stable T8 vertebral body loss of height.Healed posterior left sixth rib fracture.A small round lucency at the inferior endplate of the L2 vertebral body is minimally increased from the prior exam, likely degenerative in etiology.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: Bilateral renal cysts, unchanged.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: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Male 29 years old; Reason: Sbo History: Abdominal distention, diffuse tenderness ABDOMEN:LUNGS BASES: Left greater than right pleural effusions with underlying compressive atelectasis. Relatively dense appearance of pleural effusions, underlying hemorrhage not entirely excluded. Peripheral nodularity seen in right middle lobe, may reflect superimposed infection/aspiration. Moderate to marked cardiomegaly, please refer to recent chest radiography for additional findings.LIVER, BILIARY TRACT: Status post cholecystectomy. Relatively hyperattenuating appearance of liver, compatible with iron deposition disease, better depicted on prior MRI.SPLEEN: Small calcified spleen, likely reflecting progressive autoinfarction secondary to patient's sickle cell disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Markedly atrophic native kidneys with numerous renal cysts, too small to characterize. Relatively dense and calcification containing ovoid soft tissue structure in right iliac fossa, likely failed renal transplant. RETROPERITONEUM, LYMPH NODES: Stable to mild interval decrease in size of left-sided retroperitoneal hematoma, measuring approximately 7 x 4 cm, image 91 series 3. IVC filter present. Right-sided femoral venous line, incompletely imaged femoral stent placement. Mild retroperitoneal adenopathy, measuring up to 11 mm.BOWEL, MESENTERY: Mildly dilated small bowel loops with relatively collapsed colon, air/fluid seen distally in rectum, particularly in the left abdomen, transition point difficult to delineate. Degree of bowel dilatation not significantly changed from prior abdominal radiography. Contrast did not move beyond the mid small bowel, may be due in part to timing of exam but again suggestive of a bowel obstruction. No definite free air. Status post vascular embolization.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Diffusely increased sclerosis, compatible with patient's history of sickle cell disease. Chronically superiorly subluxed left femur with nonvisualization of normal femoral head, may be iatrogenic versus bony resorption, relatively lucent appearance of left greater trochanter, nonspecific. Hyperdense soft tissue attenuation near level of left hip joint may reflect hemarthrosis. Gynecomastia. Diffuse anasarca. Mildly asymmetric hyperdense appearance of left rectus musculature compared to right, may reflect site of additional hematoma formation. Soft tissue induration deep to the sacrum, correlation with patient's clinical history and physical exam recommended to exclude decubitus ulcer formation. | 1. Suboptimal exam without IV contrast. 2. Diffusely mildly dilated small bowel with relative collapse of colon, air and fluid seen in colon including rectum, differential considerations include a partial small bowel obstruction or ileus. Progression of enteric contrast on current study was poor. 3. Stable to mild interval decrease in size of left-sided retroperitoneal hematoma. 4. Left greater than right pleural effusions with underlying compressive atelectasis. Relatively dense appearance of pleural effusions, underlying hemorrhage not entirely excluded. Peripheral nodularity seen in right middle lobe, may reflect superimposed infection/aspiration. 5. Relatively hyperattenuating appearance of liver, compatible with iron deposition disease. 6. Small calcified spleen, likely reflecting progressive autoinfarction secondary to patient's sickle cell disease.7. Chronically superiorly subluxed left femur with nonvisualization of normal femoral head, may be iatrogenic versus bony resorption, relatively lucent appearance of left greater trochanter, may reflect brown tumor formation in setting of chronic renal disease but nonspecific and neoplastic disease not excluded. Hyperdense soft tissue attenuation near level of left hip joint suspicious for hemarthrosis. 8. Mildly asymmetric hyperdense appearance of left rectus musculature compared to right, may be a site of additional hematoma formation. 9. Soft tissue induration deep to the sacrum, correlation with patient's clinical history and physical exam recommended to exclude decubitus ulcer formation. |
Generate impression based on findings. | Sickle cell anemia. Admitted for vaso-occlusive crisis. Now with abdominal distention.VIEW: Abdomen AP (one view) 02/28/15, 1142 and 1141 Cholecystectomy clips are present. Bone changes from sickle cell anemia are noted.The urinary bladder is moderately to markedly distended. Mildly dilated bowel loops are present. | Urinary bladder distention. |
Generate impression based on findings. | 13-year-old male with history of seizure. Redemonstrated is a right posterior approach ventriculoperitoneal shunt catheter coursing through the right lateral ventricle with the tip directed inferiorly towards the pons. Ventricular configuration sized is unchanged. There is no evidence of acute intracranial hemorrhage. Unchanged dysmorphic appearance of the brain parenchyma, ventricles, and skull including diminished white matter and left frontal porencephalic cyst. MRI can better assess the parenchyma. The gray white differentiation is preserved. No midline shift or mass effect. The visualized paranasal sinuses and mastoid air cells, and orbits are clear. | Stable VP shunt and ventricular configuration. No evidence of acute intracranial hemorrhage, mass or mass effect. |
Generate impression based on findings. | Male 45 years old; Reason: 45 year old M with von Hippel Lindau and known head of pancreas lesion, please evaluate for extent of disease and/or characteristics. Recent open right adrenalectomy with regional lymphadenectomy. Postoperative changes expected. History: Pancreas protocol CT ABDOMEN:LUNGS BASES: Small bilateral pleural effusions with underlying atelectasis. Trace pericardial effusion. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Small arterially enhancing foci seen in pancreatic neck and head. Stable 7 mm pancreatic head focus, image 57 series 10. Additional stable 5 mm focus in pancreatic neck, image 50 series 10. More evident on current exam is pancreatic head focus located posteriorly near junction with uncinate process, measuring 10 x 6 mm, image 64 series 10, previously measured approximately 6 x 4 mm and was much fainter in appearance.ADRENAL GLANDS: Status post right adrenalectomy, small soft tissue attenuation seen at this level without associated arterial enhancement delineated, likely postoperative. Previously seen nearby enhancing lymph node adjacent to right diaphragmatic cruise not visualized, compatible with stated history of lymphadenectomy. Stable 6 mm enhancing focus in left adrenal gland, image 57 series 10.KIDNEYS, URETERS: Bilateral nonobstructing renal stones.RETROPERITONEUM, LYMPH NODES: Retroperitoneal postsurgical sequela, subcentimeter lymph nodes.BOWEL, MESENTERY: Portions of colon not well distended, making assessment suboptimal. Left-sided colonic diverticulosis. Submucosal fat deposition seen, particularly in ascending colon/hepatic flexure, secondary to prior inflammation.PELVIS:PROSTATE/SEMINAL VESICLES: Intraprostatic calcifications.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Spinal degenerative disease. Small pelvic ascites. Ventral abdominal subcutaneous induration, emphysema and small fluid, likely postprocedural. Small left hydrocele incompletely imaged. | 1. Arterially enhancing pancreatic lesions, one of which is more pronounced and larger in appearance, suspicious for small neuroendocrine tumors.2. Stable left adrenal enhancing lesion, likely a pheochromocytoma given patient's history of Von Hippel-Lindau disease.3. Status post right adrenalectomy and lymphadenectomy, postsurgical sequela including in ventral abdominal soft tissues as above, small pleural effusions and ascites. |
Generate impression based on findings. | 57-year-old female with history of CVA. There is no evidence of acute intracranial hemorrhage. Encephalomalacia within the right posterior temporal-occcipital lobe appear similar to prior. Encephalomalacia in the right basal ganglia is also again seen. Small lacunar infarct in the left frontal periventricular white matter extending into the basal ganglia appears chronic but new since CT from 2006. Mild periventricular and subcortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. There is advanced global parenchymal volume loss. No hydrocephalus. There is no midline shift or mass-effect. The basal cisterns are patent. The visualized paranasal sinuses, mastoid air cells, and orbits are normal. The calvarium and scalp are intact. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Chronic infarcts including the right posterior temporal and occipital lobe and right basal ganglia which were present on CT from 2006. Small lacunar infarct in the left basal ganglia is chronic but new since remote prior. Please note that CT is insensitive for the detection of acute non-hemorrhagic CVA, and if there is continued suspicion for acute ischemia consider MRI for further evaluation. |
Generate impression based on findings. | Reason: PE? History: chest pain, SOB PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Mild dependent atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without 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 the 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. | Increasing swelling of the bilateral neck for 5 weeks, worse last night with SOB. Neck biopsy revealed adenocarcinoma. NECK: There is extensive bilateral cervical lymphadenopathy with multiple matted nodal masses throughout the jugular chains and posterior triangles. Exact measurements of individual lymph nodes are difficult to determine; however, a well-defined right tracheoesophageal groove lymph node measures up to 20 mm. There is also stranding throughout the superficial and deep neck spaces. There is also enlargement of the retropharyngeal lymph nodes, left larger than right, resulting in airway narrowing. There are tonsilloliths. There is moderate atherosclerotic calcification of the bilateral proximal internal carotid arteries. There is compression and occlusion of the bilateral jugular veins due to a cluster of nodal masses. There are apparent secretions within the trachea. The thyroid and salivary glands are unremarkable. There is degenerative spondylosis of the cervical spine, which is most pronounced at C4-6. The airways are patent. The imaged intracranial structures are unremarkable. There is pulmonary emphysema and multiple bilateral solid calcified and non-calcified pulmonary nodules measuring up to 4 mm. There is also nodular pleural thickening on the left. | 1.Extensive bilateral cervical lymphadenopathy and retropharyngeal lymphadenopathy that results in airway narrowing are compatible with adenocarcinoma metastases.2.Extensive edema in the neck may be related to venous hypertension from bilateral jugular vein occlusion secondary to nodal mass compression and/or lymphedema.3.Moderate bilateral carotid bifurcation artery stenosis.4.No evidence for intracranial metastases. 5.Non-specific pulmonary nodules. Please refer to the separate chest CT report for additional details.6.Apparent secretions within the trachea suggest aspiration. |
Generate impression based on findings. | Male 60 years old; Reason: h/o VPS for NPH; evaluate for pseudocyst at catheter tip History: abdominal pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal including aortocaval and inguinal lymph nodes.BOWEL, MESENTERY: Right sided ventriculoperitoneal shunt seen traversing subcutaneous tissues of right thorax/hemiabdomen, catheter enters abdomen in mid abdominal region. Tip crosses midline and enters left abdomen and tip subsequently seen directed superiorly, image 83 series 3. No loculated fluid collection seen at level of tip or elsewhere to suggest a CSFoma, small free fluid present in pelvis. Visualized catheter is intact in appearance. Left-sided colon diverticulosis without evidence of acute diverticulitis. Normal appendix. Small to moderate stool burden, no bowel obstruction. Tiny hiatal hernia. PELVIS:PROSTATE/SEMINAL VESICLES: Intraprostatic calcifications. Scrotal surgical clips, presumably related to vasectomy. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Multilevel degenerative spinal disease. Ventral abdominal postsurgical sequela. Trace pelvic free fluid. | 1. Trace pelvic ascites. No evidence of CSFoma. |
Generate impression based on findings. | Female 67 years old; Reason: Metastatic thyroid cancer; compare to previous with measurements CHEST:LUNGS AND PLEURA: Again visualized pulmonary and pleural metastatic disease.Accounting for differences in technique and positioning, mild interval decrease in size of reference left apical mass, measuring 2.2 x 2 cm, image 13 series 5, previously measured 2.6 x 2.3 cm.Essentially stable right middle lobe reference nodular lesion, measuring 1.5 x 1.4 cm, image 55 series 5, previously measured 1.6 x 1.4 cm.Unchanged reference right lower lobe nodular focus, measuring 1 x 0.6 cm, image 79 series 5, previously measured 1.1 x 0.6 cm.Mild interval increase in size of right upper lobe lesion, measuring 1.9 x 1.6 cm, image 33 series 5, previously measured 1.9 x 1.3 cm.Interval resolution of previously seen small right pleural effusion. Sequela from prior left-sided wedge resection seen.MEDIASTINUM AND HILA: Status post thyroidectomy. Mild mediastinal and hilar lymphadenopathy, demonstrating mild interval decrease in size. For example, left hilar lymph node measuring 1.3 x 0.6 cm, image 41 series 3, previously measured 1.6 x 0.9 cm. Heart borderline in size.CHEST WALL: Left chest postsurgical sequela. Unchanged 5 mm left subpectoral lymph node, image 23 series 3.ABDOMEN:LIVER, BILIARY TRACT: Visualized liver stable in appearance. Unchanged reference right hepatic vague soft tissue attenuation focus, measuring 1.1 x 0.7 cm, image 125 series 3. Stable mild biliary ductal prominence.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate to large stool burden, no bowel obstruction.PELVIS:UTERUS, ADNEXA: Heterogeneous/lobulated uterus with left adnexal prominence again seen, appearance stable. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance with scattered nonspecific lucencies and degenerative disease of spine seen. | 1. Interval resolution of previously seen small right pleural effusion. Pulmonary and pleural metastatic disease. Mixed response again visualized with many sites stable to mildly decreased in size but again seen is mild interval increase in size of at least one nodule, submitted for reference is a right upper lobe nodule.2. Stable right hepatic lesion.3. Stable heterogeneous uterus with left adnexal prominence. Again recommended if not already performed is pelvic sonography to confirm fibroid uterus/exclude neoplastic involvement.4. Please refer to concomitant CT imaging of soft tissues of the neck from same day for findings. |
Generate impression based on findings. | Thoracic syrinx and lipomatosis. Preoperative planning.VIEWS: Thoracic spine AP/lateral/swimmer's (3 views), lumbar spine AP/lateral/lumbosacral junction lateral (3 views) 02/28/15 Thoracic vertebral body heights and disk spaces are normal. No segmentation anomalies are seen. There may be a right thoracic curve.Lumbar vertebral body heights and disk spaces are maintained. No segmentation anomalies are seen. No fracture is identified.A moderate amount of feces is present in the rectus bleed. | Normal thoracic and lumbar spine. |
Generate impression based on findings. | Metastatic lung cancer. EGFR +, on Erlotinib, now progressive disease, baseline status for trial. There is no evidence of intracranial mass. The grey-white matter differentiation appears to be intact. There is no abnormal intracranial enhancement. 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 intracranial metastases. |
Generate impression based on findings. | Left leg trauma/pain/gait abnormality.VIEWS: Left femur AP/lateral (two views) 02/28/15 The femur is normal in appearance. No fracture is seen. No soft tissue swelling is identified. | Normal examination. |
Generate impression based on findings. | Left leg trauma/pain/gated abnormality.VIEWS: Pelvis AP/frog leg (two views) 02/28/15 The round, smooth femoral heads are well directed into normally formed acetabula. No fracture is identified. | Normal examination. |
Generate impression based on findings. | Two month old male with history of mandibular distraction. Per chart, post drainage of facial abscess. There are postsurgical changes of mandibular distraction with mandibular osteotomies and placement of plate and screws. The left anterior screws are not deeply seated within the bone; correlate with surgical findings. Hardware appears otherwise intact and without complication. There is improvement in previously seen overjet. A nasoenteric tube is present. Posterior cleft palate is noted. The imaged paranasal sinuses and mastoid air cells are clear. Postsurgical changes related to left facial abscess drainage. Large right wormian bone is redemonstrated. The visualized intracranial structures are unremarkable. | 1. Postsurgical changes from mandibular distraction as detailed above. The left anterior screws are not deeply seated within the bone; correlate with surgical findings. Hardware appears otherwise intact and without complication. Postsurgical changes of left facial abscess drainage with no discrete residual fluid collection. 2. Stigmata of Pierre Robin sequence with improved overjet. Posterior cleft palate. |
Generate impression based on findings. | 41 year old female with history of persistent fevers. A small left maxillary sinus retention cyst is present. There is minimal mucosal thickening of the left frontal and right sphenoid sinus. No air-fluid levels. The remaining paranasal sinuses are clear. No evidence of an aggressive sinonasal process.There are bilateral conchae bullosa. There is mild nasal septal deviation with a prominent left nasal spur. A nasoenteric tube is present. Mild degenerative changes are present at the right temporomandibular joint. The visualized intracranial structures are unremarkable. | Minimal paranasal sinus mucosal thickening similar to 1/21/2015. There is a small left maxillary sinus retention cyst with minimal mucosal thickening within the left frontal and right sphenoid sinuses. No air-fluid levels. No evidence of an aggressive sinonasal process. |
Generate impression based on findings. | 69-year-old female with history of breast cancer. Evaluate for metastatic disease. No intracranial mass or mass effect. No pathologic enhancement to suggest metastatic disease to brain. There is a large area of encephalomalacia within the lateral aspect of the right temporal lobe which is unchanged. There is no evidence of acute intracranial hemorrhage. Mild periventricular and subcortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. The ventricles and sulci are otherwise unremarkable. No evidence of hydrocephalus. The visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. Small well-corticated lytic lesion of the left parietal bone is stable. There are postsurgical changes of right mastoidectomy and calvarial screw placement likely related to hearing implant. | 1. No CT evidence of metastatic disease to brain. If clinically indicated MRI can be considered for more sensitive evaluation.2. Right temporal lobe encephalomalacia which may be postsurgical but is unchanged since 2006. |
Generate impression based on findings. | Diffuse large B cell lymphoma in CR after 6 cycles of R-CHOP completed in 7/2014. There is no significant interval change in the irregular soft tissue lesion in the left supraclavicular fossa, which measures approximately 12 x 16 mm. There is no evidence of significant cervical lymphadenopathy elsewhere in the neck. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is an incomplete posterior arch of C1, which is an anatomic variant. There is mild degenerative spondylosis at C4-5 and C5-6. The airways are patent. The imaged paranasal sinuses are clear. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. There is scar tissue in the right anterior chest wall skin at the site of a prior catheter site. | Persistent left supraclavicular lesion compatible with treated lymphoma, without evidence of disease progression. |
Generate impression based on findings. | Newly diagnosed leukemia. There is moderate opacification of the ethmoid sinuses diffusely. There is mild mucosal thickening in the bilateral frontoethmoid recesses and inferior frontal sinuses. There is mild mucosal thickeing in portions of the sphenoid sinuses as well. The maxillary sinuses are essentially clear. The nasal cavity is also clear. The nasal septum is slightly deviated towards the right. 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 appear to be unremarkable. There appears to be a partially-empty sella. | Scattered paranasal sinus opacification in a sporadic pattern. |
Generate impression based on findings. | Head injury last night: reports blurred vision and nausea. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. However, the posterior fossa appears to be relatively small and the cerebellar tonsils up to 9 mm inferior to the foramen magnum. The ventricles are normal in size and configuration. There is no midline shift. The imaged paranasal sinuses and mastoid air cells are clear. There is no evidence of skull fracture. The scalp soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage or skull fracture.2. Small posterior fossa and low-lying cerebellar tonsils are suggestive of Chiari I malformation. Further evaluation via a brain and spine MRI may be useful. |
Generate impression based on findings. | The last formed disk space is referred to as L5-S1, consistent with prior exam. There are immediate postoperative findings related to interval L1 -- L5 interbody fusion with placement of disk spacer devices at L1-L2, L2-L3, L3-L4, and L4-L5, including foci of retroperitoneal air, paravertebral swelling and edema. There is lumbar levoscoliosis which is improved and can be better assessed with standing radiographs. Again seen are degenerative changes at each vertebral body level.. The conus terminates at L1-2.T12-L1: Disk bulge and mild right facet arthropathy which in combination with scoliosis results in moderate to severe right neural foraminal stenosis and mild effacement of the thecal sac on the right with no significant spinal canal or left neural foraminal stenosis.L1-2: Mild right facet arthropathy, posterior longitudinal ligament thickening with ligamentum flavum thickening causing moderate right neural foraminal stenosis and no significant spinal canal or left neural foraminal stenosis.L2-3: Severe right and moderate left facet arthropathy with ligamentum flavum thickening, and disk bulge causing mild spinal canal stenosis and mild right neural foraminal stenosis.L3-4: Severe bilateral facet arthropathy, ligamentum flavum thickening, and associated moderate to severe spinal canal stenosis and moderate bilateral neural foraminal stenosis.L4-5: Severe left facet arthropathy and associated ligamentum flavum thickening as well as disk bulge causing moderate spinal canal stenosis and moderate left neural foraminal stenosis. No significant right neural foraminal stenosis.L5-S1: Severe disc height loss and bilateral facet arthropathy causing moderate left and mild right neural foraminal stenosis and mild spinal canal stenosis.Overall, the degree of spinal canal and neural foraminal stenoses have perhaps mildly decreased from the prior examination at the postsurgical levels, although MRI would be helpful. | Immediate postoperative findings related to L1-5 XLIF. Interbody cages are well positioned without evidence of complication. Levoscoliosis appears relatively improved and can be further assessed with standing radiographs. Spinal canal and neural foraminal stenosis as above which can be further assessed with MRI. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There are stable posttreatment findings without recurrent tumor or significant cervical lymphadenopathy. There is an unchanged left level 2 lymph node measuring 5 x 4 mm on series 8 image 39. The patient is status post right thyroid lobe resection with no focal lesions in the small left thyroid lobe. The major salivary glands are unremarkable. There is unchanged low attenuation circumferential thickening of the bilateral common carotid arteries with calcified atherosclerotic plaque at the right carotid bifurcation and minimal plaque of the left carotid bifurcation. The major cervical vessels are otherwise patent. The osseous structures show no focal lesions. There are mild cervical degenerative changes without significant interval change. The airways are patent. The imaged intracranial structures are unremarkable. Please refer to dedicated accompanying CT chest report for additional details. | 1.Stable posttreatment findings without evidence of recurrent tumor or significant cervical lymphadenopathy.2.Please refer to accompanying dedicated CT chest report for further details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns 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 extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns 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 extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage or mass-effect. If there is persistent suspicion for subarachnoid hemorrhage, consider lumbar puncture for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is interval placement of a left posterior frontal burr hole. There is interval development of a large intraparenchymal hemorrhage in the left frontoparietal region that measures up to approximately 40 mm with a small amount of associated subarachnoid hemorrhage. There is local mass effect on the left lateral ventricle and surrounding edema. There is also a smaller area of hyperattenuation in the left parietal lobe that may correspond to the additional tumor. There is a 5 mm left to right midline shift. There is also a left subdural hematoma along the left frontotemporal convexity measuring up to 5 mm in width. There is mild parenchymal volume loss. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with mild age-indeterminate small vessel ischemic changes. There are chronic lacunar infarcts in the right basal ganglia. The imaged portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is mild scalp emphysema and minimal subgaleal hematoma at the burr hole site. There are bilateral lens implants. There is marked flattening and sclerosis of the right mandibular condyle. | 1. Post-surgical findings related to left parietal lobe mass biopsy with extensive new intraparenchymal hemorrhage and a small amount of subarachnoid hemorrhage in the left frontoparietal region with rightward midline shift measuring 5 mm.2. New left frontotemporal convexity subdural hematoma measuring 5 mm in width. 3. Mild age-indeterminate small vessel ischemic changes and evidence of basal ganglia lacunar infarcts.4. Advanced right temporomandibular joint degenerative change. |
Generate impression based on findings. | There are immediate postoperative findings related to C3-C6 laminoplasty. Spinal canal is increased in size and decompressed. Resection of the spinous processes is noted. Bone grafts appear well-positioned without displacement into the spinal canal. Expected postsurgical changes include extensive subcutaneous stranding in the posterior soft tissues, foci of gas in the soft tissues and in the posterior epidural space, along with hyperdense posterior epidural postsurgical fluid without obvious mass effect on the thecal sac. There is normal alignment of the cervical spine. The vertebral body heights are preserved. Disk and endplate degenerative changes are again seen with disk osteophyte complexes at C4-5, C5-6 and C6-7. There is improvement in the proximal aspect of neural foramina stenosis at the right C5-C6 level. Right C4-C5 neural foramina stenosis also improved.There is a right-sided central venous line partly imaged. The thyroid is heterogeneous in attenuation and bulky, but incompletely imaged. | 1.Expected postsurgical changes of C3 to C6 laminoplasty as detailed above with interval decompression of the previously seen spinal canal stenosis from C3 to C6. There is also improvement in the right C4-5 and proximal aspect of neural foraminal stenosis at the right C5-C6 level.2.Enlarged multinodular thyroid gland is partially imaged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is scattered ethmoid sinus mucosal thickening. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. NECK: There are postoperative findings related to total thyroidectomy with an unchanged hyperattenuating lobulated irregular enhancing mass in the right aspect of the thyroid that measuring 36 x 25 mm on axial series 7 image 59. A right tracheoesophageal groove lymph node on series 7 image 54 measures 5 mm, unchanged. A slightly smaller right paratracheal lymph node measures 24 x 17 mm on series 7 image 71, previously 26 x 19 mm.The airways are patent. Stable noncalcified and calcified plaque in the carotid bifurcations, worse on the right with moderate stenosis. Vascular structures otherwise patent.There is extensive destruction of the left glenoid and scapula with pathologic fracture again seen. There is extensive heterogeneous appearance of the clavicles and the left humeral head as noted before. There are extensive multilevel cervical degenerative changes and facet degenerative changes again seen, without significant overall change. | 1.No new or enlarging metastatic soft tissue lesions in the neck.2.Stable to minimally smaller right paratracheal lymph node. Otherwise, no significant interval change in metastatic disease including soft tissue mass in the right thyroid bed. Please refer to separate report for findings in the chest.3.Osseous metastases to the left scapula with pathologic fracture again seen.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is extensive nonspecific patchy periventricular and subcortical white matter hypoattenuation which is nonspecific, more focal in the bilateral centrum semiovale and the white matter adjacent to the frontal horns. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are atherosclerotic calcifications in the bilateral cavernous carotid arteries and the intracranial vertebral arteries. There is diffuse opacification of the imaged portion of the left maxillary sinus which is likely chronic. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage or mass effect. Moderate small vessel ischemic disease which is likely chronic. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Tongue squamous cell carcinoma, status post surgery, radiation, re-irradiation, and stereotatic RT to lung lesion, treated with docetaxel for metastatic disease. Neck: The images are degraded by patient motion. There are post-treatment findings in the neck. There is an enhancing mass within the left trapezius muscle, which measures 24 x 43 mm, previously 16 x 28 mm. There is also increase in size of a heterogeneously enhancing mass in the medial right deltoid muscle that measures 15 x 25 mm, previously 10 x 18 mm. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is mild multilevel degenerative spondylosis. The airways are patent. There is a partially-imaged cavitary left lung mass. Head: There is no evidence of intracranial mass. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is persistent complete opacification of the left maxillary sinus. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. Interval increase in size of the intramuscular metastasis.2. No evidence of intracranial metastases.3. Partially-imaged cavitary left lung mass. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | There is evidence of prior bilateral uncinectomy, widening of the maxillary infundibulae, partial resection of the ethmoid air cell complex, and widening of the left sphenoethmoidal recess. The frontal sinuses are hypoplastic. The prior mild mucosal thickening of the ethmoid air cells has resolved. The sphenoid sinuses and sphenoethmoidal recesses are clear. There is mild peripheral mucosal thickening in the maxillary sinuses, which unchanged. The right maxillary sinus is hypoplastic. The maxillary neo-infundibulum on the right remains more narrow than the left, however both are patent. The nasal cavity is essentially clear. There is mild nasal septal deviation. The nasal turbinates are unremarkable. The lamina papyracea and fovea ethmoidalis are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | Postoperative findings related to prior endoscopic sinus surgery with minimal residual mucosal thickening of the paranasal sinuses that has improved. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is patchy nonspecific periventricular and subcortical hypoattenuation as well as prominent hypoattenuation in the white matter adjacent to frontal horns. There is moderate diffuse global volume loss. There is no hydrocephalus. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is a nasogastric tube partly imaged. There is nonspecific soft tissue density probably represent cerumen in the bilateral external auditory canals. There is deformity involving the nasal bone likely related to prior trauma. | 1.No acute intracranial hemorrhage or mass effect. Please note, CT is insensitive for detection of early nonhemorrhagic stroke. If there is high clinical suspicion for acute ischemia, MRI can be considered for further evaluation.2.Unchanged hypoattenuation within the anterior frontal lobes which may represent posttraumatic encephalomalacia or chronic ischemic injury.3.Contrast extravasation as detailed in the technique section above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | NONCONTRAST: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is patchy nonspecific periventricular and subcortical hypoattenuation with prominent hypoattenuation in the white matter adjacent to frontal horns which may represent posttraumatic encephalomalacia versus prior ischemic injury. There is moderate diffuse global volume loss. There is no hydrocephalus. There is no midline shift or herniation. There is deformity involving the nasal bone likely related to prior trauma.CTA HEAD: The anterior circulation is patent with flow limiting stenosis. There is minimal atherosclerotic calcification in the bilateral cavernous carotid arteries without flow-limiting stenosis. There are prominent bilateral posterior communicating arteries with fetal origin of both posterior cerebral arteries. The basilar artery is hypoplastic and appears to end in the superior cerebellar arteries. The anterior communicating artery is present. The hypoplastic right vertebral artery appears to end in the right posterior inferior cerebellar artery. There is no discrete intracranial aneurysm.CTA NECK: There is a common origin of the brachial cephalic artery and the left common carotid artery. The great vessel origins are patent. The right vertebral artery is diffusely smaller compared to the left, and is hypoplastic. There is no significant flow-limiting stenosis in the right carotid bifurcation (less than 50% by NASCET criteria). There is an atherosclerotic plaque with mild calcification in the left carotid bifurcation without flow-limiting stenosis (less than 50% by NASCET criteria).There is a hypoattenuating right thyroid lobe nodule. There is mild centrilobular emphysema.There is diffuse idiopathic skeletal hyperostosis with anterior bridging osteophytes from C3 to T1. There are multilevel cervical degenerative changes including facet arthropathy, disk osteophyte complexes with uncovertebral spurring diffusely from C2-3 through C6-7 with variable mild to moderate neural foraminal stenoses. There is deformity of the right clavicle probably representing a healed fracture. | 1.Mild partially calcified atherosclerotic plaque in the left carotid bifurcation without flow-limiting stenosis. Mild atherosclerotic changes in the intracranial circulation without flow-limiting stenosis. 2.Bilateral fetal origin of the posterior cerebral arteries with hypoplastic basilar artery which apparently ends in the superior cerebellar arteries. Hypoplastic right vertebral artery ending in the right posterior inferior cerebellar artery.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 51 years old Reason: fracture History: MVC. Again seen on AP and lateral views is a nondisplaced proximal fibular fracture with overlying callus formation suggestive of partial healing. Increased Thickened wavy periosteal reaction in the distal tibia is compatible with changes from chronic osteomyelitis, as seen on ankle radiograph dated 4/21/2010. Degenerative changes of the tibiotalar joint seen on lateral views with osteophyte formation. | Changes compatible with healing proximal fibular fracture and chronic osteomyelitis as described above. |
Generate impression based on findings. | Checked playing hockey. Hit the ice and boards on right shoulder.VIEWS: Right shoulder internal/external rotation (two views) 02/28/15, 1436 and 1437 The humeral head is well directed into the glenoid fossa. No fracture is seen. The acromioclavicular distance appears increased. | Probable acromioclavicular joint injury. |
Generate impression based on findings. | Female 55 years old Reason: eval fracture, FOOSH History: eval fracture. Two views of the humerus are provided. A possible cortical step-off of the radial head seen only on the internal rotation humerus film may represent an occult radial head fracture, however this is equivocal.Four views of the elbow show a small joint effusion without underlying fracture or dislocation.Two views of the left forearm show soft tissue swelling about the forearm. | Joint effusion with questionable radial head cortical step-off seen only on the internal rotation humerus film, which may represent an occult radial head fracture. Follow-up imaging in 7-10 days is recommended. |
Generate impression based on findings. | Shortness of breath and chest pain. History of cancer and previous clot. Hemoptysis. PULMONARY ARTERIES: Main, right and left pulmonary artery caliber is normal. No filling defects are seen in the segmental arteries.LUNGS AND PLEURA: Scattered groundglass opacities are present predominantly in the lower lobes and middle lobe. No pleural effusion is seen.MEDIASTINUM AND HILA: No lymphadenopathy is identified. The heart size is normal.CHEST WALL: Normal in appearance.UPPER ABDOMEN: Arterial phase of the superior aspects of the liver, spleen, and kidneys is normal. | No pulmonary embolus. Scattered groundglass opacities most likely inflammatory or infectious. |
Generate impression based on findings. | Productive cough, fever, wheezing.VIEWS: Chest AP/lateral (two views) 02/28/15 Lung volumes are large. Mild peribronchial thickening is seen. Subsegmental atelectasis is noted in right middle lobe. No focal air space disease is present.Cardiothymic silhouette and pulmonary vascularity are normal. | Bronchiolitis/reactive disease pattern. |
Generate impression based on findings. | Male 25 years old Reason: injury History: pain. Four views of the left knee show a possible small joint effusion in the suprapatellar pouch. Otherwise there is no evidence of acute fracture or dislocation. | No acute fracture or dislocation. |
Generate impression based on findings. | 23-year-old female with history of trauma. Evaluate AC joint. Three views of the right shoulder and axillary view of right shoulder show a contour abnormality of the greater tuberosity of the humeral head compatible with an impaction fracture. There is mild surrounding soft tissue swelling. The glenohumeral joint alignment is present without evidence of dislocation. The sternoclavicular joint is within normal limits. | Humeral head impaction fracture as described above. |
Generate impression based on findings. | Status post artificial heart, bleed on prior CT Compared to 2/27/2015, there is no significant change in small subdural hematoma involving the right posterior parieto-occipital convexity. Subdural collection measures up to 4 mm in thickness and associated with minimal local mass effect. No new hemorrhage or new mass-effect. No midline shift or downward herniation. There are hypodensities involving the bilateral diffuse cerebellar hemispheres inferiorly which may represent age indeterminate infarcts. Again seen is edematous appearance of the subcutaneous soft tissues of the neck posteriorly and extending into the left parietal scalp. No hydrocephalus. Again seen is diffuse opacification of the paranasal sinuses with air-fluid levels. Mastoid air cells are clear. Calvarium is intact. | 1. No significant change in small subdural hematoma in the right parieto-occipital region with minimal local mass effect. No new hemorrhage or new mass-effect.2. Artifact related to portable technique limit evaluation of the parenchyma. There are small hypodensities involving the bilateral inferior cerebellar hemispheres similar to examination from 2/27/2015 which may represent subacute to chronic infarcts. No clear volume loss to definitively suggest that these are chronic. If patient can tolerate, consider MRI or follow-up CT for further evaluation. |
Generate impression based on findings. | Female 41 years old Reason: L ankle pain/swelling History: pain/swelling. There is soft tissue swelling about the ankle. There is an acute appearing medial malleolar fracture with inferior displacement of the distal fracture fragment. The ankle mortise is preserved. Small osteophyte formation is noted at the tibiotalar joint. Note is made of a calcaneal spur. | Medial malleolar fracture as described above. |
Generate impression based on findings. | Sitz markers placed at 3:12 p.m.VIEW: Abdomen AP (one view) 02/28/15, 1811 24 Sitz markers are seen in the mid abdomen.Rectal tube has been removed. A gastrostomy tube is present. Feeding tube is coiled upon itself in the stomach with tip in fundus.Left thoracolumbar curve and bilateral developmental hip dysplasia are noted.There appears to be contrast in the rectum. Mildly to moderately dilated bowel is noted. The colon in the right abdomen is the most dilated. Streaky opacities are seen in the lung bases. | Administration of Sitz markers. Development of bowel dilation after removal of rectal tube. |
Generate impression based on findings. | Female 77 years old Reason: eval fracture History: /sp fall. Four views of the left knee show a small joint effusion in the suprapatellar pouch and soft tissue reticulation along the superior aspect of the patella. Extensor mechanism appears to be intact. Tiny osteophytes affect the medial compartment. | No acute fracture or dislocation. |
Generate impression based on findings. | Shortness of breath and chest pain. Rule-out pneumonia.VIEWS: Chest PA/lateral (two views) 03/01/15 Cardiothymic silhouette is normal. Subsegmental atelectasis is seen in left upper lobe. No other focal opacity is present.Right thoracic and left thoracolumbar curves are most likely positional. | No pneumonia. Subsegmental atelectasis in left upper lobe. |
Generate impression based on findings. | Glioma, worsening ataxia As seen on recent MRI dated 2/16/2015, there is a infiltrating mass involving the pons extending into the midbrain. There is an area of necrosis with peripheral hyperdensity which may represent small hemorrhage and/or mineralization but not clearly changed since 2/16/2015, allowing for differences in technique. There is no frank intraparenchymal hematoma. No new mass-effect is appreciated. There is partial effacement of the fourth ventricle. Ventricles are unchanged in size without clear evidence of hydrocephalus. There is prominent global parenchymal volume loss. No midline shift or transtentorial or tonsillar herniation. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Unchanged defect in the right frontal calvarium. | 1. Compared to MRI from 2/16/2014, there is no clear change in patient's infiltrating pontine glioma with area of necrosis. There is peripheral rim of hyperdensity compatible with mineralization with possible small component of blood products. No frank intraparenchymal hematoma or new mass-effect is appreciated. If clinically indicated, follow-up MRI may be helpful.2. Partial effacement of the fourth ventricle with prominence of the ventricular system which is favored to be related to advanced global parenchymal volume loss. |
Generate impression based on findings. | Female 85 years old Reason: r/o fxr, osteo, gas gangrene History: marked swelling, erythema, tenderness . Three views of the left ankle show diffuse soft tissue swelling and reticulation about the ankle. The bones appear diffusely demineralized, but there is no definite cortical disruption to suggest infection. | No radiographic evidence of osteomyelitis. If further imaging is clinically warranted, an MRI or triphasic bone scan is recommended. |
Generate impression based on findings. | Abdominal pain. Possible appendicitis. History of diarrhea, nausea and vomiting. ABDOMEN:LUNG BASES: No focal opacity is seen. A pleural effusion is not present.LIVER, BILIARY TRACT: Liver enhancement is normal. The gallbladder is incompletely distended. No biliary ductal dilatation is identified.SPLEEN: Enhancement and size are normal.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal cortical enhancement is symmetric. No pelvicaliceal dilation is present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Distal transverse colon and and descending colon wall appears thickened however the colon is incompletely distended. The appendix is retrocecal and normal in appearance. No dilated bowel is identified.BONES, SOFT TISSUES: Normal in appearance.OTHER: No free peritoneal air or fluid is identified.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Distal transverse colon and and descending colon wall appears thickened however the colon is incompletely distended. The appendix is retrocecal and normal in appearance. No dilated bowel is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of appendicitis. Probable colitis. |
Generate impression based on findings. | Male 34 years old Reason: ? osteo History: pain over 4th metatarsal a/w cellulitis. There is a mild hallux valgus deformity. There is diffuse swelling about the forefoot without a definite soft tissue defect or ulceration is radiographically evident. The cortices of the bones are preserved without evidence of disruption to suggest osteomyelitis. | No significant osteomyelitis. If further imaging is clinically warranted, an MRI or a triphasic bone scan is recommended. |
Generate impression based on findings. | Chest tube placement. 14-week-old former 27 week gestational age patient with history of chylothorax.VIEW: Chest AP (one view) 02/28/15, 1414 A left chest tube has been placed.Right central line tip is in right atrium. Feeding tube side-port is at the GE junction.A small to moderate left basilar pneumothorax is seen. There appears to be pleural fluid laterally. Opacity in left upper and mid lung continues. Mediastinum is slightly shifted to right. Hazy opacities and right continue. Cardiac silhouette size is upper limits of normal. | Small to moderate left hydropneumothorax. |
Generate impression based on findings. | Male 70 years old Reason: r/o fracture History: shoulder pain. There is no acute fracture or dislocation. Moderate degenerative arthritic changes affect the glenohumeral and acromioclavicular joints. | Degenerative arthritic changes of the glenohumeral and acromioclavicular joints without evidence of underlying acute fracture or dislocation. |
Generate impression based on findings. | NONCONTRAST: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns 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 extracranial soft tissues are unremarkable. CTA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. Posterior and anterior communicating arteries are present. There is no evidence of flow-limiting stenosis or aneurysm. | 1.No flow limiting stenosis or intracranial aneurysm.2.No acute intracranial hemorrhage or mass-effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 35 years old Reason: assess for foreign body History: laceration from broken glass . There are soft tissue irregularities along the lateral aspect of the middle phalanx of the fourth finger compatible with lacerations in the superficial soft tissues. No radiopaque foreign body is seen. No acute fracture or dislocation is seen. | No radiopaque foreign body, acute fracture, or dislocation. |
Generate impression based on findings. | Female 53 years old Reason: r/o steroid-induced necrosis History: pain. There is no acute fracture or dislocation. No radiographic evidence of avascular necrosis. Mild to moderate degenerative arthritic changes affect the hip joints. | No radiographic evidence of avascular necrosis. If there is continued clinical concern, an MRI is more sensitive for early detection of osteonecrosis. |
Generate impression based on findings. | Female 53 years old Reason: eval for fx, dislocation; slammed hand in car door History: pain over 1st metacarpal and snuffbox tenderness. There is no acute fracture or dislocation, in particular there is no definite scaphoid fracture. There is mild to moderate osteoarthritis of the basilar and interphalangeal joint of the thumb and metacarpophalangeal and distal interphalangeal joints of the second fingers. | No acute fracture or dislocation. |
Generate impression based on findings. | There are unchanged posttreatment findings in the neck with no evidence of tumor recurrence or significant lymphadenopathy. There is an unchanged nonspecific soft tissue nodule on series 8 image 47 in the right upper back measuring 6 mm. The left parotid gland appears atrophic but unchanged from the prior exam. The remaining major salivary glands are unremarkable. The major vessels of the neck are patent. The airways are patent. There is no discrete osseous lesion. Please refer to dedicated accompanying CT chest report for further details regarding pulmonary metastases. | No locoregional tumor recurrence or significant cervical lymphadenopathy. Please refer to dedicated accompanying CT chest report for further details regarding pulmonary metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 54 years old Reason: ? pulmonary embolus. History: shortness of breath, anxiety. PULMONARY ARTERIES: Technically adequate study without evidence of a pulmonary embolus. Pulmonary caliber is within normal limits.LUNGS AND PLEURA: Severe upper lobe predominant centrilobular and paraseptal emphysema appears not significantly changed when compared to the prior exam. Focal areas of nodularity are within a left upper lobe bulla and a right upper lobe bulla are unchanged when compared to the prior exam and may reflect scarring and compressive atelectasis. There is minimal bilateral apical thickening. There is a small amount of right lower lobe atelectasis.MEDIASTINUM AND HILA: Right sided tracheal diverticula unchanged from the prior exam without evidence of an air fluid level. There is no mediastinal or hilar lymphadenopathy. Cardiac size is within normal limits without evidence of pericardial effusion or right heart strain.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No acute pulmonary embolus.PULMONARY EMBOLISM: PE: None.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Headache, chest pain, right lower extremity tingling/numbness. CVA No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic disease and progressed since 5/21/2009.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Moderate chronic small vessel ischemic disease which has progressed since 2009. |
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