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Generate impression based on findings. | Pain lower back Extensive gas and stool limits sensitivity. Otherwise the lumbar spine appears intact without evidence of focal abnormalities, specifically the vertebral bodies, disk spaces and alignment are preserved. Moderate scoliosis | Scoliosis without discrete focal abnormality superimposed upon mild degenerative changes |
Generate impression based on findings. | Male 56 years old Reason: PEG displaced overnight, attempted to secure tract with red rubber History: eval for position of red rubber securing prior PEG site. The study is limited due to lack of intravenous contrast.ABDOMEN:LUNG BASES: Dependent atelectasis at the lung bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic kidneys.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic calcifications throughout the abdominal aorta and its major branches.BOWEL, MESENTERY: G-tube is in place.BONES, SOFT TISSUES: Compression fracture of L4 vertebral body anteriorly causing more than 50% of its height.OTHER: Left lower quadrant kidney transplant.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Air containing fluid collection in the midline on the right side of the gluteal cleft fistulas into the skin. A communication between this collection and anus cannot be excluded with this noncontrast CT.OTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. G-tube is in place.Atrophic kidneys and left lower quadrant transplant kidney. Large air-containing gluteal collection in the pelvis fistulizing to the skin.Compression fracture of L4 vertebral body. |
Generate impression based on findings. | FractureVIEWS: Left tibia and fibula AP and lateral There is periosteal reaction along the middle and distal aspect of the tibia indicative of a healing fracture. The alignment is anatomic. The overlying cast has been removed in the interval. | Healing tibial fracture in anatomic alignment. |
Generate impression based on findings. | FractureVIEWS: Right wrist AP and lateral Healing fractures involving the distal radius and ulna are again noted with sclerosis and periosteal reaction. The alignment is anatomic. The overlying cast has been removed in the interval. | Healing distal forearm fractures as described above. |
Generate impression based on findings. | Foot pain following fall. Patient heard pop Foot: No radiographic abnormality. Ankle: An oblique essentially nondisplaced distal fibular fracture is observed with mild overlying diffuse soft tissue swelling. Mortise remains symmetric and intact. | Distal fibular fracture |
Generate impression based on findings. | PICC placementVIEW: Chest AP Placement of a left upper extremity PICC with tip in the right atrium. Multiple surgical clips in the GE junction. Cardiothymic silhouette normal. Right upper lobe opacity increased in the interval. Patchy atelectasis left lower lobe. | Left PICC tip in the right atrium. Right upper lobe opacity concerning for pneumonia. |
Generate impression based on findings. | New diagnosis of multiple myeloma, please evaluate SKULL: Diffusely mottled appearance throughout the entire skull suspicious for numerous confluence lesionsCERVICAL SPINE: Moderate osteoarthritic changes largely involving C4 through C6 with preservation of alignment. Disk space narrowing, osteophytes and sclerosis are observed without discrete distinct focal lesions to suggest myelomaTHORACIC SPINE: Mild osteoarthritic changes without discrete focal myelomatous lesions LUMBAR SPINE: Moderate scoliosis with mild degenerative changes most pronounced involving the lower lumbar spine. Again no discrete focal changes to suggest myelomatous involvementRIBS: Healing right posterior lateral seventh rib fracture. No additional superimposed focal lytic lesionsPELVIS: Moderate bilateral degenerative changes of both hips.UPPER EXTREMITY: No significant abnormality noted.LOWER EXTREMITY: A punctate calcification is observed projected over the distal left tibia, presumably a vascular calcification the soft tissues given discrete contours. No discrete focal changes to suggest myelomatous involvement bilaterally | Diffuse osseous changes in largely involving the skull suspicious for myelomatous involvement in the appropriate clinical setting and labs. Additionally a partially healed right rib fracture is also suspicious |
Generate impression based on findings. | Prematurity oxygen dependentVIEW: Chest AP Cardiothymic silhouette normal. NG tube removed in the interval. Minimal patchy atelectasis in the right lower lobe and left lower lobe. No pleural effusion or pneumothorax. | Minimal patchy atelectasis in the right lower lobe and left lower lobe. |
Generate impression based on findings. | Male 40 years old Reason: eval for wrist deformity History: carpal tunnel. Note is made of an ulnar positive variance without changes to suggest ulnar abutment. Otherwise, there is no acute fracture or dislocation. | Ulnar positive variance without radiographic associated degenerative changes of the lunate. |
Generate impression based on findings. | Ms. James is a 78 year old female with a personal history of benign left breast biopsy in April 2013. Patient also currently complains of long-standing pain in the left breast for the past six years. She has no new current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A biopsy marker clip is reidentified in the left retroareolar region, at site of prior benign breast biopsy. Focal asymmetry in the superior left breast is stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. Patient's long-standing breast pain should be managed clinically. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 59 years, Male. Reason: NG tube placement History: NG tube placement Three biliary drains project over the right upper quadrant. Additional surgical drain tip projects over the right upper quadrant. Nasogastric tube tip projects over the gastric antrum. Nasojejunal tube tip projects over the proximal jejunum. Relative paucity of bowel gas in the abdomen. IVC filter noted. Chest port tip is in the superior cavoatrial junction. Patchy diffuse airspace opacities are better evaluated on dedicated chest radiograph. | NG tube tip projects over the gastric antrum. Nasojejunal tube tip projects over the proximal jejunum. |
Generate impression based on findings. | 4-year-old male with neurogenic bladder. BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 8.4 cm Left: 7.8 cm Mean for age: 7.5 cm Range for age: 6.5 - 8.5 cmADDITIONAL OBSERVATIONS: Moderate stool burden in the rectum which appears similar to pelvis radiograph on 11/5/2014. | Normal examination. *SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Female 47 years old Reason: 47 F with HCC on sorafenib, please eval for interval change since prior CT. History: none CHEST:LUNGS AND PLEURA: Interval development of very large pleural effusion and in atelectasis of the right lung other than part of its upper lobe. Again noted bilateral pulmonary masses consistent with metastatic disease. Index left lower lobe pulmonary nodule measures 1.1 cm on image number 49, series number 10, not significantly changed compared to previous study. However most of the other nodules are increased in size. As a reference a more anterior nodule in the left lung now measures 1.3 x 1.4 cm on image number 50, series number 10. This nodule was measuring 7 mm in diameter on previous CT, image number 57, series number 11.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The patient is status post right hepatectomy. Index residual left hepatic lobe mass measures 4.6 x 4.6 cm in number 39, series number 9, slightly increased compared to previous study. There is more heterogeneous enhancement around this lesion on this current study which may also reflect changes secondary to sorafenib therapy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Index aortocaval node is stable measuring 13 x 10 mm on image number 139, series number 10. Other retroperitoneal lymph nodes are also grossly stable.BOWEL, MESENTERY: Small amount of ascites, unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites, increased in size compared to previous study.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval development of significant amount of right-sided pleural effusion and near complete atelectasis of the right lung. Interval increase in the size of the most of the metastatic lung lesions.Index lesion in the left lobe of the patient has slightly increased in size compared to previous study. There are new enhancing areas around this lesion which may also be secondary to sorafenib therapy.Slight interval increase in the amount of ascites. |
Generate impression based on findings. | Pain No significant interval definitive change. Minimal bridging callus formation appears similar to prior exam with minimal sclerotic densities along the fracture edges. The overlying ORIF sideplate is otherwise unchanged the evidence of complication. Persistent moderate diffuse soft tissue swelling | ORIF of the middle second right phalanx without interval change or new findings of interval healing |
Generate impression based on findings. | Epigastric pain, retained food in stomach on EGD after 12 hours of fasting. Evaluate for gastroparesis. Visually there was progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 70 % of retention 60 mins: 50 % of retention 90 mins: 25 % of retention 120 mins: 7 % of retentionT1/2 gastric emptying was 60 minutes (reference range for half-time of gastric emptying is 10-60 mins) | Gastric emptying at the upper limits of normal. |
Generate impression based on findings. | 81-year-old. History of smoking and RUL opacities and RML nodule. Evaluate for change. LUNGS AND PLEURA: Interval resolution of patchy right upper lobe opacities, which likely represented aspiration.Stable 8 mm right middle lobe nodule (series 5, image 61) since 5/2014.Mild lower lobe bronchiectasis.Stable scattered calcified and noncalcified micronodules, most likely post inflammatory.Severe centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes, unchanged.Mild coronary artery calcification.Normal heart size without pericardial effusion.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis.Splenic artery calcification. | Interval resolution of right upper lobe nodular opacities, which were most likely aspiration. 8 mm right middle lobe nodule is unchanged from 5/2014, likely benign; continued follow-up in 1 year is recommended to confirm stability. |
Generate impression based on findings. | Mandible pain, right side. Patient got punched A nondisplaced fracture through the mandibular angle is identified with extension to the impacted right third molar. No definitive second lesion is observed. Visualized portions of the sinuses are unremarkable and clear. | Right mandibular angle fracture, nondisplaced |
Generate impression based on findings. | Female 50 years old; Reason: pain There is no fracture or malalignment. No joint effusion is evident. Otherwise, no specific findings are seen to account for the patient's pain. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | Reason: r/o c-spine fx History: fall CT head:There is a hypodensity present involving the inferior aspect of the left cerebellar hemisphere associated with some mild mass effect. It measures approximately 43 by 35 mm axial dimensions.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses demonstrate opacification of the right sphenoid sinus with marked thickening of the walls.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries.CT cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. Findings are suggestive of diffuse osteopenia.At C2-3 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy.At C3-4 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is narrowing of the neural foramina bilaterally with mild encroachment of the left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is narrowing of the neural foramina bilaterally with mild encroachment of the right-sided exiting nerve roots.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is mild narrowing of the neural foramina present.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is mild narrowing of the neural foramina present.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Atherosclerotic calcifications are present at the carotid bifurcations.A hypodense focus is present in the right thyroid gland measuring 13 x 8 mm axial dimensions.Opacities present in the right upper lung field not completely evaluated on this exam. | 1.No evidence for cervical spine fracture.2.Findings suggest subacute infarction involving the left posterior inferior cerebellar artery territory. Please correlate with the patient's clinical symptoms. There is no associated hemorrhagic conversion appreciated.3.Degenerative changes are present in the cervical spine without significant compromise of the spinal canal or exiting nerve roots.4.A right thyroid gland lesion is nonspecific on CT.5.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 6.Right upper lung field air space disease. Please correlate patient's clinical symptoms and recent chest x-ray. |
Generate impression based on findings. | Hand pain and fracture repair Interval surgical placement of two K wires affixing a comminuted right distal metacarpal fracture in gross anatomic alignment. Decreasing soft tissue swelling. | Surgical fixation of a right boxer's fracture |
Generate impression based on findings. | 74 years old Female. Reason: initial staging evaluation. History: new follicular lymphoma. RADIOPHARMACEUTICAL: 13.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 84 mg/dL. Today's CT portion grossly demonstrates opacification of the left maximal sinus. There is a mass in the left breast. There are large low attenuation lesions in the liver. Multiple gallstones are noted in the gallbladder. Conglomerate enlarged lymph nodes are seen in the retroperitoneal cavity. Postsurgical changes are seen in the cervical spine and in the hips.Today's PET examination demonstrates multiple foci of increased activity in the right neck, corresponding to the enlarged lymph nodes seen on CT. There is a focus of increased activity in the retropharyngeal/retrolaryngeal space. A focus of increased activity in the seen in the left nasopharyngeal wall. A focus of increased activity is seen in the glenoid of the right scapula. Intense and heterogeneous FDG uptake is seen in the left breast mass. Intense FDG uptake is seen in the large low attenuation lesion in the liver. Intense FDG uptake is seen in the conglomerate lymphadenopathy in the retroperitoneal cavity with SUVmax of 21.5 . A hypermetabolic lymph node in also seen in the right retroperitoneal cavity at peripancreatic space.Several foci of increased activity are seen in the subcutaneous fat in the anterior abdominal wall at the level pelvis.Physiologic activity is seen in the kidneys, intestines, and bladder. No definite abnormal FDG uptake in the opacification of the left maxillary sinus is consistent with sinusitis. | 1. Extensive hypermetabolic lymphadenopathy in the neck and abdomen, osseous hypermetabolic lesion in the right scapula, hypermetabolic mass in the left breast and hypermetabolic masses in the liver, consistent with the patient's diagnosis of lymphoma.2. Mucosal involvement of the tumor in the pharynx and retropharyngeal/retrolaryngeal tumor involvement in the neck.3. Nonspecific foci of increased activity in the subcutaneous fat in the anterior abdominal wall.4. Gallstones in gallbladder. |
Generate impression based on findings. | Reason: r/o c-spine fx History: fall CT head:There is a hypodensity present involving the inferior aspect of the left cerebellar hemisphere associated with some mild mass effect. It measures approximately 43 by 35 mm axial dimensions.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses demonstrate opacification of the right sphenoid sinus with marked thickening of the walls.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries.CT cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. Findings are suggestive of diffuse osteopenia.At C2-3 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy.At C3-4 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is narrowing of the neural foramina bilaterally with mild encroachment of the left-sided exiting nerve roots.At C4-5 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is narrowing of the neural foramina bilaterally with mild encroachment of the right-sided exiting nerve roots.At C5-6 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is mild narrowing of the neural foramina present.At C6-7 there is no significant compromise to the spinal canal. There are endplate and uncovertebral osteophytes present at this level associated with loss of disk space height and mild facet hypertrophy. There is mild narrowing of the neural foramina present.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Atherosclerotic calcifications are present at the carotid bifurcations.A hypodense focus is present in the right thyroid gland measuring 13 x 8 mm axial dimensions.Opacities present in the right upper lung field not completely evaluated on this exam. | 1.No evidence for cervical spine fracture.2.Findings suggest subacute infarction involving the left posterior inferior cerebellar artery territory. Please correlate with the patient's clinical symptoms. There is no associated hemorrhagic conversion appreciated.3.Degenerative changes are present in the cervical spine without significant compromise of the spinal canal or exiting nerve roots.4.A right thyroid gland lesion is nonspecific on CT.5.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 6.Right upper lung field air space disease. Please correlate patient's clinical symptoms and recent chest x-ray. |
Generate impression based on findings. | Male 59 years old Reason: RUQ US to evaluate gallbladder and biliary tree History: RUQ pain, fever LIVER: Liver measures 21 cm, enlarged. Diffuse fatty infiltration of the liver. No focal liver lesions.BILIARY TRACT: No evidence of gallstones. Gallbladder is unremarkable. No evidence of intra-or extrahepatically or dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 10 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 12 cm. Left kidney measures 13.1-cm.OTHER: No significant abnormalities noted. | Diffuse fatty infiltration of the liver and hepatomegaly. Gallbladder is unremarkable. |
Generate impression based on findings. | Female 46 years old Reason: RUQ pain after eating, eval for Choledocholithiasis History: pain LIVER: Liver measures 15 cm. Normal echogenicity. No focal liver lesions.BILIARY TRACT: Gallbladder is unremarkable. No evidence of intra-or extrahepatic biliary dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9.8 cm. No focal lesions. No evidence of hydronephrosis.OTHER: No significant abnormalities noted. | Unremarkable study. |
Generate impression based on findings. | Male 66 years old Reason: eval for advanced heart failure, eval kidney echotexture History: mild transaminitis, chronic kidney disease LIVER: Liver measures 18.5 cm. no focal lesions. Hepatic veins and IVC are dilated.GALLBLADDER, BILIARY TRACT: Cholelithiasis and sludge in the gallbladder. Gallbladder wall is mildly thickened but this may be secondary to ascites.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen is mildly enlarged measuring 13 cm.KIDNEYS: Right kidney measures 10.6 cm. Left kidney measures 10.7 cm. no evidence of hydronephrosis. ABDOMINAL AORTA: No evidence of abdominal aortic aneurysm in the visualized portions of the aorta.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Small amount of ascites. Bilateral small pleural effusions. | Small amount of ascites. Mild hepato- splenomegaly. Dilatation of the IVC and hepatic veins are compatible with heart failure.Cholelithiasis and sludge in the gallbladder. |
Generate impression based on findings. | Male 64 years old Reason: 64M with flank to groin pain, assess for stone History: 64M with flank to groin pain, assess for stone ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific, subcentimeter hypodense lesion in the right lobe of the liver likely represents a cyst, however, cannot be optimally characterized with this noncontrast CT.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: Diffuse bladder wall thickening which may be compatible with cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of renal stones or hydronephrosis. |
Generate impression based on findings. | Male 69 years old Reason: HCC please assess and provide target lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Post operative changes related to right hepatectomy. Again noted multiple foci with arterial enhancement. Index lesion in the right lobe now measures 2.6 by 3 cm on image number 85, series number 12, slightly increased in size compared to previous study.Superior to the ablation zone the arterial enhancing lesion now measures 1.8 x 1.5 cm on image number 77, series number 12. This lesion now only demonstrates thick rim enhancement and no significant arterial enhancement centrally, different from the previous study. No new lesions are noted in the left lobe of the liver.Previously seen third lesion at the edge of the anastomosis on image number 38, series number 8 is not visualized on today's study.Enhancing lesions along the peritoneum suspicious for carcinomatosis, not significant changed. Previously mentioned, peritoneal nodule measures 9 by 7-mm image number 89, series number 12, unchanged.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right lower quadrant enhancing mass anterior to the right external iliac vessels measures 2.7 x 1.7 cm on image number 190, series number 12 and likely represents a peritoneal metastatic deposits and has not significantly changed from previous study. | Slight interval increase in the size of the one of the index lesions in the liver. The second index lesion is similar in size but it's enhancement has decreased within the interval. The third lesion is not visualized on today's study.Peritoneal carcinomatosis, unchanged. |
Generate impression based on findings. | 74 years old Female. Reason: evaluate for recurrence. History: pharynx cancer. RADIOPHARMACEUTICAL: 11.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates numerous stable predominantly calcified bilateral hilar and mediastinal lymph nodes. Scattered nodular opacities in the left lung in a segmental distribution are again noted. Atherosclerotic calcifications of the aorta and its branch vessels. Hypoattenuating lesions in both kidneys are again noted and are most likely due to benign cysts.Today's PET examination demonstrates interval decreased pharyngeal mucosal hypermetabolic activity with SUVmax 5.7 (it was 6.7 on prior study), which may be due to inflammation or tumor. There is a new focus of mildly increased activity in the right lower neck without definite CT correlation. Multiple bilateral, symmetric hypermetabolic enlarged mediastinal and hilar lymph nodes are again noted, many of which are with calcifications. Hypermetabolic nodular opacities in the left midlung in a segmental distribution are stable in size and metabolic activity.There is a new focus increased activity in the soft tissue density in the left hip adjacent to the left gluteus muscles, which is most likely due to inflammatory change. Stable focus of increased activity in the left hip over the greater trochanter is most likely due to bursitis.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. Decreased FDG uptake is seen in the upper attenuation lesions in both kidneys, suggestive of a diagnosis of renal cysts. | No convincing evidence of FDG avid tumor.1.Interval slight decreased metabolic activity in the pharyngeal mucosa, which may be due to inflammatory change. However tumor cannot be excluded.2.New a hypermetabolic focus in the right lower neck without CT correlation, which is non-specific.3.Stable hypermetabolic mediastinal and hilar lymph nodes, many of which have calcifications, suggesting benign disease, though underlying metastasis cannot be completely excluded.4.Left mid lung nodular opacities with mild FDG activity are suggestive of inflammatory etiology.5. New soft tissue density in the left hip with increased metabolic activity, which may be due to inflammatory or tumor. |
Generate impression based on findings. | Reason: history of right orbit gastric cancer met s/p RT in \R\5 2014. Eval interval change History: right eye ptosis The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. There is infiltration of the fat planes within the right orbit intraconal when compared to the January exam there is no obvious progression. There is subtle asymmetry in the cavernous sinuses. | 1.There is infiltration within the right orbit which was also present on the prior exam and remains unchanged. There is subtle asymmetry in the cavernous sinuses which has not changed and is non-specific. MRI may help further evaluate for subtle changes.2.No evidence for acute intracranial hemorrhage mass effect or edema.3.No abnormal enhancing mass lesions are appreciated within the brain parenchyma |
Generate impression based on findings. | Male 56 years old; Reason: 56 y/o male with anal ca. please compare to prior CT History: anal ca CHEST:LUNGS AND PLEURA: Scattered reticular opacities, likely atelectasis or scarring.MEDIASTINUM AND HILA: Central line tip at the cavoatrial junction. Minimal coronary artery calcifications. Grossly stable right retrocrural/periaortic node measuring 0.8 x 1.3 cm (4:83).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable reference right external iliac lymph node measuring 1.1 x 0.9 cm (4:160). Reference right inguinal lymph node measures 2.0 x 1.7 cm (4:200) compared to 2.0 x 1.8 cm (3:195). Other grossly stable pelvic lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Essentially unchanged circumferential anal thickening is somewhat difficult to visualize, but likely related to known neoplasm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable examination as described above. |
Generate impression based on findings. | Male, 41 years old, history of esthesioneuroblastoma with new left parotid fullness. Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Neck:Evidence of sinonasal surgery is again seen including partial resection of the medial wall of the right maxillary sinus, the ostiomeatal complex, perhaps part of the right middle nasal turbinate and some of the right ethmoid air cells. No evidence of recurrent tumor is seen in the operative bed. There is a small fluid level within the left maxillary sinus which is likely inflammatory. Mucosal thickening involving the sphenoid sinuses has improved from prior.The left parotid gland is somewhat more prominent than the right, but this is a stable finding and there has been no significant interval change in overall gland size. An intraparotid lymph node on the left is slightly larger than on the prior examination, now measuring 7 mm short axis, previously 6 mm. Otherwise, no new or concerning lesions are seen within or around the gland. No evidence of significant glandular inflammation is detected.The aerodigestive mucosa is unremarkable. The remaining salivary glands and thyroid are free of focal lesions. The right IJ vein is not well visualized, but the vascular structures of the markable. No pathologic adenopathy is detected. No concerning lesions are seen. | 1.No specific or concerning findings are seen to account for the reported new left parotid fullness. At most, a small intraparotid lymph node may be slightly larger than on the prior examination, but this lymph node is still quite small and shows no aggressive features.2.Redemonstration of findings related to sinonasal surgery with no evidence to suggest tumor recurrence in the operative bed.3.No pathologic adenopathy is detected in the neck.4.No intracranial metastases are seen. |
Generate impression based on findings. | 52 year-old female with colon cancer and chemotherapy. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules unchanged since 1/9/15. No new nodules, masses or evidence of air space disease is seen. Mild bibasilar atelectasis seen. No pleural disease.MEDIASTINUM AND HILA: No change in appearance of the thyroid with scattered small subcentimeter nodules. No mediastinal adenopathy.CHEST WALL: Right anterior chest wall Port-A-Cath with tip of catheter in the distal superior vena cava. Degenerative changes seen throughout the thoracic spine with mild compression deformities and sclerosis unchanged.ABDOMEN:LIVER, BILIARY TRACT: Large mass in segment 4 of the liver (series 3 and image 79) measuring 6.1 x 5.8 cm with scattered calcification, most consistent with metastatic colon cancer disease. This is slightly smaller than seen on outside CT examination 12/22/14 when this measured 9.0 x 8.3 cm. No other parenchymal liver lesions are seen. Vascular structures are normal. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Several mildly prominent left periaortic lymph nodes are seen, largest of which measures 1.0 x 1.6 cm (series 3, image 120) these appear unchanged from outside CT 12/22/14.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left hip total arthroplasty. No other significant abnormality seen.OTHER: No significant abnormality noted. | 1. Stable nonspecific scattered pulmonary micronodules. 2. Solitary large hepatic parenchymal mass most consistent with colon metastasis -- slightly decreased in size compared with 12/22/14. 3. Slightly prominent left periaortic retroperitoneal lymph nodes unchanged since 12/22/14 -- size alone does not merit diagnosing lymphadenopathy and these are of uncertain significance.. |
Generate impression based on findings. | 68 year-old female with meningioma, last surveillance in 2009, evaluate for disease progression Redemonstrated is a left parietal extra-axial hyperdense mass present currently measuring approximately 15 x 22 mm, stable in appearance. The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There are now a few foci of hypodensity within the white matter and left caudate head consistent with small vessel disease. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Left parietal extra-axial mass which is compatible with a meningioma demonstrating no significant interval change.2.There are now a few foci of hypodensity within the white matter and left caudate head consistent with small vessel disease. |
Generate impression based on findings. | Female 56 years old; Reason: s/p gastric bypass (1/8/15) and small bowel resection (1/31/15) evaluate for stricture History: abdominal pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Stable subcentimeter hypoattenuating lesions are too small to characterizeSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastric bypass and small bowel resection. No obstruction.BONES, SOFT TISSUES: Postsurgical changes of the rectus abdominis musculature and anterior abdominal subcutaneous fat.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post gastric bypass. No obstruction. |
Generate impression based on findings. | 65-year-old male with hepatitis C virus and advanced fibrosis. Screen for HCC. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Liver contour: Smooth contour with normal sized caudate lobe and without radiographic evidence to demonstrate cirrhotic morphology. Features of portal hypertension: No definite CT evidence of sizable collaterals. No splenomegaly. Portal vein: Patent and normal in appearance. Hepatic veins: Patent and normal in appearance.Hepatic artery: Conventional anatomy and are patent.Lesions: Subcentimeter low density lesion in segment 4 (series 11, image 49) and superiorly in segment two (series 11, image 19) with characteristics typical of benign cysts. No abnormal foci seen to suggest neoplastic disease.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of free peritoneal fluid, ascites seen in the dependent pelvis only. No ascites seen in upper abdomen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Normal examination of the abdomen and pelvis without CT changes to suggest cirrhotic liver morphology and no evidence for liver neoplasia. CT is not sensitive in detecting underlying cirrhosis. |
Generate impression based on findings. | Pain 5th MT, enthesiopathy/acc. growth.EXAMINATION: Left foot standing AP/lateral/oblique (3 views), right foot standing AP/lateral/oblique (3 views) 03/02/15 Bones are normal in appearance. No fracture is identified. Alignment is anatomic. | Normal examinations. |
Generate impression based on findings. | Head and neck cancer, tracheostomy, persistent sinus tachycardia. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Interval insertion of a tracheostomy tube, tip 4 cm above the carina. Small amount of dependent debris in the trachea.Multifocal patchy consolidation and nodular opacities in the bilateral lower lobes and right upper lobe consistent with pneumonia, possibly related to aspiration.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. No visible coronary artery calcification.Left chest wall port tip in SVC.CHEST WALL: Metallic spinal fixation rods in the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. G tube terminates in the stomach. | No evidence of pulmonary embolism. Multifocal consolidation consistent with pneumonia, possibly related to aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Interval resection of locally recurrent squamous cell carcinoma. Neck: There are interval post-treatment findings related to resection of a right neck mass. There is an area of ill-defined soft tissue with a low attenuation center in the surgical bed anterior to the right carotid arteries, that measures up to approximately 3 cm, with mild overlying skin nodularity. There is also ill-defined stranding of the surgical bed more posteriorly without appreciable mass effect. The upper aerodigestive track appears unchanged. The thyroid and remaining salivary glands are unchanged. There appears to be at least moderate stenosis of the origin of the right internal carotid artery. There is a left internal jugular venous catheter. The right internal jugular vein is absent. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is a right maxillary sinus retention cyst. There is a punctate left sphenoid sinus osteoma. The mastoid air cells are clear. There is deformity of the left lamina papyracea, which may be from prior trauma. The skull and scalp soft tissues are unremarkable. | 1. Interval post-treatment findings related to resection of a right neck mass. There is an area of ill-defined soft tissue with a low attenuation center in the surgical bed anterior to the right carotid arteries, that measures up to approximately 3 cm, with mild overlying skin nodularity. This may represent recurrent tumor and/or treatment effects. A PET may be useful for further evaluation.2. No evidence of intracranial metastases.3. High-grade stenosis at the origin of the right internal carotid artery. |
Generate impression based on findings. | Vaso-occlusive disease. Evaluate for osteomyelitis.EXAMINATION: Right shoulder internal/external rotation (two views) 03/02/15 is The humeral head is normal in appearance. It is well directed into the glenoid fossa. No fracture or bone destruction is identified. | Normal examination. |
Generate impression based on findings. | 15-year-old patient with colon cancer and chemotherapy. Compare to prior. CHEST:LUNGS AND PLEURA: No abnormal parenchymal nodules, masses or airspace disease. No pleural disease.MEDIASTINUM AND HILA: Normal Thymus. No mediastinal mass is otherwise seen and no adenopathy.CHEST WALL: Right anterior chest wall Port-A-Cath with tip of the catheter in the distal superior vena cava at the atrial junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted -- homogeneous parenchyma without mass lesions. Gallbladder and biliary tract appear normal..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes about the right colon. No evidence of recurrent or residual tumor is seen. Mesentery appears normal in this region with clearing of the prior noted presumed postoperative changes. Only a small amount of free mesenteric fluid is seen in the pelvic cul-de-sac, to a level seen physiologically in female patient's of this age. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal cystic lesion is decreasing in size and less intense than seen previously and its nodular component most likely represents physiologic changes. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Postoperative changes in the right colon. Clearing of the prior noted presumed postoperative changes seen on 12/10/14 examination. 2. Decrease in size and prominence of prior noted right adnexal abnormality, most likely physiologic changes evolving. 3. Small amount of mesenteric fluid in the cul-de-sac, to a degree seen physiologically in female patient's of this age. 4. No evidence seen to suggest recurrent or metastatic disease. |
Generate impression based on findings. | Female 68 years old; Reason: Bilateral lower quadrant pain left greater than right. Evaluate for evidence of diverticulitis or colitis. History: Progressive abdominal pain with chronic diarrhea. ABDOMEN:LUNG BASES: Coronary artery calcifications.Calcified right lower lobe granuloma. Emphysematous changes.LIVER, BILIARY TRACT: Stable subcentimeter hypodensity in the caudate lobe, too small to accurately characterize. Vague central hypodensity (4:28) is of unclear significance.SPLEEN: Sequela of prior granulomatous disease.PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: Stable prominence of the left external iliac/common femoral vein. | No acute abnormalities to account for patient's symptoms. 1 cm hepatic hypodensity of uncertain significance. |
Generate impression based on findings. | History of DVT and recurrent pleural effusion. Evaluate for chronic clot burden. The comparison chest radiograph performed on 3/2/15 demonstrates bibasilar interstitial edema and small pleural effusions.The ventilation images show a diffuse decreased ventilation to the entire right upper lobe on single breath image which promptly washes in on equilibrium phase images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images demonstrate several large subsegmental and segmental perfusion defects at the right lung base most prominently anterolaterally. Several additional small and medium sized perfusion defects are seen in the superior right lower lobe and the right upper lobe. A small subsegmental defect is seen in the inferior left upper lobe. These are essentially all mismatched to the ventilation findings. | 1.High probability for pulmonary embolism.2.Regarding clot burden, this would be considered a medium embolic load and predominantly right-sided. |
Generate impression based on findings. | All of the paranasal sinuses are clear as are the bilateral mastoid air cells and middle ear cavities and there are no air-fluid levels. The bilateral maxillary sinus ostia are patent as are the bilateral frontoethmoidal and sphenoethmoidal recesses. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. A right-sided septal spur is noted. Bilateral orbits and the posterior nasopharynx appear unremarkable. | A right-sided septal spur is noted. Otherwise negative CT scan of the sinuses. |
Generate impression based on findings. | Ms. Carr is a 67 year old female with a personal history of left breast mastectomy in May 2013 for adenoid cystic carcinoma. She has a family history of breast cancer in her maternal aunt. She has no current breast complaints. Three standard views of the right breast with one right spot compression view 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 focal asymmetry in the posterior central right breast (best seen on the ML view) disperses into normal breast parenchyma on spot compression images. There are no new suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | NG placement at 1140.VIEW: Abdomen AP (one view) 03/02/15, 1245 Feeding tube tip is at the GE junction. Right lower extremity PICC is no longer visualized. Multiple dilated bowel loops are seen in the giant omphalocele. | Feeding tube tip at GE junction. |
Generate impression based on findings. | Reason: follow up PNA, s/p heart/kidney transp History: none LUNGS AND PLEURA: Interval resolution of right lung consolidation, with only mild scarring or atelectasis in the middle lobe. Mild basilar subsegmental scarring/atelectasis. Scattered benign appearing micronodules. No suspicious pulmonary nodules or masses. No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: Postoperative findings of a heart transplant. The heart is enlarged, with a small pericardial effusion. No visible coronary artery calcification. Scattered nonenlarged mediastinal lymph nodes are slightly decreased in prominence from the prior exam.CHEST WALL: Status post median sternotomy. Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval resolution of right-sided pneumonia, without new acute abnormality. |
Generate impression based on findings. | Male 79 years old Reason: pt with h/o Type B aortic dissection, AAA, RCIA aneurysms History: asymptomatic CHEST:CT Angiography: Left-sided aortic arch with normal branching of the brachiocephalic vessels. There is diffuse ectasia of the thoracic aorta with the largest diameter in the ascending aorta measuring 4.4 cm (series 7, image 57). Measurements of several levels of the thoracic aorta are unchanged from the prior exam. There is no evidence of aortic dissection.LUNGS AND PLEURA: Dependent atelectasis. Calcified right basilar granuloma, unchanged.MEDIASTINUM AND HILA: Mild cardiomegaly without pericardial effusion. No suspicious nodules or masses. No pleural effusion.CHEST WALL: No significant abnormality notedABDOMEN:CT Angiography: Marked tortuosity of the abdominal aorta including a horizontal course and hairpin turns. The abdominal aorta has diffuse ectasia with aneurysmal accentuations including infrarenal aneurysmal dilatation measuring up to 3.3 cm in AP dimension (series 7, image 146). There is a high-grade stenosis of the patent celiac artery at the origin with likely post stenotic dilatation (series 7, image 124). There is stenosis of the patent SMA at the origin as well. Stable dissection involving the SMA, with the false lumen appearing just distal to the origin of the SMA (series 7, image 127). The false lumen of the SMA gives off multiple left sided branches of the mesenteric arcade, unchanged. Aneurysmal dilatation of the right common iliac artery of 2.4 cm, previously 2.4 cm, and the left common iliac artery of 1.6 cm, previously 1.7 cm.Within the right common iliac artery, there is an eccentric hypodensity which is similar to the prior exam of 9/30/2013 and is likely due to flow phenomenon (series 7, image 195). This finding was not present on the exam from 8/27/2012, and it is possible there could be an abnormal thrombus.LIVER, BILIARY TRACT: Multiple hypodense lesions within the bilateral lobes which are stable and likely represent simple hepatic cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal cyst, unchanged. Cortical thinning of the renal parenchyma bilaterally, which is not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable L2 compression fracture with focal kyphosis. Degenerative changes of the visualized spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the visualized spine.OTHER: No significant abnormality noted. | 1.Stable diffuse ectasia with focal aneurysmal accentuations of the thoracic and abdominal aorta and its branch vessels as described above. 2.Stable dissection involving the SMA and unchanged focal high-grade stenosis of the celiac artery, both of which are patent. |
Generate impression based on findings. | Distal fibular fracture. Weight-bearing for fracture assessment. Again seen is an oblique fracture of the distal fibula with fracture fragments in near-anatomic alignment. I see no additional fracture. Ankle joint alignment is within normal limits. There is mild soft tissue swelling. | Distal fibular fracture as above. |
Generate impression based on findings. | Male 27 years old; Reason: multiple metacarpal fractures MIDDLE FINGER: There is a fracture through the 3rd metacarpal neck, with approximately 60 degrees of volar angulation of the distal fracture fragment. There is also a non-displaced fracture through the base of the 3rd metacarpal, only seen on the lateral view. No phalangeal fracture is seen.RING FINGER: There is a non-displaced fracture through the base of the 4th metacarpal. No phalangeal fracture is seen. | 3rd and 4th metacarpal fractures, as above. |
Generate impression based on findings. | 49-year-old female with history of laparoscopic Roux-en-Y gastric bypass for obesity complicated by ileus which resolved now with episodes of emesis and fever. ABDOMEN:LUNG BASES: Mild basilar atelectasis and trace left pleural effusion. LIVER, BILIARY TRACT: No focal hepatic lesions. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Round right renal fluid attenuation lesion compatible with simple cyst. Additional bilateral subcentimeter low-attenuation renal lesions too small to characterize. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of roux-en-y gastric bypass surgery. Oral contrast passes into the alimentary limb which is dilated up to 3.5 cm. There is a possible transition point proximal to the jejunojejunal anastomosis (coronal series, image 90). The biliary limb and common limbs are relatively collapsed. The colon is also relatively collapsed and contains residual contrast material from prior contrast examination. No intraperitoneal free air or free fluid.The appendix is well visualized and is unremarkable.BONES, SOFT TISSUES: Small fat-containing umbilical hernia. Mild body wall edema laterally.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Focus of gas is present within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postsurgical changes of gastric bypass surgery without contrast extravasation.2.Partial small bowel obstruction of the alimentary limb. No associated free air or free fluid.3.Nonspecific focus of gas within the bladder, correlate with history of recent instrumentation.Findings communicated with physician assistant Potts at 2:30 p.m. on 3/2/2015. |
Generate impression based on findings. | Reason: Malignant Neoplasm of the base of the tongue; follow up; with measurements History: as above CHEST:LUNGS AND PLEURA: Apical pleural scarring, compatible with post radiation reaction, unchanged.No suspicious pulmonary nodules or masses.Mild basilar scarring/subsegmental atelectasis is increased from prior and may be related to aspiration. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: Surgical changes in the neck are partially visualized. See same day CT neck for additional details.The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Left chest port, tip in the SVC.Mildly prominent axillary lymph nodes are unchanged.Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. Small left hepatic lobe hypodensity, unchanged, likely a benign cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 83 years old Female. Reason: staging History: left pulmonary nodules. RADIOPHARMACEUTICAL: 10.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 85 mg/dL. Today's CT portion grossly demonstrates a cavitary nodule in the superior segment of the left lower lobe. There is a nodular density in the left lingular lobe. There is a prominence of the lung hila was calcifications. There is a a questionable nodular density in the right breast.Today's PET examination demonstrates intense FDG uptake in the nodule in the superior segment of the left lower lobe with SUVmax of 23.2, which is consistent with lung cancer. Minimal FDG uptake is seen in the nodular density in the left lingular lobe with SUVmax of 1.9.Several foci of increased activity in the mediastinal paratracheal regions and bilateral lung hila, some of which correlate with lymph nodes with calcifications.There is no definite abnormal FDG uptake in the questionable nodular density in the right breast.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Hypermetabolic hypermetabolic cavitary nodule in the superior segment of the left lower lobe, consistent with lung cancer. 2.Minimal FDG activity in the nodular density in the left lingular lobe, which is consistent with inflammatory change.3.No definite evidence of FDG avid nodal metastasis or distant metastasis. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is nonspecific periventricular and subcortical white matter hypoattenuation. Additionally, there are or focal chronic infarcts in the right cerebellar hemisphere, and in the left frontal lobe. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. There are atherosclerotic vascular calcifications in the cavernous carotid arteries. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is mild hyperdense ligamentous thickening at the posterior aspect of the dens. | 1.No acute intracranial hemorrhage or mass effect. CT is insensitive for detection of early nonhemorrhagic stroke.2.Small vessel ischemic changes and unchanged old infarcts. |
Generate impression based on findings. | History of mycobacterial disease. Chronic cough. RA on immunosuppression, cavitating nodules, assess for growth of nodules. LUNGS AND PLEURA: Small ill-defined clustered peribronchiolar nodules in the right upper lobe (series 4, image 36), right basilar peripheral nodular interstitial thickening, and thick walled cystic lesion in the right lung base (series 4, image 67), suspicious for an indolent infection. These findings are similar to prior exam.The previously mentioned reference right lower lobe nodule has an angular morphology and abuts the major fissure consistent with a stable benign intrapulmonary lymph node.Mild centrilobular emphysema and minimal paraseptal emphysema.Calcified left lung nodules consistent with healed granulomatous disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Moderate coronary artery calcification.Normal heart size without a pericardial effusion.CHEST WALL: Prominent bilateral axillary lymph nodes, mildly decreased in size.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Calcified atherosclerotic disease of the abdominal aorta and branch vessels.Calcified hepatic granulomata. | Unchanged clustered right upper lobe peribronchiolar nodules and right base cystic thick-walled lesion, consistent with an indolent infection, such as MAI. These findings are similar to prior exam with no new sites of infection. |
Generate impression based on findings. | Female 67 years old Reason: Recurrent breast cancer on palliative Tamoxifen; restaging in 1-month History: See Above CHEST:LUNGS AND PLEURA: Bilateral calcified granulomas and scattered pulmonary nodules are unchanged. Slight interval increase in the peripheral wedge-shaped area in the left upper lobe compatible with focal scarring from postradiation changes. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with prior granulomatous disease. Cardiac size is within normal limits without pericardial effusion. No visualized coronary artery calcifications.CHEST WALL: Again seen is a punctate right breast calcification, unchanged (series 3, image 12). ABDOMEN:LIVER, BILIARY TRACT: Hepatic granulomata. No biliary ductal dilatation or focal masses. SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lumbar peritoneal shunt tip is seen at T12/L1 and courses inferiorly exiting at the level of L2/L3, and enters the abdomen on the left side, courses anteriorly and terminates in the mid abdomen.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Again seen is a destructive, lytic appearing lesion in the left femoral head (series 3, image 170) which corresponds to the focus of activity in the nuclear medicine bone scintigraphy study from 12/3/2014 and is compatible with metastatic disease. The size and extent of lytic component appears similar to prior exam.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Stable, small calcified nodule adjacent to the sigmoid colon (series 3, image 168) may be a sequelae of chronic inflammation | Stable destructive lesion in the left femoral head compatible with metastatic disease. No new areas of metastatic disease. |
Generate impression based on findings. | Knee pain. Joint pain in the hands. RIGHT HAND: Moderate to severe osteoarthritis affects the right hand, particularly at the DIP and PIP joints, and similar to prior. Mild osteoarthritis affects the MCP joints. No specific features of rheumatoid arthritis or chondrocalcinosis are seen.LEFT HAND: Severe osteoarthritis of right hand, particularly at the DIP and PIP joints, with ankylosis of the second and fifth DIP joints, slightly progressed compared to prior. Mild osteoarthritis affects the MCP joint. No specific features of rheumatoid arthritis or chondrocalcinosis are seen.RIGHT KNEE: Small enthesophytes are noted at the tibial tubercle and patella. Otherwise no significant degenerative changes are noted. No joint effusion is evident.LEFT KNEE: Small enthesophytes are noted at the tibial tubercle and patella. Otherwise no significant degenerative changes are noted. No joint effusion is evident. | 1. Findings compatible with erosive osteoarthritis of the hands, left worse than right, and slightly progressed compared to 2011.2. No specific findings in the knees to account for the patient's pain. |
Generate impression based on findings. | Question of PE on CT without contrast. Evaluate for PE. The comparison chest radiograph performed on 3/2/2014 demonstrates bilateral small to moderate pleural effusions and non-specific bilateral lower lobe opacities.The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images demonstrate multiple small to moderate mismatched perfusion defects in the bilateral lower lobes. A photopenic area within the left upper lobe on perfusion images correlates with the patient's pacemaker. | Small to moderate perfusion defects within the bilateral lower lobes with corresponding effusion and opacity on chest radiograph is non-specific, intermediate probability for pulmonary embolus. |
Generate impression based on findings. | 47 year-old female with gastric cancer and chemotherapy break. Compare to prior CT. CHEST:LUNGS AND PLEURA: Scattered micronodules, many which are calcified are again seen. No new nodules or evidence of airspace disease. No pleural disease.MEDIASTINUM AND HILA: Small, normal-sized lymph nodes seen in the anterior and mid mediastinum. No change is seen since prior examinations. No enlarged lymph nodes meeting criteria for lymphadenopathy is seen. Left anterior chest wall Port-A-Cath is again seen with tip of catheter in distal superior vena cava.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted -- small subcentimeter presumed cysts are unchanged. Gallbladder and biliary tract show no diagnostic abnormalities..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prior reference index nodule situated between the liver and the right hemidiaphragm crus (series 3 come image 94) is unchanged measuring 1.1 by 0.6 cm, previously 1.0 x 0.6 cm. Small subcentimeter periaortic lymph nodes are again seen as reported on previous examination. Exact delineation of the small left index lesion reported as subcentimeter cannot definitely be differentiated amongst the myriad of small densities in the area for measurement, but this is certainly not increased in size and is at least stable in size. No new foci of lymphadenopathy are seen.BOWEL, MESENTERY: Postsurgical changes about the collapsed stomach are again seen. Orally administered contrast rapidly empties through the small bowel without evidence of obstruction. No intrinsic abnormalities are seen in the small ball. Extensive fecal material is seen throughout the entire colon with marked distention of the colon by the feces.Ascites is again seen pooling in dependent portions laterally and in the pelvis. No peritoneal masses are seen. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive fecal material is seen distending the rectum, sigmoid and extensively in the right colon. Moderate amount of ascites is again seen. No focal mesenteric mass lesions are seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Postoperative changes about the stomach with similar appearance to prior examinations. 2. Stable appearance to small subcentimeter lymph nodes in the abdomen as measured and described above. 3. Again, extensive fecal material seen throughout colon with colonic and rectal distention. |
Generate impression based on findings. | Male 30 years old Reason: R/o acute fracture after ski accident History: Decreased ROM and pain. Three views of the left shoulder show no fracture or malalignment.Four nonweightbearing views of the left knee show no fracture or malalignment.Four nonweightbearing views of the right knee show no fracture or malalignment. | No fracture or malalignment. No specific findings to account for the patient's pain. |
Generate impression based on findings. | Female 72 years old Reason: left hip pain History: left hip pain and pain and swelling about the right foot, evaluate for fracture 3-5 metatarsals. We have 3 views of the right foot. The bones appear demineralized, suggesting osteopenia, but we see no fracture. Small midfoot osteophytes indicate mild osteoarthritis.We have 3 views of the left hip and an AP view of the pelvis. The hip joints appear normal for age. There are mild chronic enthesopathic changes along the greater trochanter of the left femur. Mild sclerosis along the pubic symphysis is likely degenerative in etiology. Degenerative arthritic changes affect the lower lumbar spine. The bones appear demineralized, suggesting osteopenia. | Degenerative arthritic changes as described above. We see no fracture. |
Generate impression based on findings. | 15-year-old male, history of boxer's fractureVIEWS: Right hand, PA, oblique, and lateral (3 views) 3/2/15 13:43 Interval removal of splint. There is persistent soft tissue swelling about the hand. A boxer's fracture of the fifth metatarsal with volar angulation of the distal fragment is again visualized. The fracture line remains visible. | Boxer's fracture and persistent soft tissue swelling as described above. |
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. Circumscribed, typically benign appearing mass in the left posterior upper outer breast is likely a lymph node. 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.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. | Female 43 years old Reason: Bilateral first MTP pain and right second toe pain History: ? Etiology. We have 3 views of the right foot. Two screws are noted within the distal diaphysis of the first metatarsal, presumably affixing a healed osteotomy. Minimal osteoarthritic changes affect the first metatarsophalangeal joint. Mild deformities of the PIP joints suggest prior surgery. We otherwise see no specific findings to account for the patient's pain.We have 3 views of the left foot. Two screws are noted within the distal diaphysis of the first metatarsal, presumably affixing a healed osteotomy. Mild osteoarthritis affects the first metatarsophalangeal joint. Narrowing of the head of the proximal interphalangeal joint of the second toe, with cyst formation in the underlying proximal phalanx, is likely degenerative in etiology. Mild deformity of the distal interphalangeal joint of the third toe may be due to prior trauma or surgery. | Postoperative and mild osteoarthritic changes as above. |
Generate impression based on findings. | 2-year-old female with history of fall from bunk bed. Evaluate for skull fracture. There is a moderate sized right parietal subgaleal hematoma and probable skin laceration. There is no evidence of underlying acute intracranial hemorrhage or calvarial fracture. The ventricles and sulci are symmetric. The gray-white differentiation is preserved. The basal cisterns are intact. The visualized paranasal sinuses, mastoid air cells, and orbits are normal. | Moderate sized right parietal subgaleal hematoma and probable skin laceration without underlying calvarial fracture or intracranial hemorrhage. |
Generate impression based on findings. | History of metastatic colon cancer. Evaluate for new bony metastatic disease with special attention to the left shoulder/acromion/clavicle. New onset point tenderness. There are increased foci of uptake within the anterior right 8th rib and the proximal and mid right femur. Increased uptake within the mid-thoracic spine correlates with prior surgery; it is difficult to discern a metastatic lesion vs post-operative change in this region. Asymmetric increased uptake is also noted in the left acromion, which does not correlate with areas of sclerosis on a recent CT, is non-specific. Otherwise, degenerative uptake is noted in the shoulders. | Multiple metastatic bone lesions. |
Generate impression based on findings. | Female 62 years old Reason: Fracture healing History: s/p cast immobilization. Three views of the right hand again show a nondisplaced fracture of the fifth metacarpal diaphysis appearing similar to that seen on the prior study. | Fifth metacarpal fracture appearing similar to the prior study. |
Generate impression based on findings. | Male 69 years old Reason: LESION History: PAIN. We have 3 views of the pelvis. There is poorly defined sclerosis in the right sacral wing that is nonspecific and could represent a marrow replacing lesion or a healing stress fracture. We see no additional lesions. Minimal osteoarthritis affects the hips. Calcifications in the lower abdomen likely reside in lymph nodes, and multiple metallic coils likely reflect prior hernia repair. | Poorly defined sclerosis in the right sacral wing is nonspecific and could represent an intramedullary lesion, healing stress fracture, or sequelae of prior radiation therapy. |
Generate impression based on findings. | 73-year-old male with metastatic esophageal cancer status post esophagectomy and chemotherapy. Evaluate treatment response. CHEST:LUNGS AND PLEURA: There is been an increase in size and number of the multiple pulmonary nodules bilaterally. The right basilar reference nodule (series 10284, image 69) measures 3.1 x 1 .7 cm, previously 1.8 x 1.5 cm. The other nodules that were smaller show similar increase in the lungs and new nodules are seen. Marked increase in bilateral pleural effusions. MEDIASTINUM AND HILA: Prior noted small mediastinal and hilar lymph nodes have increased in size in the pretracheal, subcarinal, and hilar regions. Reference example for increase ini size is in subcarinal lymph node (series 3, image 54) which measures 2.8 x 2 .0 cm, which previously measured 1.7 x 1.5 cm.Patient is status post esophagectomyyCHEST WALL: No change nonspecific subcutaneous nodule (series 3, image 46) of certain significance -- this is been present dating back to 2013 examination but not 2012..ABDOMEN:LIVER, BILIARY TRACT: Scattered small subcentimeter benign-appearing hypodensities are unchanged. No solid suspicious lesions are seen in the liver. The right hepatic dome lesion reference on 5/16/13 CT examination but not seen and 2014 again cannot be seen. Gallbladder and biliary tract show no diagnostic abnormalities.SPLEEN: No significant abnormality noteddPANCREAS: Heterogeneity in the pancreatic head which may involve low density subcentimeter cystic lesions are again seen with similar appearance. This may represent IPMN but is stable in appearance. No other abnormalities.ADRENAL GLANDS: No significant abnormality noteddKIDNEYS, URETERS: No significant abnormality noteddRETROPERITONEUM, LYMPH NODES: The periaortic adenopathy has decreased in size previously inferiorly below renal arteries. The reference peri-aortic lymph node more superiorly shows less dramatic change measuring 2.2 x 1.7 cm comparde with previous 2.3 x 2.3 cm.BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: Anterior abdominal wall ventral hernia containing only mesenteric fat. Diffuse degenerative changes throughout the skeletal system again seen. No foci of bone destruction is seen to suggest metastatic disease, however nuclear medicine bone scan is more sensitive indicator of activity is potential for skeletal metastatic disease.OTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: Diffuse descending colon/sigmoid diverticular changes without complication. No intrinsic abnormality otherwise seen in the small or large bowel. No free mesenteric fluid.Enlargement of the right obturator internus is again seen presumably from metastatic disease and appears essentially unchanged since 11/10/14, but again does not show the peripheral enhancement seen on prior examination. Diffuse degenerative changes are seen throughout the skeletal system. Nuclear medicine bone scan is a more sensitive indicator of activity of potential skeletal metastatic disease.OTHER: No significant abnormality notedd | 1. Increase in size and number of diffuse pulmonary nodules. 2. Mixed response in lymph nodes with increase in size of thoracic mediastinal lymph nodes, and slight decrease in retroperitoneal, periaortic lymph nodes. 3. Stable appearance to right obturator internus with no change in size since 11/10/14, but decreased enhancement since earlier scans.. |
Generate impression based on findings. | Right-sided thoracotomy with chest wall resection and right upper lobectomy and mediastinal lymph node dissection. EPIC history: basal cell carcinoma on left chest with open wound LUNGS AND PLEURA: Post-surgical findings of right upper lobectomy for resection of lung mass. No evidence of residual/recurrent or metastatic disease.Small amount of loculated pleural fluid at the right apex with associated pleural thickening and enhancement, likely post-surgical.Calcified left lung micronodules consistent with healed granulomatous disease.Stable right lower lobe micronodule adjacent to the major fissure (series 5, image 53), likely an intrapulmonary lymph node.Moderate upper zone centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Interval resection of previously seen right hilar lymph node.Mild coronary artery calcification.Normal heart size without a pericardial effusion.CHEST WALL: Post-surgical findings of partial right 4th and 5th rib resection.Large open wound in the left chest wall with soft tissue thickening at its base that extends down to the clavicle, consistent with known site of basal cell carcinoma.Sclerosis in the underlying left clavicular diaphysis is unchanged, may represent chronic osteomyelitis or reactive bone formation due to tumor infiltration.Stable L1 vertebral body compression deformity.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable right hepatic lobe hypodensity, likely a cyst. | 1. Interval en bloc resection of right upper lobe subpleural mass. No evidence of recurrent/residual disease or metastases.2. Large left chest wall open wound with soft tissue thickening at its base related to patient's known basal cell carcinoma. Sclerosis of the underlying left clavicle may represent chronic osteomyelitis or reactive bone formation due to tumor infiltration, not significantly changed. |
Generate impression based on findings. | 75-year-old male with history of dilated small bowel now with abdominal pain, evaluate for carcinoid in the mesentery. ABDOMEN:LUNG BASES: Severe emphysema. There is a masslike area of consolidation in the right lower lobe with spiculated margins (series 12, image 26) measuring 1.8 x 3.2 cm which is nonspecific but suspicious for neoplasm. The additional previously described pulmonary nodules are beyond the field-of-view.LIVER, BILIARY TRACT: There are several peripheral subcentimeter arterially enhancing foci within the liver (for example, series 8, image 18) which are nonspecific. A subcentimeter hypoattenuating lesion in the right hepatic lobe has not increased in size since 2010 and is likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is again a high attenuation lesion in the right renal upper pole which does not enhance and probably represents a hyperdense cyst. Additional subcentimeter low attenuation renal lesions are too small to characterize. Punctate nonobstructive calyceal calculi are present on the left. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic disease affects the abdominal aorta and its branches. There is narrowing of the origins of the celiac axis and SMA with contrast flow present distally.BOWEL, MESENTERY: Oral contrast rapidly traverses the stomach, small bowel, and proximal colon without evidence of bowel obstruction. No enhancing mesenteric lesions are identified. BONES, SOFT TISSUES: Thoracolumbar scoliosis with superimposed severe degenerative changes of the spine.OTHER: No significant abnormality noted PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Several bladder diverticulum. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Oral contrast rapidly traverses the stomach, small bowel, and proximal colon without evidence of bowel obstruction. No enhancing mesenteric lesions are identified. BONES, SOFT TISSUES: Thoracolumbar scoliosis with superimposed severe degenerative changes of the spine.OTHER: No significant abnormality noted | 1.No mesenteric or small bowel enhancing lesions are identified.2.Several nonspecific subcentimeter hyperenhancing hepatic lesions.3.Severe pulmonary emphysema. Right lower lobe masslike consolidation suspicious for malignancy, recommend dedicated chest CT for further evaluation. |
Generate impression based on findings. | MAXILLOFACIAL: There is significant interval worsening of non-expansile paranasal sinus disease without osseous remodeling or erosions. There is complete opacification of the right maxillary sinus with scattered foci of central hyperattenuation. There is mild left maxillary and moderate to severe bilateral ethmoid sinus mucosal thickening, worsened from prior exam. There is new minimal right frontal, mild right and moderate to marked left sphenoid sinus mucosal thickening as well. There is opacification of the ostiomeatal units bilaterally along with opacification of the middle meati and superior aspect of the nasal cavity. There is a right Haller cell. There is mild nasal septal deviation to the right. The carotid canals are covered by bone. The orbits, zygomas, pterygoid plates and the skull base are intact. The fat in the pterygopalatine fossa is preserved. There is no superficial soft tissue swelling or fluid collection.HEAD: There is no suspicious intracranial enhancement, fluid collection, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. | 1.Significant interval worsening of pansinus mucosal thickening with central hyperattenuation in the right maxillary sinus suggesting either noninvasive allergic fungal sinusitis and/or inspissated secretions.2.No osseous erosions to suggest osteomyelitis in the calvarium or facial bones.3.Unremarkable CT of the brain. |
Generate impression based on findings. | Male 49 years old; Right rib pain s/p contusion Radiopaque BB markers are noted at the right lower rib cage, in the location of the patient's stated pain. No rib fracture is evident.No pneumothorax is present. Mild degenerative disk disease affects the thoracolumbar spine. Cholecystectomy clips are noted. | No rib fracture evident. |
Generate impression based on findings. | Female 70 years old; Reason: h/o HNC and CRT, compare to previuos images History: has lump in groin CHEST:LUNGS AND PLEURA: Biapical fibrosis. Consolidation and air bronchograms posterior aspect of the right apex with post radiation subpleural fibrotic and bronchiectatic changes in the anterior chest wall of the right upper and middle lobes. Unchanged scattered unchanged pulmonary micronodules.MEDIASTINUM AND HILA: Calcified hilar granulomatous disease. No new lymphadenopathy. Stable small supraclavicular and mediastinal lymph nodes. Coronary artery calcifications.CHEST WALL: Surgical clips are noted in the left axilla.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcification of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: Few prominent stable less than 1 cm in axial dimension right inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. New 1.1 x 1.1 cm irregular pulmonary nodule in the left upper lobe (5:90) is suspicious for new metastatic disease.2. Stable fibrotic and postradiation changes in the lungs as described above. Stable right apical consolidation. 3. No definitive correlate to "lump in groin." |
Generate impression based on findings. | Reason: evaluation of spontaneous pneumo/blebs History: evaluation of spontaneous pneumo/blebs LUNGS AND PLEURA: Small scattered lucencies with apical predominance, best seen on MINIP, compatible with centrilobular emphysema. A previously described left perifissural air space cyst is not seen on this exam, now with a local focus of linear scarring. Scattered ill-defined small subpleural areas of lucency, without focal bullae.Mild basilar subsegmental atelectasis/scarring.Scattered benign appearing micronodules. No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: Mediastinum the heart is normal in size, without significant pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Thoracic scoliosis.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Aortic stent partially visualized. | Mild centrilobular emphysema. A previously described left perifissural air space cyst is not seen on this exam, likely representing air previously loculated within the fissure rather than a bulla. No discrete apical bullae are identified, apart from small subpleural cysts at the right base. |
Generate impression based on findings. | Left knee pain Very mild osteoarthritis affects the left knee, with small osteophytes and minimal medial joint space narrowing. No joint effusion is evident.Note is made of a Pelligrini-Stieda lesion in the right knee, indicating prior MCL injury. Orthopedic staple noted in the medial proximal right tibia. | Very mild left knee osteoarthritis. |
Generate impression based on findings. | T4N1 gingival squamous cell carcinoma status post docetaxel+cis+5-FU and TFHX completed on 9/13/13. The exam is limited by the lack of intravenous contrast and streak artifact from dental hardware. There are stable postoperative findings related to resection of the right marginal mandibulectomy with bone graft and metallic plate reconstruction and right neck dissection. There is mild persistent ill-defined soft tissue standing in the right parapharyngeal and medial masticator spaces, without definite evidence of mass lesions. There is unchanged patchy sclerosis of the right mandible adjacent to the surgical margins without evidence of erosion to suggest tumor involvement. There are no appreciable significantly enlarged cervical lymph nodes. The remaining salivary glands and thyroid are grossly unchanged. The imaged paranasal sinuses and mastoid air cells are clear. There is persistent consolidation with bronchiectasis in the right posterior lung apex. | No definite evidence of locoregional tumor recurrence or significant lymphadenopathy, although the exam is limited by the lack of intravenous contrast. |
Generate impression based on findings. | Patient with metastatic melanoma status post 4 cycles of Pembro. There is no evidence of intracranial hemorrhage or abnormal intraparenchymal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is moderate mucosal thickening of the bilateral ethmoid and maxillary sinuses. The remaining imaged paranasal sinuses and mastoid air cells are clear. There is an unchanged 7 mm dural based mass overlying the left cerebral convexity. The skull is otherwise unremarkable. There is 2 mm focus of skin thickening overlying the right parietal bone, previously 1.8 mm. | 1. No evidence of intraparenchymal mass. 2. Unchanged 7 mm dural based mass overlying the left cerebral convexity. While this has the typical appearance of a meningioma, a metastasis could potentially have a similar appearance. Continued follow-up imaging is suggested. 3. 2 mm right parietal dermal nodule, which may be slightly increased in size. This is nonspecific and may be inflammatory in nature. However, given the patient's clinical history, direct inspection is recommended. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is mild mucosal thickening of the right maxillary sinus. The left maxillary sinus is clear. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is mild left to right nasal septal deviation with a right-sided septal spur. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Mild mucosal thickening or small mucous retention cyst of the right maxillary sinus. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative unenhanced brain CT. Specifically, there are no CT findings to explain the patient's altered mental status. |
Generate impression based on findings. | Left lower extremity radiculopathy Leftward curvature of the lumbar spine is noted. Moderate degenerative disk disease affects the L3/L4 level. Moderate to severe facet joint hypertrophy affects the lower lumbar spine. No spondylolisthesis is evident.A left total hip arthroplasty device is partially visualized. Degenerative changes affect the visualized right hip, pubic symphysis, and sacroiliac joints. Abdominal aortic calcifications are noted. | Degenerative changes of the lower lumbar spine, as described above. |
Generate impression based on findings. | Tonsillar SCC staging. Assess for nodal and metastatic spread.RADIOPHARMACEUTICAL: 10.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 77 mg/dL. Today's CT portion grossly demonstrates an ill-defined mass within the region of the right pharyngeal wall, right base of tongue, and into the right aryepiglottic fold. There are multiple enlarged bilateral cervical lymph nodes. A tracheostomy tube is in place. There are multiple prominent mediastinal lymph nodes and an enlarged subcarinal lymph node. There is patchy opacity in the inferior right upper lobe and right middle lobe. There is a 10 mm right lower lobe nodular opacity which was present on a recent OSH CT. There are prominent portocaval and gastrohepatic lymph nodes. The prostate is enlarged.Today's PET examination demonstrates a markedly hypermetabolic mass within the right pharyngeal wall, right base of tongue, right tonsils, and right aryepiglottic fold (max SUV = 22.8). There are multiple bilateral markedly hypermetabolic level II, III, and IV lymph nodes. Mild hypermetabolic activity surrounding the tracheostomy tube likely represents inflammatory change.There is mild activity within right middle lobe and right upper lobe opacities which likely represents inflammation. There are two mild to moderate hypermetabolic lymph nodes in the right hilum (max SUV = 3.5) and subcarinal regions (max SUV = 4.8). A right lower lobe nodular opacity with mild activity (max SUV = 1.75) is non-specific. There is a mildly hypermetabolic portocaval lymph node (max SUV = 3.2). No FDG avid lesion is identified in the pelvis. | 1. Markedly hypermetabolic mass centered within the right pharyngeal wall which is consistent with tumor with metastatic involvement of multiple bilateral level II-IV lymph nodes.2. Mild to moderate hypermetabolic activity within right hilar, subcarinal, and portocaval lymph nodes is non-specific; this may represent infection, inflammation, or metastatic disease. 3. Right lower lobe nodular opacity is non-specific. |
Generate impression based on findings. | Female 98 years old Reason: r/o fx History: fall. We have 4 views of the left elbow. The bones are demineralized suggesting osteopenia. We see no fracture, malalignment, or joint effusion. There is chondrocalcinosis of the elbow joint. | Chondrocalcinosis. We see no fracture. |
Generate impression based on findings. | Female 51 years old Reason: pt with metastatic melanoma s/p 4 cycles of Pembro History: met melanoma CHEST:LUNGS AND PLEURA: Index right middle lobe nodule now measures 7 mm in diameter image number 45 series number 5, not significantly changed from previous study. Left lower lobe is no longer visualized.MEDIASTINUM AND HILA: Index subcarinal lymph node is no longer visualized.CHEST WALL: Bulky confluent right axillary metastatic adenopathy is also significantly smaller and measures 1.1 by 0.9 cm on image number 15, series number 3. There are multiple other enlarged lymph nodes in the right axilla, they are all smaller compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Most of the liver lesions are smaller. Index liver lesion in the right lobe now measures 5 mm in diameter image number 73, series number 3.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Significant interval decrease in the size of the multiple index lesions. Some of index lesions have completely resolved. |
Generate impression based on findings. | 59-year-old male with facial weakness. No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes. Redemonstrated is prominence of the cortical sulci, ventricular system, cerebellar and vermian folia disproportionate for patient's stated age of 57 without gross interval change. There is no acute intracranial hemorrhage, mass, mass effect, or midline shift. Also redemonstrated is white matter hypodensity without associated mass effect. Unremarkable calvarium, limited images through the orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial hemorrhage.2.Small vessel disease of indeterminate ages. If there is continued clinical concern for acute ischemia, MRI would be recommended.3.Redemonstrated is prominence of the cortical sulci, ventricular system, cerebellar and vermian folia disproportionate for patient's stated age of 57 without gross interval change. |
Generate impression based on findings. | Triple negative breast cancer with progressive disease and new neck adenopathy, please measure using Recist criteria and immune related response criteria, rule out brain metastases. Head: There is a patchy area of hyperattenuation in the left pons that measures up to approximately 10 mm. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Neck: There is a heterogeneous, ill-defined left supraclavicular lymph node that measures up to 23 x 27 mm. The lymph node is indistinct from the adjacent musculature and left internal jugular vein. There is also upper mediastinal lymphadenopathy. The thyroid and major salivary glands are unremarkable. There is a left subclavian venous catheter. The carotid arteries appear to be patent. The osseous structures are unremarkable. There is a subcentimeter low attenuation lesion in the midline just inferior to the hyoid bone, which likely represents a thyroglossal duct cyst. The airways are patent. There are several subcentimeter pleural-based nodules in the partially-imaged right lung. | 1. Metastatic left supraclavicular lymphadenopathy with suggestion of extracapsular extension. Upper mediastinal lymphadenopathy also likely represents metastatic disease. Please refer to the separate chest CT report for additional details.2. A patchy area of hyperattenuation in the left pons that measures up to approximately 10 mm may represent a metastasis or vascular malformation. A dedicated brain MRI without and with contrast may be useful for further characterization. 3. Several subcentimeter pleural-based nodules in the partially-imaged right lung are nonspecific. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Male 63 years old; Reason: Restaging cholangiocarciona History: NA CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Right middle lobe pulmonary micronodules likely represent intrapulmonary lymph nodes.MEDIASTINUM AND HILA: Stable to slight interval increase in prominent subcarinal lymph node measuring 1.1 x 2.3 cm (4:43). Stable to slight interval increase in prominent right hilar lymph node measures 1.6 x 1.9cm (4:39), previously 1.3x 1.5 cm (4:45). Redemonstrated atherosclerotic chronic changes of the coronary arteries. Right central line tip at the cavoatrial junction.CHEST WALL: Healing right 11th rib fracture. Stable sclerotic focus in the anterior right seventh rib.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes related to cholecystectomy. Unchanged positioning of the common bile duct stent with associated pneumobilia. Circumferential soft tissue thickening involving the entire common bile duct, which may be post procedural, however, underlying tumor not excluded.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Post-RFA changes of the inferior pole of the right kidney and interpolar region of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Unchanged nonenlarged periportal/hilar lymph node (4: 87)BOWEL, MESENTERY: No obstruction. Spigelian herniation of a loop of the ascending colon into the right lateral abdominal wall, unchanged, without evidence of obstruction.BONES, SOFT TISSUES: Moderate multilevel degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Unchanged prostatic hypertrophy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the right hip.OTHER: No significant abnormality noted | 1.Grossly stable to slight interval increase in borderline enlarged hilar and mediastinal lymph nodes as described above.2.Stable appearance of the common bile duct, further detailed above. No specific evidence of metastatic disease.3.Post ablation changes in the retroperitoneum and right kidney. |
Generate impression based on findings. | Female 86 years old Reason: pre op L knee fusion History: previous antibiotic spacer. AP view of the left femur, two views of the left knee and an AP view of the left tibia/fibula again show an antibiotic cement spacer affixed between the distal femur and proximal tibia via an intramedullary rod. There is lucency about the proximal aspect of the intramedullary rod that appears to have increased when compared with the prior study. Furthermore, the proximal end of the intramedullary rod is more anteriorly positioned within the femur and there is a small amount of periosteal new bone formation along the adjacent anterior femoral cortex; these findings suggest loosening.The proximal femur appears intact. There is a stent within the femoral artery distally.The distal tibia and fibula appear intact. | Antibiotic spacer as described above, with findings suggestive of loosening of the intramedullary rod within the distal femur. |
Generate impression based on findings. | Hiccups and abdominal pain. Evaluate gastric emptying after vagotomy. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 59.0 % of peak activity (normal >70 %)1 hour: 42.1 % of peak activity (normal 30-90 %) 2 hours: 14.9 % of peak activity (normal <60 %) 4 hours: 2.2 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | 14-year-old male, evaluate healing of fracture.VIEWS: Right clavicle axial (1 view) 3/2/2015 14:36 Again seen is a vertically oriented fracture through the mid clavicular diaphysis with inferior and posterior displacement of the distal fracture fragment. Periosteal reaction is present compatible with healing. | Healing displaced midclavicular fracture as described above. |
Generate impression based on findings. | Metastatic breast cancer.RADIOPHARMACEUTICAL: 13.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 90 mg/dL. Today's CT portion again grossly demonstrates multiple stable sclerotic osseous lesions involving the spine. A left arm port catheter tip extending to the cavoatrial junction is stable in position. Status post right mastectomy with right axillary clips. Right lower quadrant surgical clips in the pelvis are also noted. No change in the size of the left adnexal structure.Today's PET examination demonstrates symmetric diffuse increased activity in the neck, chest wall and paraspinal regions consistent with benign brown fat. There is no evidence of FDG avid tumor in the neck, chest, abdomen or pelvis. Decreased activity (SUVmax of 4.6 compared to 5.8 previously) is seen in the left left pelvis, which is most likely due to functional ovarian cyst. | 1.No definite evidence of FDG avid tumor.2.Slight decrease in the activity within the left adnexal region likely representing a functional ovarian cyst. However given to persistency of the activity, ultrasound is recommended for further evaluation. |
Generate impression based on findings. | 60 year-old female with acute onset dysarthria, left sided facial droop, right upper extremity weakness yesterday at 6:10 a.m., somewhat improved today, unable to obtain MRI secondary to pacemaker No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There is mild left greater than right maxillary sinus mucosal thickening. Mastoid air cells are clear. Calvarium is intact. Prominent periapical lucency noted involving a partially visualized left maxillary molar tooth. | 1.No CT evidence of acute territorial, cortical infarct.2.No acute cranial hemorrhage. |
Generate impression based on findings. | 16 year old female with abdominal pain and early satietyEXAMINATION: MR enterography without and with IV contrast 3/2/15 14:12 ABDOMEN:LIVER, BILIARY TRACT: Normal signal intensity, without focal lesion or biliary ductal dilatation.SPLEEN: Normal splenic morphology and enhancement.PANCREAS: Uniform pancreatic enhancement.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Normal renal enhancement without focal lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The small bowel is normal in caliber without wall thickening or abnormal enhancement. No evidence of inflammation or stricture. Moderate to large colonic stool burden.BONES, SOFT TISSUES: A small T2 bright, nonenhancing left breast lesion likely represents a cyst, as seen on prior CT examinations.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Physiologic appearance for age.BLADDER: Moderately distended and otherwise, normal.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The small bowel is normal in caliber without wall thickening or abnormal enhancement. No evidence of inflammation or stricture. The terminal ileum is patent. Moderate to large colonic stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of inflammatory bowel disease. Interval resolution of colonic wall thickening/inflammation. Moderate to large stool burden. |
Generate impression based on findings. | Patient with a recent PE this admission but would like eval for smaller clots and chronic thromboembolic disease. The comparison chest radiograph performed on 3/2/2015 demonstrates a wedge-shaped focal opacity within the right middle lung compatible with a large pulmonary infarct better seen on the recent previous chest CT. Reduced right lung volume and a pleural effusion on the right.The ventilation images show large areas of decreased ventilation in the right lung base and right midlung periphery.The perfusion images also show defects in the right midlung and right lung base compatible with two triple matched defects. Additional small to moderate mismatched defects are noted in the lung bases bilaterally. | Two triple matched defects in the right lung and multiple small to moderate VQ mismatches in the lung bases bilaterally correlating with the patient's known PEs diagnosed by recent CT. Note that superimposed new thromboembolic disease cannot be excluded on the basis of this exam. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Fluid is present within a few right mastoid air cells, also demonstrated in 2012. The visualized portions of the paranasal sinuses and left mastoid air cells are clear. | Fluid is present within a few right mastoid air cells, also demonstrated in 2012. Otherwise negative unenhanced brain CT. |
Generate impression based on findings. | Right pulsatile tinnitus for the past 2 years. Right: The external auditory canal is patent. The middle ear cavity is well-pneumatized and clear. There is minimal opacification of the mastoid air cells. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course, although it may be dehiscent along the tympanic segment. The jugular bulb and carotid canal are intact. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course, although it may be dehiscent along the tympanic segment. The jugular bulb and carotid canal are intact. Miscellaneous: There is a right lens implant. There is mild paranasal sinus mucosal thickening. | No evidence of semicircular dehiscence, venous diverticulum or dehiscence, or temporal bone mass lesions. |
Generate impression based on findings. | Call back from screening mammogram for a new cluster of calcifications in the left breast. An ML view and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. There is a new cluster of amorphous calcifications at posterior lower outer quadrant, measuring 9 mm, in the left breast. Stereotactic core needle biopsy is recommended for these calcifications. | Indeterminate cluster of calcifications at posterior lower outer quadrant in the left breast. Stereotactic core needle biopsy is recommended. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Reason: R/o PE History: SOB, O2 requirement, diffuse pain PULMONARY ARTERIES: Exam is somewhat limited by decreased spatial resolution and patient body habitus. Within these limitations, no pulmonary embolus is identified to the segmental level. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension.LUNGS AND PLEURA: Moderate dependent atelectasis and basilar subsegmental atelectasis/scarring. Mild new upper zone groundglass and nodular opacities bilaterally. No septal thickening. No pleural effusions.Scattered calcified granulomas and benign-appearing micronodules are unchanged. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. Enlarged right atrium. Straightening of the intraventricular septum and competitor in the reflux of contrast, similar to the prior exam and suggestive of right heart strain.Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatomegaly. Scattered splenic calcified granulomas. | 1. No evidence of pulmonary embolism to the segmental level.2. New upper zone groundglass and nodular opacities bilaterally may relate to respiratory bronchiolitis in a smoker. In a nonsmoker, findings may represent hypersensitivity pneumonitis. Less likely considerations include atypical infection such as viral or atypical mycobacterial, or atypical edema.3. Findings suggestive of pulmonary hypertension, with evidence of right heart strain and hepatomegaly, compatible with a history of right heart failure, similar to prior.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Positive. |
Generate impression based on findings. | 96 year-old female who fell and struck the floor without loss of consciousness Examination demonstrates no acute intracranial hemorrhage, mass-effect, midline shift or hydrocephalus. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes however. Redemonstrated is mild periventricular low attenuation of white matter which is a nonspecific finding however considering patient's stated age of 96 most likely represents mild aging determinate small vessel ischemic disease. Examination also redemonstrates an isodense mass within the sella extending into the right cavernous sinus, flattening and inferior displacement of the floor of the sella on the right and without detectable extension into the basal cistern or mass effect upon the chiasm. The finding is highly suggestive of a pituitary adenoma. The cerebral cortex and cortical sulci as well as the ventricular system and CSF spaces and gray/white differentiation is otherwise unremarkable. Unremarkable calvarium and soft tissues of the scalp. Unremarkable paranasal sinuses and mastoid air cells. | 1.No acute CT evidence for intracranial process.2.Mild age indeterminate small vessel ischemic disease.3.Presumed pituitary adenoma within the sella with extension into the right cavernous sinus, flattening/inferior displacement of the floor of the sella. There is no extension into the basal cistern and no detectable mass effect on the chiasm. |
Generate impression based on findings. | 54-year-old female with a history of lumpy breast. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced. 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. | Reason: anatomic evaluation History: trach dependent,mmultiple prior surgeries LUNGS AND PLEURA: S/P right pneumonectomy with large pleural cutaneous defect. Packing material and a small amount of fluid in the right chest cavity. Large 1-2 cm open communication between the right bronchial stump and the right hemithorax. Air also extends anteriorly around the posterior aspect of the aortic root. Packing material is seen in the right bronchial stump.Left pleural effusion with multifocal airspace opacity on the left suggestive of pneumonia or aspirate. Post op change left apex.MEDIASTINUM AND HILA: Right PICC tip in SVC. Bronchopleural fistula and air collections within the mediastinum as described above. Mild coronary calcification. Status post tracheostomy with tip 4-5 cm above the carina.CHEST WALL: Extensive post op change on the right with multiple rib resections and open pleurocutaneous defect. Status post median sternotomy. Compression deformity of T3.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | S/P right pneumonectomy with large pleural cutaneous defect. Packing material and a small amount of fluid in the right chest cavity. Large 1-2 cm open communication between the right bronchial stump and the right hemithorax. Air also extends anteriorly around the posterior aspect of the aortic root. Packing material is seen in the right bronchial stump.Left pleural effusion with multifocal airspace opacity on the left suggestive of pneumonia or aspirate. |
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