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Generate impression based on findings. | 76 years, Female, Reason: Metastatic ovarian cancer needs re-evaluation and compare to prior scans. Per RECIST 1:1 bi-dimensional measurements where applicable. History: Metastatic ovarian cancer needs re-evaluation and compare to prior scans. Per RECIST 1:1 bi-dimensional measurements where applicable.. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. Scattered nonspecific micronodules are unchanged. No suspicious nodules or masses.MEDIASTINUM AND HILA: Thyroid nodules unchanged. Chest port catheter tip terminates at the cavoatrial junction. Severe coronary artery calcifications.CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata. Perihepatic hypodensities which likely represent metastases overall similar in size with a posterior reference lesion measuring 3.1 x 1.7 cm (3/70), previously 3.2 x 1.6 cm. Portal vein is patent.SPLEEN: Hypoattenuating lesion within the inferior spleen is increased since the prior exam. Reference lesion at the splenic hilum is not significantly changed in size measuring 3.4 x 2.4 cm (3/85), previously 3.6 x 2.1 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right-sided stent with moderate to severe right-sided hydroureteronephrosis which is unchanged. Mesenteric nodularity adjacent to the distal right ureter measures 4.6 x 2.2 cm (3/47), slightly increased from 4.4 x 2.9 cm previously.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple soft tissue nodules throughout the mesentery are minimally increased in size. A soft tissue nodule adjacent to the greater curvature of the stomach measures 3.2 by 2.7 cm (3/83), previously 2.0 x 2.4 cm. Reference nodule along the right paracolic gutter measures 1.6 x 1.0 cm (3/28), previously 1.2 x 0.8 cm. Reference nodule in the pelvis measures 3.3 x 2.7 cm (3/168), previously 3.4 x 3.0 cm.No evidence of small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Atrophic/absent uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Right inguinal node is slightly increased measuring 2.0 x 1.9 cm (3/172), previously 2.2 x 1.7 cm. Pelvic lymphadenopathy is unchanged.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: No significant abnormality noted. | 1.Multiple mesenteric masses are minimally increased in size.2.Splenic hypodensity is increased in size.3.Multiple perihepatic lesions are not significantly changed in size.4.Moderate to severe right-sided hydronephrosis is unchanged. |
Generate impression based on findings. | The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Myelination appears appropriate. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid is noted within a few bilateral mastoid air cells. | Fluid is noted within a few bilateral mastoid air cells. Otherwise negative noncontrast brain MRI. Previously identified possible hypoattenuation of the cerebral white matter is felt to be related to the stage of myelination and not intracranial pathology. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Multiple bilateral benign morphology calcifications and masses (which are probably cysts or fibroadenomas) are noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Male 49 years old Reason: is there fracture at the left mcp of the 2nd digit? Or along the proximal shaft of the second digit? History: Pain, swelling, s/p injury. A deformity seen along the lateral aspect of the fifth proximal phalanx likely reflects remote trauma. No acute fracture or dislocation is identified. There is, perhaps, mild soft tissue swelling about the first and second digits. | No acute fracture or dislocation. |
Generate impression based on findings. | 57-year-old female with a history of Marfan's syndrome, multiple CVAs, CHF, carotid endarterectomy and visual disturbances. CT head without contrast: There is no evidence of acute intracranial hemorrhage. Encephalomalacia within the right posterior temporal/occipital lobe and right basal ganglia appears similar to prior. Chronic small infarct within the frontal periventricular white matter is also stable. There is mild periventricular and some cortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. There is advanced volume loss for age. No evidence of midline shift or mass-effect. The paranasal sinuses and mastoid air cells are calvarium and soft tissues are within normal limits.CT angiography: The aortic arch shows a normal configuration, although there is evidence of a prior ascending aorta repair. The origin of the right vertebral artery is mildly attenuated. The right internal carotid artery is completely occluded just distal to the bifurcation. The age of this occlusion is unknown although we suspect that it is chronic given the well established collateral intracranial circulation. The distal right ICA is reconstituted by an intact circle of Willis. There is a 2 x 2 mm saccular outpouching of the communicating segment of the left internal carotid artery just distal to the PCOM which may represent an aneurysm or anterior choroidal infundibulum although no clear vessel is appreciated arising from it. There is narrowing of the left mid PCA and right MCA distal to the bifurcation. There is a persistent left fetal circulation with a hypoplastic left P1. The ACOM artery is large and fenestrated or duplicated.Mild to moderate degenerative disease affects the cervical spine. Surgical clips are present in the right aspect of the neck. There is mild basilar atelectasis/edema which is incompletely evaluated. | 1. Complete occlusion of the right internal carotid artery of unknown age, although likely chronic. Reconstitution of the distal right ICA from an intact circle of Willis. Mildly attenuated right vertebral artery at its origin.2. 2 x 2 mm saccular outpouching of the left paraclinoid internal carotid artery distal to the PCOM may represent a tiny aneurysm or infundibulum although no clear vessel is seen arising from it. This can be confirmed with angiography if clinically warranted.3. Narrowing of the left mid PCA and right MCA distal to the bifurcation.4. Multiple bilateral chronic cerebral infarctions and global volume loss appearing similar to prior. |
Generate impression based on findings. | Male 57 years old Reason: midline cspine pain History: neck pain. Two views of the cervical spine show no acute fracture or malalignment. Cervical vertebral body heights and intervertebral disk spaces Apparent straightening of the cervical spine is likely due to cervical collar. Moderate degenerative arthritic changes affect the cervical spine distally from C5 to T1 with anterior vertebral body osteophyte formation. The bilateral neuroforamina are patent.Three views of the thoracic spine show no acute fracture or subluxation. There is mild to moderate degenerative disk disease with anterior vertebral body osteophyte formation. The thoracic vertebral body heights and intervertebral disk spaces are preserved. The visualized ribs appear intact.Five views of the lumbar spine show no acute fracture or subluxation. There is moderate degenerative disk disease with multilevel anterior vertebral body osteophyte formation. The lumbar vertebral body heights and intervertebral disk spaces are preserved. There are mild degenerative changes seen at the bilateral sacroiliac joints. | Degenerative disk disease as described above without acute fracture or subluxation. Alignment is preserved. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral benign morphology calcifications and asymmetries are stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 13 year old female with injury.VIEWS: Right ankle AP, oblique and lateral (3 views) 3/2/2015 8:28 Alignment is normal. No soft tissue swelling or joint effusion. No fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Reason: h/o tonsil and nasopharynx caRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Unchanged benign-appearing micronodules.No evidence of metastases.Scattered ground glass regions particularly in the right upper lobe are suggestive of aspiration or infection. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Very mild coronary calcifications are present, the heart and pericardium otherwise unremarkable.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable benign cystlike hepatic hypodensities.SPLEEN: Accessory splenule, normal variant.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative abnormalities affect the lumbar spine.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left biopsy and sarcoidosis. History of maternal aunt diagnosed with breast cancer. Two standard digital views of both breasts with additional bilateral CC views were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 68 years, Male. Reason: NGT placement History: as above Enteric feeding tube tip projects over the expected area of the right bronchus intermedius. Nonobstructive bowel gas pattern. Suture material projects over the right lower quadrant and hemipelvis. The lower portion of the pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the expected area of the right bronchus intermedius. |
Generate impression based on findings. | 37 years, Female, Reason: assess intraabdominal cyst, r/o hydronephrosis History: RLQ, groin abdominal pain, hematuria. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 11.4 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.BLADDER: The bladder is unremarkable.OTHER: There is a simple appearing anechoic lesion in the right lower quadrant which measures 10.0 x 5.5 x 9.7 cm and corresponds to cyst seen on recent CT. No solid enhancing components or septations are visualized. | 1.No hydronephrosis.2.Simple appearing mesenteric cyst in the right lower quadrant, likely benign. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A left central breast focal asymmetry is stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 68 years, Male. Reason: ng History: ngt placement Enteric feeding tube tip projects over the distal gastric body. Nonobstructive bowel gas pattern. Suture material projects over the right lower quadrant and right hemipelvis. The lung bases are clear. There is a residual contrast noted in the collecting systems of the bilateral kidneys without evidence of hydronephrosis. | Enteric feeding tube tip projects over the distal gastric body. |
Generate impression based on findings. | 54 years, Male. Reason: cause of abdominal and back pain History: abdominal pain Nonobstructive bowel gas pattern with moderate stool burden in the colon. | Nonobstructive bowel gas pattern with moderate stool burden in the colon. |
Generate impression based on findings. | There is a 1.2 x 1.1 cm (series 2, image 16) heterogeneous lesion in the right frontal lobe with a hypointense hemosiderin rim as noted on the T2/FLAIR images; this lesion demonstrates prominent susceptibility effect with evidence of mild internal enhancement. Finding most consistent with a cavernoma. No associated DVA is seen. Scattered T2/FLAIR signal foci in the subcortical and periventricular white matter are nonspecific. No midline shift. There is no evidence of acute intracranial hemorrhage or diffusion weighted abnormalities to suggest acute ischemia. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. The paranasal sinuses and mastoid air cells are clear. | 1.Right frontal lobe lesion as above most consistent with a cavernoma.2.Nonspecific scattered T2/FLAIR signal foci in the subcortical and periventricular white matter. |
Generate impression based on findings. | Previously treated thyroid cancer. Surveillance. CHEST:LUNGS AND PLEURA: Small left and trace right pleural effusions, new from prior.Interval wedge resection of left upper lobe nodule.No suspicious pulmonary nodules or masses are identified.MEDIASTINUM AND HILA: New mildly enlarged left lower paratracheal lymph node that is 11 mm in short axis (series 4, image 36). There are additional subcentimeter mediastinal lymph nodes that are slightly larger.No visible coronary artery calcification. Diffuse mild pericardial thickening, which may be post-treatment related.Right chest port tip in SVC.Postoperative changes of a total thyroidectomy and bilateral neck dissection.Small hiatal hernia.CHEST WALL: Stable compression deformity of T7 vertebral body.Mild degenerative changes of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta without aneurysm. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Scattered colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Interval wedge resection of left upper lobe nodule. No evidence of pulmonary metastases. 2. New mildly enlarged left paratracheal lymph node and slightly increased size of small subcentimeter nodes, may be reactive and are of unclear clinical significance. 3. Small bilateral pleural effusions. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. Questionable coronary calcifications, the heart and pericardium otherwise unremarkable.CHEST WALL: Right jugular catheter tip in SVC.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic lobe hemangioma unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts are unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastases, or other significant abnormality. |
Generate impression based on findings. | Reason: pleuritic chest pain, history of asthma, recent diagnosis EoE after EGD 1 month ago History: chest pain LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No acute cardiopulmonary abnormality to account for the patient's symptoms. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with additional left MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Vascular calcifications are noted bilaterally. Left sided catheter noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 13-year-old male, evaluate fourth toe fractureVIEWS: Left foot, AP and lateral (two views) 3/2/15 9:35 Oblique fracture of the fourth proximal phalanx in near anatomic alignment with interval callus formation and sclerosis consistent with healing. | Healing fracture of the fourth proximal phalanx. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 64 year old female with history of right mastectomy for DCIS in March 2010. Patient has had left mammoplasty. No new breast complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. An oil cyst with rim calcification is noted at the 6 o'clock position of the left breast and unchanged, adjacent to two surgical clips. No new masses, suspicious microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: evaluate hilar shadow noted on chest x ray (left) History: cough LUNGS AND PLEURA: Mild dependent opacities and calcified granulomata.No sign of malignant disease in the lungs.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.Moderate coronary calcifications are present although the heart and pericardium are otherwise unremarkable in appearance.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hyperintense hepatic focus right lobe image 104 series 4 is almost certainly a benign hemangioma. | No significant abnormality. No evidence of mediastinal or hilar mass as questioned in the clinical data provided. |
Generate impression based on findings. | Reason: 51 y/o M with PMH of CHF, rule out COPD/emphysema History: wheezing LUNGS AND PLEURA: Scattered benign-appearing micronodules, some calcified. No suspicious pulmonary nodules or masses.Mild basilar subsegmental atelectasis. No evidence of pulmonary edema. No focal air space consolidation. No pleural effusions.No evidence of emphysema.MEDIASTINUM AND HILA: The heart is enlarged, without significant pericardial effusion. Severe coronary artery calcification. ICD leads terminate at the right atrium, ventricle.No mediastinal or hilar lymphadenopathy.CHEST WALL: Left chest ICD partially visualized.Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of emphysema or other acute abnormality to account for the patient's symptoms. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Postoperative findings from prior sinus surgery.Frontal sinus: Interval improvement in aeration of frontal sinuses without significant mucosal thickening.Anterior ethmoid sinuses: Interval improvement in aeration of bilateral anterior ethmoid sinuses.Maxillary sinuses: significant interval worsening of opacification of the right maxillary sinus. No significant interval change in moderate opacification of left maxillary sinus.Posterior ethmoid sinuses: Mild interval improvement in aeration of bilateral posterior ethmoid sinuses.Sphenoid sinuses. No significant change in opacification of the left sphenoid sinus.There is sclerosis of the bilateral maxillary and left sphenoid sinus wall consistent with changes of chronic sinusitis. Bilateral mastoid air cells and middle ear cavities. The bilateral maxillary sinus ostia are patent. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. Mild rightward nasal septal deviation. Bilateral orbits and the posterior nasopharynx appear unremarkable. | Sinus inflammatory disease and changes consistent with chronic sinusitis as above. |
Generate impression based on findings. | 88 year-old male with shortness of breath, preoperative evaluation for MVR. ANGIOGRAM: Please see accompanying cardiac CT report for description of thoracic aorta. Mild atherosclerotic disease affects the abdominal aorta and its branches. There is no evidence of abdominal aortic aneurysm, dissection, or significant stenosis. The origins of the great vessels, celiac axis, SMA, and renal arteries are patent.There is moderate deviation of the bilateral common iliac arteries. There is marked tortuosity of the right common iliac artery with kinking less 90 degrees. There is moderate tortuosity of the left common iliac artery. No circumferential atherosclerotic calcifications are noted within the common/external iliac arteries.VESSELS:SUPRARENAL ABDOMINAL AORTA: 2.3 x 2.3 cmINFRARENAL ABDOMINAL AORTA: 1.5 x 1.6 cmRIGHT COMMON ILIAC ARTERY: 9.1 x 10.3 mmRIGHT EXTERNAL ILIAC ARTERY: 7.1 x 8.2 mmRIGHT COMMON FEMORAL ARTERY: 7.3 x 8.3 mmLEFT COMMON ILIAC ARTERY: 8.8 x 9.7 mmLEFT EXTERNAL ILIAC ARTERY: 6.4 x 6.6 mmLEFT COMMON FEMORAL ARTERY: 10.8 X 8.1 mmLEFT SUPERFICIAL FEMORAL ARTERY: 6.2 x 6.7 mmABDOMEN:LUNG BASES: Please see accompanying cardiac CT report for description of pulmonary findings. Moderate right pleural effusion.LIVER, BILIARY TRACT: Phase of contrast limits evaluation for liver lesions. Small hypoattenuating lesion in segment 6 unchanged, likely benign cyst. Reflux of contrast into the IVC and hepatic veins suggestive of right heart failure.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of right hemicolectomy.BONES, SOFT TISSUES: Degenerative changes of the visualized osseus structures. Previously seen anterior abdominal wall hernia no longer visualized. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate. Calcifications are present at the site of the previously described enhancing prostatic lesion suspicious for malignancy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Fat-containing right inguinal hernia, unchanged. Bilateral hydroceles. Degenerative changes of the visualized osseus structures. OTHER: No significant abnormality noted | 1.Please see dedicated cardiac CT for details regarding the chest and thoracic aorta.2.Abdominal vascular measurements as above including somewhat narrow caliber of the left external iliac artery. Severe tortuosity of the right common iliac artery including kinking < 90 degrees. Moderate tortuosity of left common iliac artery.3.Redemonstration of right peripheral zone prostatic lesion suspicious for carcinoma. |
Generate impression based on findings. | 13-year-old male evaluate for bronchiectasis, ABPA in setting of atypical pneumonia LUNGS AND PLEURA: Ground glass opacities are present in the bilateral lower lobes, right greater than left. On the right the opacities are seen in the superior segment, posterior basal segment, lateral basal segment and medial basal segment with the anterior basal segment less involved. On the left lower lobe, the opacities are seen in the posterior basal and anteromedial basal segments with sparing of the superior and lateral basal segments. There is associated bronchiectasis in the distribution of the ground glass opacities extending to the proximal subsegmental bronchi where the bronchial caliber is similar to the accompanying arteries. Additionally bronchiectasis is noted in the right middle lobe where the bronchi are almost the size of the the accompanying arteries. Bronchial wall thickening is noted in the distribution of the bronchiectasis as well as in the bilateral upper lobes. Pleural based opacity in the right lung base medially is noted. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No mediastinal or hilar adenopathy.CHEST WALL: No suspicious osseous lesions. No axillary lymphadenopathy is noted.UPPER ABDOMEN: No evidence of pathology in the upper abdomen. | Bronchiectasis, bronchial wall thickening and ground glass opacities predominantly in the lower lobes, right greater than left. There is no mucoid impaction. Findings are not typical for ABPA since these findings are usually seen in the upper lobes. |
Generate impression based on findings. | Female 61 years old Reason: re-staging of progressive myeloma History: increasing back pain. SKULL: Two views of the skull show multiple lucent lesions of the calvarium compatible with myelomatous deposits, appearing similar to the prior study.CERVICAL SPINE: Two views of the cervical spine. The bones appear diffusely demineralized. There are new lytic appearing lesions in the cervical bodies and posterior elements, particularly the C4 vertebral body and posterior elements, that are suspicious for new myelomatous deposits. Cervical vertebral body heights and intervertebral disc spaces are preserved.THORACIC SPINE: One view of the thoracic spine again shows orthopedic fixation with posterior stabilizing rods and screws in T6, 7, 8, 10, 11, and 12 and corpectomies of the T9 through T12 vertebral bodies. Again seen are compression fracture deformities of T6 and T12 appearing similar to the prior study. No discrete myelomatous lesion is evident.LUMBAR SPINE: Two views of the lumbar spine show a loss lung L5 spinous process inferiorly, which may be postoperative in etiology. There is disk space narrowing at L5/S1 which is unchanged from the prior exam. No discrete myelomatous lesion is evident.RIBS: One view of the ribs. Previously seen right posterior lesion is not well seen on today's examination. Poorly defined lucencies in the left clavicle and acromion are again seen and may represent myelomatous deposits.PELVIS: Mild osteoarthritic changes affect the bilateral hips and pubic symphysis. No discrete myelomatous lesion is seen.UPPER EXTREMITY: Two views of the right humerus show no discrete myelomatous lesions.Two views of the left humerus show no discrete myelomatous lesions.Single AP view of the right forearm shows no discrete myelomatous lesions.Single AP view of the left forearm again shows a lytic appearing lesion in the mid radial diaphysis, unchanged from the prior study and may reflect a myelomatous deposit.LOWER EXTREMITY: Two views of the right femur show poorly defined lucencies in the distal femoral diaphysis, which are unchanged from the prior exam and may represent myelomatous deposits, but this is equivocal.Two views of the left femur show no discrete myelomatous lesion.AP views of the bilateral tibias/fibulas show no discrete myelomatous lesions. Moderate posterior arthritic changes affect the bilateral knees and appear unchanged from the prior exam. | Findings compatible with multiple myeloma as described above without any evidence of interval progression. |
Generate impression based on findings. | Male 56 years old Reason: 55M history of bladder cancer s/p cystectomy, surveillance imaging History: as above ABDOMEN:LUNG BASES: Calcified left lower lobe micronodule, unchanged. No pleural effusion. No evidence of pleural disease.LIVER, BILIARY TRACT: Stable punctate hypodensity in the posterior segment of the right lobe which likely represents a cyst (series 7, image 26). No biliary ductal dilatation.SPLEEN: Calcified splenic granulomas. Normal splenic size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval placement of bilateral nephroureteral stents. There has been interval resolution of the left hydronephrosis and hydroureter seen on previous exam. No right hydronephrosis.There is asymmetric contrast excretion with prompt excretion on the right and delayed excretion on the left. There is thinning of the left renal cortex and slight atrophy of the left kidney compared to prior exam. Exam is limited secondary to lack of opacification of the left ureter due to delayed excretion. The right ureter is well opacified. Within these limitations, there are no findings to suggest disease recurrence.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta. Small left periaortic nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Interval repair of the large ventral bowel hernia seen on previous exam with postsurgical changes in the anterior abdominal soft tissues. Degenerative changes of the thoracic spine.OTHER: Moderate coronary artery calcifications.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy and ileal conduit with urinary diversion.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1.Status post cystectomy and ileal conduit with urinary diversion without evidence of tumor recurrence or metastatic disease.2.Interval placement of bilateral nephroureteral stents with resolution of the previously seen left hydronephrosis. There is delayed excretion and slight atrophy of the left kidney compared to prior exam. |
Generate impression based on findings. | Male 33 years old. Stab wound to forearm. On a both first and second digits on right hand. The bones of the forearm and hand appear normal, without fracture or malalignment.The soft tissues of the forearm and hand are unremarkable, without defects, masses, or hematoma evident. No appreciable soft tissue edema is noted. The musculature is unremarkable given the noncontrast CT technique. | No specific findings to account for the patient's symptoms. If further imaging evaluation is clinically warranted, MRI may be more sensitive for soft tissue evaluation. |
Generate impression based on findings. | Reason: eval esophageal GIST History: esophageal GIST c/b bleeding from necrosis, planning for esophagectomy CHEST:LUNGS AND PLEURA: Scattered areas of groundglass and consolidation in the left upper lobe, decreased in prominence from the prior CT abdomen pelvis dated 2/27/2015. Moderate subsegmental atelectasis and a small right pleural effusion are similar to the recent prior CT abdomen pelvis exam.A right middle lobe pleural-based solid, well-marginated nodule measures 12 x 9 mm (series 6, image 44), not significantly changed from 1/3/2015.MEDIASTINUM AND HILA: The heart is mildly enlarged, without significant pericardial effusion. Mild coronary artery calcification.Heterogeneous thyroid, right lobe larger than the left, which is better evaluated with ultrasound imaging.No mediastinal or hilar lymphadenopathy.Dilated, fluid filled proximal esophagus. Esophageal stent in place in the distal esophagus across the GE junction. Ill-defined surrounding soft tissue mass around stent is compatible with the patient's known GIST tumor, not significantly changed from prior CT dated 2/27/2015.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Markedly atrophic left kidney, 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.Small residual enteric contrast within the colon from recent prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Scattered areas of groundglass and consolidation in the left upper lobe, improved from the prior CT abdomen pelvis dated 2/27/2015, and likely infectious or aspiration in etiology.2. An approximately 1-cm right middle lobe pleural-based nodule, not significantly changed from 1/3/2015 and not hypermetabolic on recent PET imaging dated 1/26/2015. Likely benign, but continued close interval followup is recommended.3. Ill-defined soft tissue mass surrounding an esophageal stent, compatible with the patient's known GIST tumor. See recent prior CT abdomen pelvis dated 2/27/2015 for additional details. |
Generate impression based on findings. | Reason: hx of thoracic compression fx, evaluate healing History: back pain. thoracic spine:There is a superior compression fracture present at T5 with approximately 25% loss of vertebral body height which is new since the 2011 exam. There is a compression fracture present at T10 with approximately 50% loss of vertebral body height which is unchanged since the 2011 exam. There is a compression fracture present at T12 and inferior endplate compression and loss of 25% of vertebral body height which is unchanged since the 2011 exam.The thoracic vertebral bodies are appropriate in the overall alignment. There is no compromise of thoracic spinal canal or exiting nerve roots. No bony lesions are identified in the thoracic spine. Incidental note is made of a hiatal hernia which was also present on the prior exam.lumbar spine:Five lumbar type vertebral bodies are presumed to be present. There is a marked levo curvature to the lumbar spine. There is 15% loss of vertebral body height at L1 which is new since the 2011 exam. There is a mild left lateral translation of L4 on L5. There is mild right lateral translation of L2 on L3.There are sclerotic foci present in the S1 segment vertebral body measuring up to 11 mm in diameter located and located just to the right of midline. There is a spina bifida defect at L5.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a minor disk bulge present at this level and mild narrowing of the facet joints.At L4-5 there is loss of disk space height, vacuum disk phenomenon and a several millimeter left lateral translation of L4 on L5. There is a diffuse disk bulge present at this level associated with partial effacement of the fat within the neural foramina and mild encroachment of the right-sided exiting nerve roots. There is also partial effacement of the fat in the right lateral recess at this level with mild encroachment of the nerve roots at the right lateral recess. Overall there is a mild degree of spinal stenosis at this level. The spinous processes of L4 and L5 abut each other. At L3-4 there is loss of disk space height and normal right side than the left associated with endplate reactive changes and right-sided endplate osteophytes. There is effacement of the fat in the right neural foramen at this level with some encroachment of the right-sided exiting nerve roots within the right neural foramen. The spinous processes of L3 and L4 abut each other and are associated with sclerotic change. The L3 spinous process overrides the L4 spinous process and is to the left of the L4 spinous process along its inferior aspect. There appears to be a defect present at inferior aspect of the right L3 lamina associated distortion of the right L3-4 facet joint as well as atrophy of the right-sided musculature more than the left. At L2-3 there loss of disk space height, vacuum disk phenomenon and 5 mm right lateral translation of L2 on L3. Loss of disk space height is eccentric towards the right side. There is diffuse disk bulge present at this level associated with facet hypertrophy. The L2 and L3 spinous processes abut each other in appearance the right facet joint is substantially eroded at this levelAt L1-2 there is no significant compromise to spinal canal or neural foramina. There is a diffuse disk bulge present associated minimal right lateral translation of L1 on L2 and vacuum disk phenomenon. There is mild narrowing of the neural foramina bilaterally with mild encroachment of the left exiting nerve roots.There are atherosclerotic calcifications present in the aorta and many of its branches.Surgical clips are present in the expected location of the gallbladder.The right ureter appears to be mildly changed proximally and at the right renal pelvis is minimally enlarged compared to the left renal pelvis. | 1.Since 2011 new compression fractures have developed at T5 and L1. 2.There are stable compression fractures present at T10 and T12. In general these have a benign appearance.3.There are multilevel degenerative changes present in the lumbar spine associated with a marked levo-curvature and narrowing of neural foramina and some distortion of posterior elements as detailed above.4.There are sclerotic foci present in the right sacrum. I suspect these are degenerative in nature, however, the patient has a known primary tumor a bone scan may be of further benefit in evaluating this. Follow-up imaging may be helpful. |
Generate impression based on findings. | Male 69 years old; Reason: OSH transfer. Right iliopsoas muscle enlargement seen concerning for hemorrhage. History: right hip pain, swelling There is soft tissue density enlargement involving the right iliacus muscle, measuring 3.4 cm AP x 6.9 cm TV x 8.6 cm CC (series 4, image 47). The fat planes of the iliacus are no longer visible. A small amount of hyperattenuation within this mass-like lesion may represent hemorrhage, enhancement, and/or calcification. The adjacent right psoas muscle is unremarkable. The underlying right iliac bone appears normal. Mild osteoarthritis affects the right hip. | Soft tissue mass-like enlargement at the right iliacus muscle. The appearance of this lesion is non-specific on CT and may represent a hematoma, however, a neoplasm or infection cannot be entirely excluded. Evaluation with MRI with IV contrast may be helpful. |
Generate impression based on findings. | 84-year-old female with history of chronic sinusitis. The paranasal sinuses are clear. The ostiomeatal units, frontoethmoidal and sphenoethmoidal recesses are clear. The lamina papyracea are intact. The orbits are normal. Mild leftward nasal septum deviation. Mild periventricular and subcortical white matter hypoattenuation is partially imaged but appears similar to prior brain MRI. | 1. No significant sinus disease.2. Partially imaged periventricular and subcortical white matter hypoattenuation is nonspecific, but appears similar to prior brain MRI. |
Generate impression based on findings. | 18 year old male with left breast lump. With physical exam, left nipple appears larger than right, and there is a soft thickening behind the left nipple. Focused ultrasound of left retroareolar region detects a small amount of hypoechoic tissue consistent with gynecomastia. No solid or cystic masses are detected. | Left retroareolar thickening, consistent with gynecomastia. Clinical follow up is recommended and no further imaging assessment is needed. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, denser than on the prior study suggesting interval weight loss. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | 55-year-old male with atrial fibrillation and multiple embolic strokes, evaluate for hemorrhagic transformation Redemonstrated is hypodensity involving gray and white matter located in the left medial frontal lobe involving superior frontal gyrus and cingulate gyrus, unchanged in appearance.Hypodensity involving gray and white matter located in the right postcentral gyrus has enlarged over the interim.Right supramarginal gyrus hypodensity, punctate foci of hypodensity along the right angular gyrus, loss of gray white differentiation along the left superior parietal lobule and part of the the left superior internal parietal artery territory are again noted and unchanged.Small foci of hypodensity along the posterior aspect of the right insular cortex as well as the the left caudate nucleus also stable.Redemonstrated is a focus of encephalomalacia present involving the left inferior parietal lobule.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. An enteric tube is present in the left nares.Atherosclerotic calcifications are present along the distal vertebral arteries. | Evolving multiple cerebral infarcts without hemorrhagic transformation. |
Generate impression based on findings. | Ms. Townsend is a 64-year-old female with screen detected area of architectural distortion in the left upper outer breast with a sonographic correlate. She presents today for ultrasound guided biopsy of this area. Left breast ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic area measuring 8 x 5 x 8 mm at the 10 o’clock position with increased vascularity, 4 cm from the nipple. The lesion was very subtle.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views along with tomosynthesis view in the MLO view revealed the percutaneously placed Hydromark clip to be in the expected location at the posterior aspect of the area of architectural distortion (best seen on tomosynthesis view). No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Sheth. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left breast lesion with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Two year old female with history of fracture.VIEWS: Left femur AP and lateral (two views) 3/2/2015 10:01 Overlying cast obscures fine bony detail. Again noted is fracture involving the proximal diaphysis of the left femur which is in near anatomic alignment. There is continued periosteal reaction and sclerosis compatible with healing. | Continued healing of left femoral fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal aunts with breast cancer. Two standard digital views of both breasts and additional bilateral MLO views were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of mother with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast core biopsy. History maternal aunt with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the left lower inner breast is stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 79-year-old female with history of metastatic carcinoid tumor. ABDOMEN:LUNG BASES: New trace right greater than left pleural effusions.LIVER, BILIARY TRACT: Extensive bilobar hepatic metastases are again present with varied appearances, many necrotic and low density from necrosis following treatment, but often with peripheral nodular enhancement persisting. While most lesions have not significantly changed in size or appearance (particularly the large lesions), there has been an overall mixed response compared to prior most recent CT. For example: *The reference right hepatic lobe lesion is unchanged in size measuring 6.1 x 4.6 cm (series 7, image 51), previously 6.1 x 4.6 cm. *An arterially enhancing segment 8 lesion (series 6, image 37) has increased in size measuring 2.9 x 4.2 cm, previously 1.6 x 2.2 cm*At least two of the small previously arterially enhancing lesions in the lateral segment of the left lobe no longer enhance suggesting interval necrosis.There is reflux of contrast into the IVC and hepatic veins suggesting right heart failure. The hepatic and portal veins are patent. Mild intrahepatic biliary ductal dilatation is present. The common bile duct is mildly dilated, similar to prior. Trace amount of perihepatic ascites, slightly increasedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Mild nodularity left adrenal gland unchanged.KIDNEYS, URETERS: Right upper pole renal cysts. Left renal exophytic partially calcified lesion, unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mildly prominent gastrohepatic lymph nodes appear similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesion in the T12 vertebral body, unchanged.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subtle right ilium sclerotic lesion, unchanged.OTHER: Small amount of pelvic free fluid is present, new from prior. | 1.While many liver lesions are unchanged, there is overall a mixed response of hepatic lesions as described above with increase in size of some lesions and interval necrosis of some other lesions.2.Sclerotic T12 and right ileal osseous lesions similar to prior, thought bone scan is more sensitive for osseous metastatic disease. 3.There is reflux of contrast into the IVC and hepatic veins suggesting right heart failure. 4.New small amount of pelvic fluid, new trace right pleural effusion, and increased trace perihepatic ascites. |
Generate impression based on findings. | 43 year-old female with known left breast cyst presents for followup mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. The small cyst in the left 12 o'clock position is no longer present. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral, scattered benign morphology masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 68 years old Male. Reason: extent of relapse prior to initiation of chemotherapy. History: relapsed diffuse B cell lymphoma based on bone marrow biopsy from outside hospital. RADIOPHARMACEUTICAL: 13.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 122 mg/dL. Today's CT portion grossly demonstrates splenomegaly with low-attenuation areas and new left small pleural effusion. There is a consolidation in the left lower lung. Numerous lytic lesions are seen in the skeleton.Today's PET examination demonstrates intense FDG uptake in the enlarged spleen with wedge-shaped areas of decreased metabolic activity. There is increased of activity in the numerous lytic lesions in the skeleton. The above findings are consistent with patient's diagnosis of relapsed lymphoma. Diffuse increased activity in the bone marrow is also noted, which is nonspecific. There is a new focus of increased activity in the left mandible, which can be due to tumor or periodontal disease.Physiologic activity is seen in the liver, spleen, kidneys, intestines, uterus and bladder. | 1.Splenomegaly with increased metabolic activity and wedge-shaped decreased areas of metabolic activity, consistent with tumor involvement and splenic infarcts.2.Lytic lesion in the skeleton with increased activity, consistent with tumor involvement.3.Nonspecific increased bone marrow activity.4.New focus of increased activity in the left mandible, which can be due to tumor or periodontal disease. 5.Left small effusion with compression atelectasis, new as compared with prior study. |
Generate impression based on findings. | Male 54 years old; Reason: Multiple myeloma with right sided rib pain RIBS: Radiopaque BB markers are noted at the lower lateral right rib cage, indicating the site of the patient's pain. Multiple bilateral rib deformities compatible with myelomatous lesions and/or old healed fractures are present, similar to the prior osseous survey. No definite acute displaced fracture is evident. The mass with associated left third rib destruction has progressed compared to prior, now measuring approximately 10 cm in CC dimension. Additional lytic lesions in the clavicles and scapulae are compatible with myelomatous deposits.No pneumothorax is present.T-SPINE: There is mild kyphosis. Otherwise, the alignment is anatomic. The T8 vertebral body pathological compression fracture is slightly progressed compared to prior studies. An L1 kyphoplasty is again noted. Again seen is the aforementioned left third rib lesion. No definite lytic lesions are otherwise evident. | 1. Multiple bilateral rib deformities compatible with myelomatous lesions and/or healed fractures, without definite acute displaced rib fracture.2. Enlargement of the destructive left third rib lesion.3. T8 vertebral body pathological compression fracture, slightly progressed. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Bilateral benign morphology calcifications are stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. The small cyst at 12 o'clock position in left breast is not well visualized on current study. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient. |
Generate impression based on findings. | 15-year-old female with crampy lower abdominal pain, evaluate for abscess or obstruction ABDOMEN:LUNG BASES: Minimal atelectasis.LIVER, BILIARY TRACT: No focal hepatic lesion or biliary ductal dilatation. The gallbladder is moderately distended and otherwise normal.SPLEEN: No focal splenic lesion.PANCREAS: Normal pancreatic enhancement and morphology.ADRENAL GLANDS: Both adrenal glands are well visualized and normal.KIDNEYS, URETERS: Symmetric renal cortical enhancement. Small bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Surgical clips are noted proximal to the celiac artery origin. The origins of the celiac, SMA, and IMA are patent.BOWEL, MESENTERY: Fat stranding and inflammatory changes in the right lower quadrant involving distal and terminal loops of ileum with matted bowel adjacent to the cecum. The appendix is not well visualized. No loculated fluid collection. The small bowel is normal in caliber.BONES, SOFT TISSUES: Postoperative changes of anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The uterus and adnexa appear physiologic for the patient's age.BLADDER: Moderately distended and otherwise, normal.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fat stranding and inflammatory changes in the right lower quadrant involving distal and terminal loops of ileum with matted bowel adjacent to the cecum. The appendix is not well visualized. No loculated fluid collection. The small bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic fluid is likely physiologic. | 1. Nonspecific inflammatory changes in the right lower quadrant involving the distal and terminal ileum extending adjacent to the cecum. The appendix is not visualized. No free or loculated fluid collection. No bowel obstruction. Findings discussed with Dr. Kohler at the time of dictation. 2. Postoperative changes of median arcuate ligament release. |
Generate impression based on findings. | 65 years, Male. Reason: advanced DHT from earlier placement History: advanced DHT from earlier placement Dobbhoff tube tip projects over the gastric body. Extensive bilateral nonspecific airspace opacities are better evaluated on prior chest radiograph. There is a paucity of bowel gas. Pelvis is excluded from the field-of-view. Central venous catheter tip projects over the cavoatrial junction. | Dobbhoff tube tip projects over the gastric body. Paucity of bowel gas. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of paternal aunt with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral asymmetries including a round asymmetry in the left medial breast are unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Unchanged bilateral asymmetries. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 65 years, Male. Reason: DHT placement History: DHT placement Note that the examination is mildly limited due to patient motion. Dobbhoff tube tip projects over the gastric body. Note that the pelvis and far lateral left abdomen are excluded from the field-of-view. Nonspecific bilateral opacities are better evaluated on prior chest radiograph. Central venous catheter tip projects over the cavoatrial junction. General paucity of bowel gas noted. | Dobbhoff tube tip projects over the gastric body. |
Generate impression based on findings. | 77 years, Male. Reason: obstruction, megacolon History: diarrhea, hx of Cdif Nonobstructive bowel gas pattern. No pneumoperitoneum on upright imaging. Gastrotomy tube projects over the gastric body. Esophageal stent projects over the distal esophagus. Average stool burden in the colon. Surgical clips project over the testes. | Nonobstructive bowel gas pattern with average stool burden. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 81 years, Male. Reason: eval leak History: s/p hepaticojejunostomy, bile in drain Residual enteric contrast is seen in the gastric fundus and colon. Sigmoid colon diverticula noted. Ileus type bowel gas pattern. Surgical drain projects over the right hemiabdomen. Surgical staples project over the right upper quadrant and skin staples project over the right hemiabdomen. | Persistent ileus type bowel gas pattern and residual enteric contrast. |
Generate impression based on findings. | Female 43 years old Reason: right shoulder pain History: right shoulder pain. Four views of the right shoulder show no acute fracture or dislocation. Alignment of the glenohumeral and coracoclavicular joints is within normal limits. | No acute fracture or dislocation. No radiographic evidence account for patient's pain. |
Generate impression based on findings. | 52 year old with history of left mastectomy for IDC grade 3 in 2003, followed by chemotherapy and radiation. Status post bilateral implant placement. No breast complaints. Two standard and pushback views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Retropectoral saline implant is unchanged in position and contour. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral benign morphology calcifications are noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 62 years, Male. Reason: NGT placement History: above Enteric feeding tube tip projects over the gastric body. Nonobstructive bowel gas pattern. The pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | 22 year old female with history of Celiac disease on a gluten free diet and Hashimoto's thyroiditis presents for epigastric pain with occasional vomiting and diarrhea since October. Patient reports a 10 pound weight loss since. Limited single contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.The stomach was normal in size, shape, and position. Solid food debris and fluid was noted in the stomach despite the patient being NPO for at least 9 hours suggestive of gastric hypomotility. Spontaneous emptying of contrast into the D1 and D2 portions of the duodenum was observed. To and fro movement of contrast was noted in the duodenum with delayed transit past midline (cine series 25 and 26). Initially there was slight dilution of contrast in the duodenum and jejunum suggestive of residual fluid in the bowel. There was eventual transit of contrast into the normal appearing jejunum and distal small bowel. TOTAL FLUOROSCOPY TIME: 8:28 minutes | 1.Findings compatible with SMA syndrome as described above.2.Findings suggestive of gastric hypomotility. |
Generate impression based on findings. | 64 years, Male. Reason: r/o obstruction History: as above Gastrostomy tube tip projects over the gastric body. Nonobstructive bowel gas pattern. Presumed T-tack noted in the left lower quadrant. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 42 year-old female patient with history of lupus presents with dysphasia for solids with sensation of food getting caught in cervical esophagus. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Cholecystectomy clips are noted.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, trace provoked gastroesophageal reflux was observed and spontaneously cleared. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Finally, a 13 mm barium pill was administered and was hung up at the mid thoracic esophagus at the level of the left mainstem bronchus. The patients symptoms in the cervical esophagus were reproduced. The pill passed after several sips of warm water. There was no anatomic abnormality to account for the pill stasis.TOTAL FLUOROSCOPY TIME: 6:03 minutes | 1.Provoked gastroesophageal reflux.2.Delayed passage of barium pill in the mid thoracic esophagus without anatomic abnormality. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy in 1973. History of mother, maternal aunt, and maternal grandmother with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Local architectural distortion and parenchymal thickening from left breast biopsy appears stable. Bilateral, scattered, benign morphology calcifications are also noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 29 years old Reason: eval of prox rectum and distal colon for redundancy and motility History: abdominal pain.Additional history: Noonan syndrome. Per patient, history of cholecystectomy, segmental colonic resection of necrotic bowel a few years ago. Inability to evacuate colon for four months. Recent enemas were used to evacuate rectum.Unable to lye completely flat. Contrast flowed slowly from rectum to the splenic flexure. There was small amount of solid fecal debris initially in the distal sigmoid colon and rectosigmoid. Stool moved proximally with inflation of contrast.No areas of stricture were seen. Colonic length and position are within normal limits. No diverticula. Although the exam is not sensitive for polyps or masses no definite non-mobile lesions are seen in the left colon.The rectum was observed at rest and with patient's squeezing-in (movie loop Series #24). There was nearly little movement of the pelvic floor or change in the anorectal angle.Patient was instructed to attempt evacuation in the restroom. Following this fluoroscopy demonstrated that there had been retrograde flow of contrast filling the transverse and right colon. There is a large amount of retained solid debris in the transverse and right colon. Lateral and shallow oblique views show no evidence of stricture. In particular in the region of the suture lines in the splenic flexure as seen on the CT scan series 3 image 38/154, probably correspond to an area that was adequately visualized and distensible. A small amount of retained contrast was seen in the descending, sigmoid and rectum. Patient was instructed to Valsalva and attempt evacuation maneuver in the recumbent lateral position. The movie loop was made, series #27. There is no substantial movement of the pelvic floor or change in the anorectal angle.FLUOROSCOPY TIME: 9 min 25 sec. | Limited static and dynamic exam as described.I cannot verify any significant change in the anorectal angle at pelvic floor with either squeezing and or straining. Nevertheless, in the restroom contrast presumably emptied both antegrade and retrograde.No anatomic stricture to explain chronic retention of stool and Sitz markers. Presumed marked motor abnormality of the colon and rectum.Discussed with Dr. Semrad. |
Generate impression based on findings. | Female 55 years old Reason: right knee pain History: r knee pain. Minimal degenerative arthritic changes affect the right knee with sharpening of the tibial spines and tiny osteophyte formation, appears unchanged from the prior exam.Frontal views of the left knee show minimal osteoarthritic changes. | Minimal right knee osteoarthritis, unchanged from the prior exam. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with additional bilateral MLO and cleavage view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | There is an area of somewhat convoluted and perhaps thickened cortex along the right central sulcus (series 601, image 6; series 701, image 15). The pattern of myelination is within acceptable limits for the stated age. There are no masses, mass effect or midline shift. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute ischemia. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. | Region of somewhat convoluted and perhaps thickened cortex along the right central sulcus suspicious for cortical dysplasia or migrational anomaly. |
Generate impression based on findings. | Male 62 years old Reason: Prosthetic assess History: post-op. AP view of the pelvis and two views hips show hardware components of a right total hip arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. There is sclerosis and osteophyte formation at the superior aspect of both left hip joint compatible with osteoarthritis, which is unchanged from the prior exam.Three views of the left knee show hardware components of a left total knee arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. | 1.Left total knee arthroplasty and right total hip arthroplasty as described above.2.Severe osteoarthritis of the left hip joint. |
Generate impression based on findings. | 18 year-old female patient with hypermobile joints, nausea, vomiting and epigastric pain immediately after eating for the past 3 months with associated 18-pound weight loss. Single contrast evaluation of the esophagus showed no morphologic abnormalities. Fluoroscopic evaluation of the esophageal peristalsis demonstrated a normal primary peristaltic wave. The stomach was normal in size, shape, and position. There was passage of the barium into the duodenum with mild dilatation of the proximal duodenum and to-and-fro peristalsis in the second and third portions of the duodenum proximal to midline (cine series 12). Five minute delayed imaging demonstrated filling of the jejunum with normal appearing peristalsis and fold pattern (series 17). No small bowel diverticula or hernias seen. TOTAL FLUOROSCOPY TIME: 4:50 minutes | Findings compatible with mild superior mesenteric artery syndrome with normal appearing jejunum. |
Generate impression based on findings. | 73 years, Male. Reason: r/o ileus proximal to ostomy History: no ostomy output Bilateral pleural effusions. Midline surgical staples. Suture material and clips in the midline and left pelvis. Rectal tube and left-sided surgical drain is noted. Gaseous distention of small and large bowel in an ileus type bowel gas pattern. | Ileus type bowel gas pattern. |
Generate impression based on findings. | Knee and hip pain. RIGHT HIP/PELVIS: Mild osteoarthritis affects the hip joints bilaterally, right greater than left. Mild degenerative changes are noted at the sacroiliac joints.RIGHT KNEE: Moderate to severe osteoarthritis affects the right knee with marked medial joint space narrowing and tricompartmental osteophytes, similar to 2014. There is a mild genu varus. A small joint effusion is noted.LEFT KNEE: Severe osteoarthritis affects the left knee with marked medial joint space narrowing and tricompartmental osteophytes, similar to 2014. There is mild genu varus. A small joint effusion is noted. | Osteoarthritis, as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of sister with DCIS. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is an area of developing asymmetry with fine calcifications in the right upper outer breast. Additionally, there is an asymmetry in the anterior inner left breast seen on the CC view. No additional suspicious masses, microcalcifications or areas of architectural distortion are present. | Developing asymmetry with calcifications in the right breast. Asymmetry in the anterior left breast. Spot compression views with possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female 30 years old Reason: eval frac History: pain. Again seen is a comminuted intra-articular fracture of the distal radius with the fracture fragments in near anatomic alignment, and not significantly changed from the prior exam. | Distal radial fracture as described above. |
Generate impression based on findings. | No acute intracranial hemorrhage. Since the prior examination, there has been parenchymal volume loss with widening of the sulci and ventricles, particularly affecting the temporal lobes with thinning of the medial temporal structures. Additionally, there is subcortical and periventricular hypoattenuation consistent with chronic small vessel ischemic disease. Again noted is encephalomalacia in the left posterior parietal lobe consistent with a chronic infarct. No CT evidence of acute large territorial ischemia. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. Mild ethmoid and moderate right frontal sinus mucosal thickening; otherwise, visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No acute intracranial abnormality. If there is high clinical concern for acute ischemia, further evaluation with MRI is recommended.2.Chronic infarct in left posterior parietal lobe.3.Global volume loss, particularly affecting the temporal lobes bilaterally in a pattern that is suggestive of a neurodegenerative process, possibly Alzheimer's disease. |
Generate impression based on findings. | 32-year-old male patient with history of Kurd and globus lesions. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces. On AP images during swallowing there was broad based bowing of the esophagus at the cervicothoracic junction. On physical exam the thyroid gland was not enlarged. Otherwise, evaluation of the hypopharynx and cervical esophagus were unremarkable.During the exam, provoked gastroesophageal reflux was observed to the level of the aortic arch and spontaneously cleared. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. There was normal passage of a 13 mm barium pill.TOTAL FLUOROSCOPY TIME: 4:13 minutes | Broad based leftward bowing of the esophagus at the cervicothoracic junction from presumed thoracic outlet narrowing. |
Generate impression based on findings. | 68 years, Female. Reason: ngt, eval placement - ngt advanced 10cm History: ngt placement NG tube tip projects over the gastric antrum. Cholecystectomy clips and suture material in the left mid abdomen. Diffuse dilatation of small and large bowel compatible with ileus. Again noted is scarring and volume loss in the right lung base with rightward mediastinal shift. Note that the pelvis is excluded from the field-of-view. | Ileus type bowel gas pattern. NG tube tip projects over the gastric antrum. |
Generate impression based on findings. | Male 57 years old; Reason: s/p ORIF Two views of the right femur demonstrate a plate and screw device affixing a prior distal right femoral fracture in near-anatomic alignment. There is no radiographic evidence of hardware complication. The fracture line is indistinct, with a mature callus along the posterior aspect of the distal femur, compatible with healing. | Healing fixed right distal femoral fracture. |
Generate impression based on findings. | Ms. Sanfratello is a 52 year old female with a personal history of left breast lumpectomy in January 2010 for IDC followed by radiation and tamoxifen therapy. Family history of breast cancer in mother and ovarian cancer in paternal grandmother. She has no current breast relayed complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, surgical clips, and coarse dystrophic calcifications present within the left lumpectomy site. Surgical clips are also present in the left axilla. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Right breast cancer; surgery 3/2/15. Right breast sentinel node biopsy and Right wire/seed loc partial mast in DCAM. RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.51 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the right axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the right axilla. |
Generate impression based on findings. | 68 years, Female. Reason: eval ngt History: ngt NG tube side-port is above the gastroesophageal junction with tip projecting over the gastric cardia. Cholecystectomy clips and suture material in the left mid abdomen. Diffuse dilatation of small and large bowel compatible with ileus. Again noted is scarring and volume loss in the right lung base with rightward mediastinal shift. Note that the pelvis is excluded from the field-of-view. | Ileus type bowel gas pattern. NG tube tip projects over the gastric cardia with side-port above the GE junction, advancement is recommended. |
Generate impression based on findings. | Follow up NSCLC. This study was performed for restaging.RADIOPHARMACEUTICAL: 16 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 92 mg/dL. Today's CT portion of the neck and pelvis demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest and abdomenToday's PET examination demonstrates a markedly hypermetabolic focus within collapsed lung/scar tissue in the anterior right upper lobe (max SUV = 9.9, previously 10.5), which appears slightly larger in size. There is also a new significantly hypermetabolic focus within right paramediastinal opacity/the right suprahilar region (max SUV = 6.8) consistent with tumor. Hypermetabolic foci within the left hilum and a subpleural nodule within the superior left upper lobe are similar to the prior examination. No FDG avid lesion is identified in the neck, abdomen, or pelvis. Linear areas of activity within the neck, upper chest, shoulders, and upper arms correlate with physiologic muscle activity. | 1. Progression of disease with a new hypermetabolic focus within a right paramediastinal opacity/ the right suprahilar region and slightly increased size of a hypermetabolic focus in the right upper lobe.2. Hypermetabolic foci within the left hilum and a left lower lung subpleural nodule are unchanged.3. No FDG avid lesion in the neck, abdomen, or pelvis. Diagnostic CTs of the chest and abdomen also performed at today's visit will be reported separately. |
Generate impression based on findings. | Female 60 years old; Reason: History of lumbar fusion, evaluate hardware and stability of spine. Surveillance imaging. Again seen is a posterior stabilization device with screws entering L4 and L5, with an intervertebral spacer device at L4/L5. There is no radiographic evidence of hardware complication. The alignment is unchanged on neutral, flexion, and extension views. No evidence of instability is seen.Severe degenerative disk disease affects the L3/L4 level, similar to prior. Slight rightward curvature of the lumbar spine is unchanged. | Postoperative changes, without evidence of instability. |
Generate impression based on findings. | Esophageal Cancer. For restaging.RADIOPHARMACEUTICAL: 12.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 98 mg/dL. Today's CT portion again grossly demonstrates distal esophageal thickening. Enlarged left paratracheal and gastrohepatic lymph nodes are similar in size. Scattered atherosclerotic calcifications, including of the coronary arteries. Interval placement of a right-sided Port-A-Cath which terminates in the SVC. Today's PET examination demonstrates a decrease in the hypermetabolic distal esophageal lesion with an SUVmax of 7.6, previously the activity was 15.8.A punctate adjacent distal paraesophageal hypermetabolic lymph node is no longer visualized and has likely resolved.Larger metastatic left paratracheal hypermetabolic lymph nodes are stable with an SUVmax of 11.5 compared to 12.8 previously.Enlarged markedly hypermetabolic metastatic gastrohepatic ligament lymph node has decreased in activity now with an SUVmax of 5.3 compared to 12.8 previously.No new suspicious FDG avid lesion is identified. | Overall interval decreased metabolic activity of the distal esophageal primary malignancy and lymph node metastases. |
Generate impression based on findings. | 59 years, Male. Reason: s/p NG tube placement, eval position and eval status of ileus History: abd pain NG tube tip is above the gastroesophageal junction. Diffuse gaseous dilatation of predominately the large bowel in an ileus type bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube tip projects over the gastroesophageal junction. Advancement is recommended. |
Generate impression based on findings. | Reason: 68 y/o newly dx lung ca please restage History: see above CHEST:LUNGS AND PLEURA: Mild centrilobular and paraseptal emphysema. An irregular right upper lobe nodule measures 25 x 24 mm (series 6, image 35), not significantly changed from the prior exam dated 12/25/2014, compatible with known primary lung cancer.A 4-mm anterior right upper lobe nodule (series 6, image 38) is unchanged. Additional clustered punctate left lower lobe nodules are not clearly seen on the prior exam.Scattered bronchial wall thickening. No new focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: Heterogeneous thyroid, with calcifications, similar in appearance to the prior exam.The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.No mediastinal lymphadenopathy. A reference right paratracheal lymph node measures 9 mm (series 4, image 36), unchanged. A subcarinal opacity, similar to a lymph node corresponds with a pericardial extension as seen on reformatted images. Hilar lymph nodes are difficult to evaluate on noncontrast imaging, but no definite evidence of hilar lymphadenopathy is identified.CHEST WALL: Mild degenerative disease of the thoracic spine, with mild scoliosis.ABDOMEN: Absence of IV and 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: Right renal hypodensity, likely a benign cyst. Nonobstructing left renal calcification. 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.Scattered colonic diverticula.BONES, SOFT TISSUES: Anterolisthesis of L4 over L5.OTHER: No significant abnormality noted. | Right upper lobe nodule compatible with known primary lung cancer. Clustered micronodules in the left lower lobe, new from prior, are indeterminate but could be infectious in etiology. Additional scattered small nodules are similar to prior. Continued close interval followup is recommended.No mediastinal or hilar lymphadenopathy or evidence of extrathoracic disease involvement. |
Generate impression based on findings. | Pain. Preoperative. Severe osteoarthritis affects the left knee, with approximately 14 degrees of genu varus deformity. | Osteoarthritis with genu varus deformity, as above. |
Generate impression based on findings. | Female 52 years old; Reason: Bilateral hip pain Mild osteoarthritis affects the hip joints bilaterally. Otherwise, no specific findings are seen to account for the patient's pain. | Mild osteoarthritis of the hips. |
Generate impression based on findings. | 70 year-old male with history of chronic sinusitis. There are postoperative changes of bilateral uncinectomy and antrostomies. There is moderate mucosal thickening within right maxillary sinus and bilateral ethmoid air cells. There is relatively mild mucosal thickening within the left maxillary, bilateral frontal and bilateral sphenoid sinuses. The frontal-ethmoidal recesses are opacified. The sphenoethmoidal recesses are clear. There is mild leftward nasal septum deviation. The lamina papyracea are intact. | Postoperative changes and paranasal sinus disease as above, worse in the right maxillary sinus and ethmoid air cells. |
Generate impression based on findings. | Postop follow-up, total hip arthroplasty Pelvis: The right total hip arthroplasty appears unchanged without evidence of new interval complication other than minimal heterotopic bone adjacent to the greater trochanter and superior acetabulum. Moderate osteoarthritic changes of the left hip with more mild degenerative changes of the SI joints and symphysis are otherwise observed unchanged.Hip: Femoral stem component appears intact without evidence of interval complication. Alignment preserved. Interval removal of surgical drain | Right total hip arthroplasty without evidence of complication |
Generate impression based on findings. | Multiple myeloma. In remission. Right sided flank pain, check level T10 Thoracic spine: Scattered moderate degenerative changes throughout the thoracic spine without definite evidence of new interval change. Specifically no specific findings to suggest myelomatous lesions in this limited evaluation. No new compression fractures. Limited view of the ribs. Particular attention was given to level T10 which demonstrates a questionable deformity involving the origin of the left 10th rib, not clearly new since the prior study. Given the opposite side of patient's symptoms, this appearance is of uncertain significanceLumbar spine: Persistent moderate to more marked degenerative changes tactically involving L4-5 unchanged. Alignment preserved. No specific new plain film findings to suggest myelomatous involvement. Exam limited by gas and stool | Scattered degenerative changes without definitive new superimposed focal changes of either the thoracic or lumbar spine to suggest myelomatous involvement. See detail provided above |
Generate impression based on findings. | 80-year-old female with history of confusion. Evaluate for hemorrhage. There is no evidence of acute intracranial hemorrhage. Multiple chronic infarctions are noted within the left cerebellar hemisphere and left parietal lobes. There is mild periventricular and subcortical white matter hypoattenuation compatible with age-indeterminate small vessel ischemic disease. The gray-white differentiation is otherwise preserved. No midline shift or mass-effect. The basal cisterns are patent. The ventricles and sulci are symmetric. No evidence of hydrocephalus. The visualized paranasal sinuses, mastoid air cells, and orbits are unremarkable. The calvarium and soft tissues are normal. | 1. No evidence of acute intracranial hemorrhage.2. Mild age-indeterminate small vessel ischemic disease and chronic left cerebellar/parietal infarcts appearing similar to the prior study. |
Generate impression based on findings. | Chronic knee pain Severe osteoarthritic changes in all 3 compartments but greater in the medial weight-bearing aspect. Bone-on-bone narrowing, sclerosis and osteophytes. Questionable calcific densities are also projected potentially within the lateral posterior aspects, possible loose body. Small effusion. | Severe osteoarthritic with a questionable loose body. |
Generate impression based on findings. | Evaluation for mass is limited by lack of intravenous contrast.HEAD: There is no evidence of intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is unchanged asymmetric nodular calcification in the left lateral ventricle glomus. There is no midline shift or herniation. There is minimal mucosal thickening of the bilateral sphenoid sinuses. The other imaged paranasal sinuses are clear. There is partial opacification of the bilateral mastoid air cells. The skull and extracranial soft tissues are unchanged. A nasogastric tube is partially imaged.NECK: Redemonstrated is a right chest wall lesion with erosion and destruction of the lateral right third rib. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is an irregular lytic lesion within the odontoid process. There is also a subcentimeter lucency in the T2 vertebral body. There are degenerative changes of the cervical spine with disc-osteophyte complexes at C5-C6 and C6-C7. The airways are patent. The imaged portions of the lungs demonstrate mild bilateral pleural effusions and diffuse bilateral patchy opacities, which is new from CT chest dated 2/16/2015. A calcified granuloma is noted in the right upper lobe. A right internal jugular approach catheter and left peripheral line are partially imaged. There is mild stranding in the soft tissues of the right lower neck in the region of the catheter insertion site. | 1. No acute intracranial hemorrhage.2. Interval development of mild bilateral pleural effusions and diffuse bilateral patchy opacities, which may represent aspiration pneumonitis or be infectious/inflammatory in etiology.3. Right chest wall lesion with destruction of the lateral right third rib again noted, most likely related to a known history of myeloid sarcoma. Likewise, a lesion in the C2 vertebra is compatible with a metastasis, but a lesion in the T2 vertebral body is of indeterminate significance. 4. No cervical lymphadenopathy by size criteria, although the assessment is limited by the lack of intravenous contrast.5. Apparent mild hemorrhage in the right lower neck associated with the right internal jugular venous catheter insertion site.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 59 years, Male. Reason: advanced NG tube by 6cm, eval position History: NG tube placement NG tube side-port is at the gastroesophageal junction. Diffuse gaseous dilatation of predominately the large bowel in an ileus type bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube side-port is at the gastroesophageal junction. Advancement is recommended. |
Generate impression based on findings. | Male 55 years old Reason: hx of bladder cancer s/p radical cystectomy with orthotopic neobladder urinary diversion, evaluate for metastatic disease with delayed imaging History: see above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Interval development of diffuse hepatic steatosis. No focal hepatic lesions or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval removal of a bilateral nephroureteral stents. No significant hydronephrosis.Small hypodense lesions within the left kidney which are too small to characterize but likely represent cysts. Symmetric nephrographic phase and symmetric excretion of contrast bilaterally. The ureters are well opacified nearly throughout their entire course and drain into the continent neobladder. No evidence to suggest recurrent or metastatic disease.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdomen or its branches. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with interval resolution of postsurgical fluid collection seen on prior exam. Interval removal of surgical drains. Status post neobladder formation which is opacified with minimal contrast.LYMPH NODES: No pelvic lymphadenopathy. Interval resolution of the fluid collection adjacent to the proximal left common iliac artery.BOWEL, MESENTERY: Postsurgical changes from neobladder construction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post cystectomy and continent neobladder formation without evidence of recurrent or metastatic disease.2. Interval resolution of postoperative fluid collections. |
Generate impression based on findings. | Check fusion Definite interval fusion of the first MCP with persistent into medullary screw. No evidence of hardware complication. In addition however a dorsal avulsion fracture involving the base of the distal first phalanx is currently observed, possibly interval injury. Fracture fragment remains well corticated presumably representing an old more remote injury. Please correlate with physical exam and site of pain | Interval development of a distal first phalanx avulsion fracture of uncertain chronicity |
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