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Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 72 years old Reason: evaluate for response/progression. History: metastatic soft tissue sarcoma CHEST:LUNGS AND PLEURA: Interval increase in size of the left upper lobe pulmonary lesion measuring 1.8 x 1.7 (series 5, image 35), previously 1.3 x 1.1 cm. New left upper lobe nodule measuring up to 5 mm (series 5, image 58). There are a few scattered micronodules, unchanged. Right upper lobe micronodule is stable (series 5, image 58).MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No coronary artery calcifications. Right chest wall port with catheter tip in the distal SVC. Small right hilar and mediastinal lymph nodes, unchanged.CHEST WALL: Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Normal liver morphology. No biliary ductal dilatation or focal hepatic lesion. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: Stable subcentimeter hypodense focus in the pancreatic head/uncinate process (series 3, image 129) is too small to characterize.ADRENAL GLANDS: Stable, bilateral adrenal nodularity most prominent left.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple retroperitoneal lymph nodes not significantly changed in size. Reference pre-aortic lymph node measures 0.9 x 1.0 cm (series 3, image 148), previously 1.1 x 1.0 cm. BOWEL, MESENTERY: Reference right peritoneal nodule has increased in size and now measures 1.8 x 2.9 cm (series 3, image 173), previously 1.5 x 2.1 cm. Peripherally calcified structure adjacent to the cecum which is similar in size and may represent a calcified diverticula or node or site of fat necrosis .PELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple small right inguinal and iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Incompletely imaged heterogeneous mass involving the anterior, medial and lateral compartments of the right thigh with obliteration of fascial planes consistent with biopsy-proven sarcoma. A lateral component of the mass measures 1.8 x 1.8 cm (series 3, image 240), previously 1.1 x 1.2 cm. There is worsening neoplastic involvement of the right superior pubic ramus and right anterior acetabulum with additional cortical destruction. Persistent subcutaneous edema of the right thigh. | 1.Interval increase in size of the primary right thigh sarcoma and multiple known sites suspicious for metastasis. 2.New small left upper lobe nodule is suspicious for an additional site of metastatic disease. |
Generate impression based on findings. | 56-year-old male with history of left MCA aneurysm rupture and clipping. CT head without contrast: There are postoperative changes from left frontotemporal craniotomy and aneurysm clips in the left M1 region. There is encephalomalacia within the left middle and inferior frontal gyri, left superior parietal lobule, and superior aspect of left post-central gyrus with ex vacuo dilatation of the lateral ventricle appearing similar to the prior study. There is also mild periventricular and subcortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. There is no evidence of acute intracranial hemorrhage. There is no midline shift. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.Angiography: There is diffuse atherosclerotic disease of the intracranial vessels. The distal M1 segment is ectatic. Artifact from aneurysm clips in the left M1 region limits evaluation of the MCA in this proximity, however the distal MCA, though ectatic, is opacified with contrast. A stent is also partially visualized in the M2 segment that is non-occluded. There is moderate narrowing of the left P2, right distal A1 and left proximal A2 segments, likely atherosclerotic in etiology. The ACOM and PCOMs are intact. There is no evidence of additional intracranial aneurysms or significant stenoses. | 1. Prior left MCA M1 aneurysm clipping and stenting with adequate opacification of the MCA distal to the clips and stent. Overall, this appears similar to the prior exam from 1/2014.2. Moderate diffuse atherosclerotic disease of the intracranial vasculature.3. Chronic left cerebral encephalomalacia and chronic small vessel ischemic disease appearing similar to prior. |
Generate impression based on findings. | Reason: Evaluate for progression of metastatic disease; compare to previous scan History: none CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules, compatible with metastatic disease, not significantly changed from the prior exam. Reference right middle lobe nodule measures 3.7 by 3.3 cm (series 5, image 56), unchanged. No new pulmonary nodules identified.Mild basilar scarring/subsegmental atelectasis. No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, with no pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Right chest wall intramuscular lipoma, unchanged. Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic hemangioma, unchanged.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. | Stable pulmonary metastases. No new sites of disease identified. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 60 years old Reason: follow up History: follow up. Again seen are tension wires affixing a transverse fracture of the patella in near anatomic alignment. Posteriorly, the fracture appears slightly less distinct on the current study than on the prior study, suggesting some interval healing. There is a small joint effusion. Mild osteoarthritis affects the knee. | Orthopedic fixation of healing patellar fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 68 year old female status post right lumpectomy in 2004 for IDC, presents today for routine follow up. Patient received radiation and Arimidex. History of benign left breast biopsy. No current breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker is in place in the scar overlying the upper outer far posterior right breast. Additionally, there is a linear scar marker overlying the upper outer left breast. Expected underlying postsurgical changes are present. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Surgical clips are present in the right axilla. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Scattered benign calcifications are again seen in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 4-year-old female with painful swelling fourth fingerVIEWS: Left hand, PA, left fourth digit, PA and lateral (2 views) 3/3/15 9:30 There is soft tissue swelling about the fourth digit without underlying fracture identified. Alignment is within normal limits. | Soft tissue swelling without fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male; 74 years old. Reason: Pleural mesothelioma, please compare to prior exam per RECIST criteria. ABDOMEN:LUNG BASES: Please see separately dictated chest CT report. LIVER, BILIARY TRACT: Scattered subcentimeter hepatic hypodensities, too small to characterize but unchanged and likely benign. Trace perihepatic ascites. SPLEEN: No significant abnormality notedPANCREAS: Coarse scattered calcifications in the pancreatic body and uncinate, compatible with chronic calcific pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. No hydronephrosis. Additional scattered renal hypodensities are too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse mesenteric and omental haziness/soft tissue infiltration, with blurring of soft tissue planes between the bowel and anterior abdominal wall. Findings are most pronounced in the left and mid ventral abdomen with induration also noted between bowel loops in these regions. Progression is noted since the prior CT, suspicious for metastatic disease. Scattered colonic diverticula with thickening of the splenic flexure and transverse colon; favor neoplastic involvement rather than inflammation given the additional above findings. Mild dilatation of small bowel loops up to 3.3 cm, most pronounced on the left, with relatively normal caliber right sided loops and lack of visualized contrast in the colon. Some angulation of pelvic small bowel loops is also noted. Findings may represent underlying partial obstruction and/or adhesive disease. BONES, SOFT TISSUES: Moderate multilevel spinal degenerative changes. PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate measures 5.9 x 4.2 cm.BLADDER: No significant abnormality notedBOWEL, MESENTERY: There has been interval development of mild mesenteric haziness within the pelvis. No obstruction or free air. BONES, SOFT TISSUES: Moderate multilevel spinal degenerative changes.OTHER: Moderate pelvic free fluid, new. | 1. Interval increase in abdominal mesenteric haziness and omental soft tissue infiltration/thickening, with new extension of disease into the upper pelvis. Findings are suspicious for progression of metastatic mesothelioma. 2. Mild dilatation of left sided small bowel loops, with lack of visualized colonic contrast and angulated appearance of pelvic loops. Findings may represent underlying partial obstruction and/or adhesive disease. 3. New pelvic ascites. |
Generate impression based on findings. | Female, 25 years old, history of stage IIa Hodgkin's lymphoma status post chemotherapy. Seven months off therapy. No pathologic adenopathy is detected by size criteria. Surgical clips are demonstrated in the left supra-clavicular neck. The aerodigestive mucosa is normal. The salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally. No concerning osseous lesions are detected. | No evidence of active disease in the neck. |
Generate impression based on findings. | Reason: Pleural mesothelioma please compare to prior exam per recist criteria. History: Pleural mesothelioma LUNGS AND PLEURA: Postsurgical changes in the right hemithorax, with associated volume loss, and findings of a diaphragmatic mesh or prior pleurodesis.Nodular thickening in the right hemithorax is again demonstrated, with thickening of the fissures.At the level of the T4 vertebral body (series 4, image 32): The lesion at the 4 o'clock position measures 10 mm, previously 9 mm.At the level of the right main pulmonary artery (series 4, image 52): The lesion at the 7 o'clock position measures 7 mm, previously 7 mm.At the level of the coronary sinus (series 4, image 67): The lesion at the 4 o'clock position measures 14 mm, previously 12 mm.Nodular pleural/pericardial thickening adjacent to the right atrium (series 4, image 60) is slightly increased from the prior exam.A small ground glass nodule in the superior segment of the left lower lobe (series 6, image 49), is unchanged.Focal scar like opacity in the left lower lobe along the major fissure is unchanged.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.Mediastinal lymphadenopathy, mildly increased from the prior exam. A precarinal lymph node measures 14 mm (series 4, image 40), previously 11 mm.CHEST WALL: Extrathoracic tumor invasion into the right inferolateral chest wall (series 4, image 76), similar to prior.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Bilateral renal cysts, unchanged. Diffuse haziness of the intra-abdominal fat anteriorly in the upper abdomen is increased from the prior exam, suggestive of progressive metastases. See same day CT, abdomen and pelvis for additional details. | Mild interval increase in nodular pleural thickening, with reference measurements as above. Increasing pleural/pericardial thickening adjacent to the right atrium as well as increasing mediastinal lymphadenopathy. See same day CT abdomen pelvis report for additional findings. |
Generate impression based on findings. | There is a slightly displaced fracture involving the left frontal bone, the inferior-most extent of which extends to the left lambdoid suture. Soft tissue swelling and scalp hematoma is noted overlying the fracture. There is no underlying brain parenchymal associated abnormality. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence of acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extra-axial fluid collections or subdural hematomas. The mastoid air cells are clear. | There is a slightly displaced fracture involving the left parietal bone, the inferior-most extent of which extends to the left lambdoid suture. Soft tissue swelling and scalp hematoma is noted overlying the fracture. There is no underlying brain parenchymal associated abnormality. |
Generate impression based on findings. | Female, 55 years old, with locally recurrent oral tongue squamous cell carcinoma. Postsurgical findings are again seen including evidence of right partial glossectomy with flap reconstruction, right partial mandibulectomy with bone graft repair, and extensive bilateral neck dissection.Again seen is a bulky infiltrative tumor involving the left masticator space, parapharyngeal space and pharyngeal mucosal space. Since the prior examination, this lesion has grown in size with a maximal transaxial dimension of up to 49 mm, previously 36 mm. There is also evidence of further tumor spread into the soft palate and into the contralateral right pharyngeal mucosa. Further extension of tumor is suspected within the residual left tongue and floor of mouth. Significant new soft tissue ulceration through the left face is seen with a new orocutaneous fistula.The left masticator space tumor erodes through the posterior wall of the left maxillary sinus to a greater degree than on the prior examination. The pterygoid plates and a portion of the left hard palate are also eroded. The left mandibular ramus is largely absent with progressive erosion at the level of the mandibular condyle. The residual left mandibular body is sclerotic and permeative in appearance, similar to the prior examination, possibly representing metastatic involvement or osteoradionecrosis.Tumor erodes through the floor of the left middle cranial fossa where it closely approximates the undersurface of the left temporal lobe as well as Meckel's cave. No definite brain parenchymal lesions are seen at this time, though MRI would provide a more sensitive evaluation.Spread of infiltrative tumor is suspected to some degree along the left carotid space down at least to the level of the hyoid. More inferiorly, a cluster of prominent left level 6 lymph nodes is probably not significantly changed. Ill-defined enhancement at level 2 in the right neck is unchanged and nonspecific.The right clavicle shows a somewhat sclerotic and permeative appearance which is similar to the prior examination and of uncertain significance. The left mastoid air cells and middle ear cavity are opacified similar to prior. Mucosal thickening has progressed within the maxillary sinuses. | Progression of disease with increasing size of a bulky left masticator space/pharyngeal mucosal space tumor, as well as evidence of tumor spread to the contralateral right pharyngeal space. The soft tissues of the left face are progressively ulcerated with a new orocutaneous fistula.Tumor erodes through the floor of the left middle cranial fossa where it closely abuts the undersurface of the left temporal lobe and Meckel's cave. Although no definite brain parenchymal lesions are seen at this time, MRI would provide a more sensitive evaluation. |
Generate impression based on findings. | 13-year-old female with hip painVIEWS: Pelvis AP and frog leg (two views) 3/3/2015 10:11 Sclerosis of the left femoral head is again seen and confined to the medial and posterior surfaces. The left femoral head is flattened and slightly broadened. Subchondral lucency is predominantly along the posterior surface of the left femoral head. Joint space is slightly widened on the left unchanged from prior study. Alignment is normal. The femoral heads are well seated within the acetabula. No fracture or dislocation is noted. | Avascular necrosis of the left femoral head which is unchanged. |
Generate impression based on findings. | 22-year-old male with history of lymphoblastic lymphoma on therapy. LUNGS AND PLEURA: No pulmonary nodules or masses. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Right-sided chest port catheter tip terminates in the right atrium. The left internal jugular vein is not visualized consistent with thrombus.UPPER ABDOMEN: No evidence of pathology in the upper abdomen. | No evidence of recurrent disease or metastases. |
Generate impression based on findings. | Metastatic renal cell carcinoma status post left nephrectomy and right lower lobe wedge resection CHEST:LUNGS AND PLEURA: Postoperative changes right lower lobe status post wedge resection.Soft tissue focus associated with the suture line best seen on image 63 of series 5 measures 4.8 x 1.3 cm.MEDIASTINUM AND HILA: Moderately severe coronary calcification again noted.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable segment 6 right lobe low attenuation focus best seen on image 97 of series 3 measuring 1.3 x 0.9 cm. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy site demonstrates stable focal fluid collection best seen on image 101 of series 3 measuring 2 x 1.7 cm; favor benign postoperative collection.Stable 0.5 x 0.5 cm low attenuation focus within the right kidneyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Trace ascites.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: Trace ascitesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Postoperative changes right lower lobe consistent with wedge resection. Soft tissue focus associated with suture line; favor postoperative finding; however would recommend special attention to this area on future surveillance scans.New trace ascites. No evidence for new metastatic focus. |
Generate impression based on findings. | 59 year old woman with history of right IDC s/p lumpectomy in 2011. Three standard views of both breasts, an exaggerated right CC view and a spot compression left CC view 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. Local architectural distortion, volume loss, and dystrophic calcifications are noted in the right upper breast at the lumpectomy site. No dominant mass or suspicious microcalcifications are seen. Benign-morphology calcifications in the left breast are stable. An asymmetry in the left inner breast disperses with spot compression and represents overlapping tissue.Surgical clips noted in the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Head and neck cancer per protocol scans. CHEST:LUNGS AND PLEURA: There are new patchy centrilobular and tree in bud opacities within the inferior right upper lobe and superior right lower lobe is suggestive of aspiration and/or infection. No suspicious pulmonary nodules are identified. Apical scarring/post-radiation change is again noted. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. There are no visible coronary artery calcifications. A prominent high left paratracheal lymph node measures 6 mm (image 11, series 3), unchanged.CHEST WALL: A left PICC tip is at the superior atriocaval junction.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.A gastrostomy tube is noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. New patchy centrilobular nodular opacities within the right upper and lower lobes is suggestive of aspiration and/or infection.2. No significant interval change in a non-specific left paratracheal lymph which may be reactive or due to tumor involvement. |
Generate impression based on findings. | 65 year old female status post right lumpectomy in 2002 for IDC and DCIS, presents today for routine follow up. Patient received radiation and chemotherapy. No current breast complaints. Family history of breast carcinoma in her paternal aunt and two paternal cousins. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linear marker has been placed in the upper central right breast with expected underlying postsurgical change and dystrophic calcifications. There is stable cutaneous distortion of the right breast. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 76 year old female with history of subarachnoid hemorrhage. CT head without contrast: Bilateral frontal ventriculostomy catheters are unchanged in position. Right frontal hematoma with surrounding edema adjacent to the catheter is stable in size and appearance. There is a new small hematoma within the left anterior frontal lobe which measures 1.6 x 1.4 cm in maximum axial dimensions. A small amount of air is present within the non-dependent portion of the left lateral ventricle. Diffuse subarachnoid hemorrhage extending into the ventricles appears similar to prior. A coil mass is present in the right paraclinoid region. The ventricular size and configuration is unchanged. The visualized paranasal sinuses, mastoid air cells, and orbits are unremarkable.Angiography and perfusion: There is a coil mass present within a small PCOM aneurysm without evidence of contrast opacification or extravasation. The left distal internal carotid artery stent is also widely patient without evidence of thrombosis. There is mild atherosclerotic narrowing of the right P1-P2 segment, but otherwise the intracerebral vasculature appears normal without evidence of vasospasm. No additional aneurysms are identified. Normal perfusion was appreciated bilaterally. | 1. New small left frontal hematoma as above.2. Normal perfusion bilaterally with no evidence of vasospasm.3. Distal right ICA stent and PCOM coil mass are unremarkable with no evidence of thrombosis or complication.4. Stable bifrontal ventriculostomy catheters, diffuse subarachnoid hemorrhage, and right intraparenchymal hematoma. |
Generate impression based on findings. | Male 65 years old; Reason: Pancreas cancer s/p neoadjuvant chemo, please assess per pancreas protocol imaging for treatment response prior to Whipple surgery and provide index lesion measurements for RECIST CHEST:LUNGS AND PLEURA: Small subcentimeter nodular foci seen along right major fissure without significant change from prior study, most likely intrapulmonary lymph nodes. MEDIASTINUM AND HILA: Atherosclerotic thoracic aorta. Central venous catheter seen with tip in distal SVC. Severe calcified coronary artery disease. Subcentimeter juxtaphrenic lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Again seen is dominant mass involving pancreatic tail, accounting for differences in technique, measuring smaller than on prior study, measures approximately 2.6 cm in AP dimension by 2.3 cm in transverse dimension by 3.1 cm in craniocaudal dimension, axial image 49 series 8 and coronal image 58 series 8065, previously measured 3.1 x 2.9 x 3.3 cm. Again seen is relatively heterogeneous hypoattenuated appearance of distalmost pancreatic tail, similar to earlier study and may reflect parenchymal atrophy secondary to aforementioned mass but adjacent direct invasion by dominant mass not entirely excluded. Stable pancreatic ductal dilatation seen at this level, measuring approximately 6 mm. Proximal celiac artery, SMA and hepatic artery patent, no involvement by tumor. Moderate to marked narrowing of adjacent splenic vein, which remains patent. Patent SMV.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Status post ileocecectomy.PELVIS:PROSTATE, SEMINAL VESICLES: Intraprostatic calcifications in enlarged prostate, measures up to 5.8 cm in transverse dimension.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance including multilevel degenerative changes of spine. | 1. Mild interval decrease in size of pancreatic tail mass. Unchanged moderate to marked narrowing of adjacent splenic vein, which remains patent. 2. Remainder of exam without significant change as above. |
Generate impression based on findings. | Seven-year old male, evaluate Perthes lesionVIEWS: Pelvis, AP (one view) 3/3/15 10:27 Sclerosis and collapse of the left femoral head and broadening of the femoral neck appear similar to the prior exam. There is remodeling of the left acetabulum. The right femoral head is normally formed and well directed with respect to the acetabula. Moderate to large colonic stool burden. | Unchanged left Perthes disease. |
Generate impression based on findings. | LIVER: The liver measures 8.1 cm. No focal lesion.GALLBLADDER, BILIARY TRACT: The gallbladder is moderately distended and otherwise, normal. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 5.5 cm.KIDNEYS: The right kidney measures 5.9 cm. The left kidney measures 5.6 cm. No focal lesion or hydronephrosis.OTHER: No significant abnormality noted. | Normal examination. |
Generate impression based on findings. | Knee pain Four views of the right knee are provided. There is narrowing of the medial tibiofemoral compartment with near bone on bone apposition. There are also tricompartmental osteophytes. These findings indicate severe osteoarthritis. There is a slight varus deformity of the knee.Osteoarthritis also affects the left knee, as seen on the frontal views, with densities overlying the distal femur likely representing loose bodies in the suprapatellar pouch. | Osteoarthritis. |
Generate impression based on findings. | Right knee pain, osteoarthritis Four views of the right knee are provided. Tricompartmental osteophytes and mild joint narrowing indicate moderate osteoarthritis, particularly considering the patient's relatively young age. Similar osteoarthritic changes affect the left knee as seen on the frontal views. | Osteoarthritis. |
Generate impression based on findings. | 82 years, Female, Reason: 82F with gross hematuria History: gross hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Enlarged common bile that measuring 1.4 cm with mild intrahepatic biliary ductal dilatation is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Prominent pancreatic duct is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 1.5 x 1.1 cm enhancing lesion in the right renal pelvis (7/44) suspicious for transitional cell carcinoma. Subcentimeter left renal hypodensity likely represents a cyst. Subcentimeter right renal nonenhancing hypodensity is of slightly higher attenuation than water (7/43), likely hemorrhagic/proteinaceous cyst.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta with stable abnormal configuration of the iliac bifurcation. Chronic thrombosis of the right external iliac artery is unchanged.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Enhancing lesion in the right renal pelvis is suspicious for a transitional cell carcinoma. No regional adenopathy or metastatic lesion.Findings discussed with Dr. Alberts on 3/3/2015 at 11:30 a.m. |
Generate impression based on findings. | Female; 71 years old. Reason: Assess Crohn's History: Abdominal pain; worsening diarrhea. Hx of multiple small and large bowel obstructions for Crohn's. ABDOMEN:LUNG BASES: Minimal dependent scarring/atelectasis. No pleural effusions or focal areas of consolidation.LIVER, BILIARY TRACT: No suspicious hepatic lesions or biliary ductal dilatation. Cholelithiasis without gallbladder wall thickening or pericholecystic fluid.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered nonobstructive right renal stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Suprarenal and infrarenal IVC filters are unchanged. Bilateral common iliac vein stents. Scattered normal sized lymph nodes, also unchanged. BOWEL, MESENTERY: Postsurgical changes status post multiple small bowel resections and partial colectomy with ileosigmoidostomy. There is adequate and uniform small bowel distention from ingested Volumen oral contrast material, without focal narrowing to suggest obstruction. No bowel wall thickening or mesenteric inflammation. No free air. Small hiatal hernia. Large duodenal diverticulum. BONES, SOFT TISSUES: Moderate multilevel spinal degenerative changes. OTHER: No free fluid or focal fluid collections. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes status post multiple small bowel resections and partial colectomy with ileosigmoidostomy. There is adequate and uniform small bowel distention from ingested oral contrast material, without focal narrowing to suggest obstruction. No bowel wall thickening or mesenteric inflammation. No free air. Small hiatal hernia. Large duodenal diverticulum. BONES, SOFT TISSUES: Moderate multilevel spinal degenerative changes. Fatty atrophy vs small lipoma adjacent to left iliac wing, unchanged. OTHER: No significant abnormality noted | Extensive postsurgical changes as described above without evidence of active inflammatory bowel disease. |
Generate impression based on findings. | Pain. Arthroplasty follow-up. Components of the "reverse" total shoulder arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. A small focus of gas density is seen within the soft tissues beneath the acromion process; I suspect that this may reflect a recent subacromial injection or perhaps a small focus of residual postoperative gas, but please correlate for any clinical signs of infection. | Postoperative changes of left total shoulder arthroplasty as described above. |
Generate impression based on findings. | Female 53 years old Reason: eval for fx, dislocation History: fall. Three views of the left shoulder show a comminuted surgical neck fracture of the humerus which appears slightly impacted and there is medial displacement of the distal fracture fragment. There is no dislocation of the shoulder joint. The acromioclavicular joint appears intact.Two views of the left humerus show the aforementioned humeral surgical neck fracture. The distal portion of the humerus appears unremarkable without acute fracture or malalignment.Four views of the left elbow show no fracture or malalignment. The elbow joint appears intact. | Left humeral comminuted surgical neck fracture as described above. |
Generate impression based on findings. | 57 year old female status post left lumpectomy in 2009 for DCIS, presents today for routine follow up. Patient received radiation and tamoxifen therapy. No current breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker has been placed on a scar overlying the central outer left breast, with expected underlying postsurgical changes changes, dystrophic calcifications, and surgical clips. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Headache and visual field cut. Evaluate for tumor, status post left occipital tumor resection and stereotactic radiosurgery. RADIOPHARMACEUTICAL: 11.2 mCi F-18 fluorodeoxyglucose (FDG)BLOOD GLUCOSE (FASTING): 100 mg/dL Today's PET brain demonstrates a large area of predominantly decreased FDG uptake within the region of low-attenuation in the occipital/posterior parietal lobe on CT corresponding with the site of prior tumor resection. However there is a rim of increased FDG activity in the left medial occipital lobe which corresponds to the region of rim of enhancement seen on the MRI. Postsurgical changes are noted on the CT of a left occipital craniotomy. | Findings suspicious for recurrent or residual tumor within the left medial occipital lobe. |
Generate impression based on findings. | Female 21 years old Reason: assess healing History: s/p IMN. Two views of the right femur show an intramedullary rod with two fixation screws both proximally and distally affixing a comminuted femoral diaphyseal fracture unchanged in position and in near-anatomic alignment. There is no radiographic evidence of hardware complication. Three views of the right ankle show no acute fracture or dislocation. There is no soft tissue swelling. There is no joint effusion. | Orthopedic fixation of a comminuted femoral diaphyseal fracture. Normal-appearing right ankle. |
Generate impression based on findings. | There is no evidence of mass lesions or significant cervical lymphadenopathy. The Waldeyer ring structures are within normal limits. The thyroid and major salivary glands are unremarkable. There is a right chest wall Mediport catheter again seen. There is unchanged chronic occlusion of the left internal jugular vein. The remaining major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is mild left maxillary sinus mucosal thickening. There is incompletely imaged anterior mediastinal soft tissue again seen. There is a stable tiny calcified granuloma in the left upper lobe anteromedially, and a stable micronodule on series 5 image 76. Please refer to dedicated accompanying CT chest report for further details | 1.Stable exam with no significant cervical lymphadenopathy by CT size criteria.2.Chronically occluded left internal jugular vein. |
Generate impression based on findings. | Male 53 years old with shoulder pain and ventral foot pain. Three views of the right shoulder show no acute fracture or dislocation. A rounded ossicle in the area of the axillary recess may represent a loose body the joint. There is no radiographic evidence to account for patient's pain.Three views of the right foot show no fracture or dislocation. The right foot appears normal. There is no radiographic evidence to account for patient's pain. | Unremarkable right shoulder shoulder and right foot described above without radiographic evidence to account the patient's pain. |
Generate impression based on findings. | 2 y/o M w/ repaired spina bifida and VP shunt EXAMINATION: Oropharyngeal motility study 3/3/15 10:45 Julie Ecclestone (pager 8293), speech and language therapist, supervised the examination.26 seconds of fluoroscopy was used.Limited exam due to oral aversion. Immature oral skills were noted including munching rather than suction to express fluid. There was premature spillage into the hypopharynx with slight delay in swallow but no penetration or aspiration with thin liquids or puree. | Oral aversion and limited oral skills, without penetration or aspiration. Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Female 62 years old Reason: r/o DJD psoriatic arthritis right basilar joint History: joint pain; psoriasis. There is osteoarthritis of the distal interphalangeal joints with osteophyte formation. Radiopaque densities lung the ulnar aspect of the fifth proximal interphalangeal joint of unknown significance may represent dystrophic calcifications. An osteophyte of the third metacarpal head as a drooping appearance, raising the possibility of CPPD arthropathy. | Osteoarthritis, predominantly of the distal interphalangeal joints, with an osteophyte of the third metacarpal head suggestive of CPPD arthropathy. |
Generate impression based on findings. | Male 63 years old; Reason: NSCLC/AC; on ceritinib, follow-up ABDOMEN:LUNGS BASES: Please refer to concomitant CT chest exam from same day for additional findings.LIVER, BILIARY TRACT: Hepatic dome and inferior right hepatic lobe hypoattenuating lesions, too small to characterize but stable.SPLEEN: Splenule present. Multiple scattered punctate splenic calcifications, likely related to prior granulomatous disease. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys stable in appearance. Right-sided renocortical scarring. Stable heterogeneous relatively hypoattenuated appearance of medial portions of both kidneys, may reflect postradiation sequela and correlation with patient's clinical history recommended.RETROPERITONEUM, LYMPH NODES: IVC filter present. Unchanged small gastrohepatic lymph nodes. BOWEL, MESENTERY: Collapsed stomach but diffuse moderate circumferential wall thickening suggested, centered in gastric body, correlation with patient's clinical history recommended to exclude underlying gastritis.PELVIS:PROSTATE/SEMINAL VESICLES: Prominent heterogeneous prostate, measuring 5.2 cm in transverse dimension. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Again visualized osseous metastatic disease, similar to earlier exam, including associated L1 vertebral body compression deformity. Lesions in T10 and T12 vertebral bodies also seen. Additional sites of abnormal sclerosis also seen, e.g., in pelvis such as in bilateral ilia, left superior pubic ramus and right femur. Multilevel degenerative disease. Ventral abdominal subcutaneous nodularity and emphysema, likely sequela from prior injection sites. | 1. Osseous metastatic disease, without significant interval change.2. Collapsed stomach but diffuse moderate circumferential wall thickening suggested, correlation with patient's clinical history recommended to exclude underlying gastritis.3. Please refer to concomitant CT chest study from same day for additional findings. |
Generate impression based on findings. | Images are limited by patient motion. Postoperative changes are again seen from previous right frontal parietal temporal craniotomy, with underlying right frontal, parietal, and temporal lobe encephalomalacia, with areas of confluent T2/FLAIR hyperintensity within the white matter. There is again ex vacuo dilatation of the right lateral ventricle which does not appear significantly changed. There is slight bowing of the midline to the right secondary to the volume loss which is stable. There is also a confluent area of T2/FLAIR hyperintensity in the left frontal lobe periventricular white matter is perhaps minimally increased in extent compared to more remote exams, nonspecific. Areas of irregular intrinsic T1 hyperintensity and prominent susceptibility again noted along the right basal ganglia, likely relating to dystrophic mineralization. Other foci of susceptibility are also noted along the presumed previous surgical tract, likely related to chronic hemosiderin deposition. There is mild dural thickening and enhancement of the right anterior cranium, likely postoperative.Since the more remote exams, there has been interval development of a dural based homogeneously enhancing extra-axial mass along the posterior medial margin of the right sphenoid wing along the right middle cranial fossa. The mass is T1 isointense and mildly T2 hypointense with respect to gray matter. The dominant lobule the mass measures 1.1 x 1.3 cm in greatest axial dimensions 23/17, by 1.2 cm in greatest CC dimension and 22/11. There is an additional smaller medial tubular component of the mass located inferior to the optic canal, just inferior to the right internal glenoid process. This measures approximately 0.6-cm transverse by 1.2-cm AP. There is abutment of the anterior cavernous right internal carotid artery with minimal cavernous sinus involvement suggested. There is no extension posteriorly to involve Meckel's cave. However, the mass does appear to abut the lateral margin of the foramen rotundum with questioned slight asymmetric prominence of the right maxillary nerve. Comparing to the more recent outside exam, the mass appears grossly similar allowing for differences in technique.The ventricles and sulci are stable. The cisterns remain patent. There is no mass effect. There are no areas of pathological intra-axial enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a near completely empty sella. The remainder of the midline structures and craniocervical junction are within normal limits. There is right sided Wallerian degeneration.No abnormal orbital mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable. | 1. Motion limited exam with limited comparison to outside exam. Within these limitations, no significant interval change in appearance of an extra-axial homogeneously enhancing bilobed appearing mass centered on the medial right lesser sphenoid wing with extension inferior to the right anterior clinoid process. Abutment of cavernous right internal carotid artery laterally with partial involvement of cavernous sinus likely, as well as abutment of the right foramen rotundum and questioned slight asymmetric prominence of the right maxillary nerve. Given broad-based dural attachment, this is felt most likely to represent a meningioma, which may be post radiation induced if clinical history is appropriate, provided patient's previous history of right frontal malignancy. No evidence of optic nerve canal compromise.2. Stable postoperative is from previous right right sided craniotomy with areas of right cerebral encephalomalacia. 3. Compared to more remote exams, slight progression of nonspecific somewhat confluent T2/FLAIR hyperintensity in the left frontal periventricular white matter. |
Generate impression based on findings. | Male 49 years old; Reason: pre-op eval for Mako Stryker robotic system left uni-arthroplasty knee History: pain. LEFT HIP: Axial scan was performed through the left hip. Mild osteoarthritis affects the left hip.LEFT KNEE: Severe tricompartmental osteoarthritis affects the left knee, particularly at the medial tibiofemoral compartment with near bone on bone apposition. A small joint effusion is present with a loose body in the suprapatellar pouch. An additional smaller loose body is present in the lateral synovial recess. A focus of ossification medial to the medial femoral condyle reflects prior injury to the MCL. There is medial extrusion of the body of the medial meniscus. A bony excrescence projecting from the posterior aspect of the distal femoral diaphysis, seen on prior radiographs, is incompletely imaged. Arterial calcifications are noted.LEFT ANKLE: Axial scan was performed through the left ankle. A small ossicle posterior to the medial malleolus may reflect old trauma. | Osteoarthritis. |
Generate impression based on findings. | Tachypnea and concern for pneumatosis. Two day old former 39 week gestational age patient.VIEWS: Chest and abdomen AP (two views) 03/03/15 Feeding tube tip is in gastric body. Umbilical venous catheter tip is at junction of right atrium and SVC. Cardiothymic silhouette is upper limits of normal in size. No focal lung opacity is present. Bowel gas pattern is disorganized. Few mildly dilated loops are seen. No pneumatosis intestinalis, portal venous gas, or free peritoneal air is seen. | No focal lung opacity. No evidence of NEC. |
Generate impression based on findings. | 58 years, Female, Reason: metastatic breast cancer with bidimensional measurements per recist 1.1 History: liver mets. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: Right chest port tip terminates in SVC.CHEST WALL: Fluid collection in the lateral subcutaneous tissues of the thorax is unchanged measuring 4.2 x 1.9 cm (3/35), previously 4.3 x 2.0 cm. There are peripheral calcifications and clips and this most likely represents postoperative seroma. Right chest wall port. ABDOMEN:LIVER, BILIARY TRACT: Liver metastases have overall progressed. A reference left hepatic lesion is unchanged measuring 4.9 x 4.9 cm (3/91), previously 5.2 x 5.0 cm upon remeasurement. While some lesions are also unchanged in size, many additional hepatic lesions are increased in size. For example, a left hepatic lesion measures 1.5 x 1.7 cm (3/72), previously 1.1 x 1.1 cm.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: FemaleUTERUS, ADNEXA: Uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Minor degenerative changes of the visualized spine. Deformity and healing fracture of the left iliac wing is unchanged. Please see bone scan performed on the same day as it is more sensitive for the early detection of osseous metastasis.OTHER: No significant abnormality noted. | Mild Progression of size of some hepatic metastases. Others unchanged. |
Generate impression based on findings. | 52 year old female status post left mastectomy in 2008 for IDC, with implant reconstruction and placement of right sided implant, presents today for routine follow up. Patient received chemotherapy, or radiation, and tamoxifen therapy. Family history of breast carcinoma in her maternal grandmother at age 38 and maternal aunt at age 40. Family history ovarian carcinoma in her maternal cousin. No current breast complaints. Two standard and 3 implant displaced views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A retropectoral silicone implant is present. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion 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: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 12 y/o F restaging osteosarcoma s/p chemotherapy VIEWS: Left femur AP, lateral (2 views) 3/3/15 11:01 Lucent expansile lesion of the distal femoral diaphysis extends approximately 15 cm in length with poorly defined proximal and distal margins. Note is made of associated cortical thinning and medial soft tissue mass as well as extensive associated periosteal reaction. | Findings consistent with left femoral diaphyseal osteosarcoma. |
Generate impression based on findings. | Female 69 years old Reason: liver ultrasound, s/p tips, evaluate for clot LIVER: The liver measures 16.6 cm in length. The liver has a nodular contour. The parenchyma is diffusely heterogeneous and echogenic. No worrisome mass is identified. Status post TIPS. There is no ascites. BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 0.9 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 11.6 cm. The cortex is increased in echogenicity. Within the superior pole of the kidney is a 3.9 x 3.8 x 2.8 cm simple appearing renal cyst. No worrisome mass, shadowing calculi or hydronephrosis is present. The left kidney measures 10.9 cm. The cortex is increased in echogenicity. No worrisome mass, shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 14.3 cm. in length. | 1.Cirrhotic liver. No worrisome mass is identified.2.Patent TIPS without evidence of clot. Persistent hepatopetal flow in the undivided left portal vein. No ascites.3.3.9 cm simple appearing right renal cyst, stable compared to the recent MRI. |
Generate impression based on findings. | Chest pain radiating to back, shortness of breath, hypotension. Question of pulmonary embolism and dissection. PULMONARY ARTERIES: Technically adequate study without evidence of an acute pulmonary embolus. The main pulmonary artery is enlarged which can be seen in the setting of pulmonary arterial hypertension.LUNGS AND PLEURA: No focal lung opacity to suggest infection or pulmonary hemorrhage/infarct. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No significant pericardial effusion or evidence of right heart strain. A coronary stent along with mild coronary calcifications are noted. There is no mediastinal or hilar lymphadenopathy.Evaluation for aortic pathology is suboptimal on this examination due to early phase of contrast for optimal opacification of the pulmonary arteries. However, there is no gross evidence of aortic dissection and the thoracic aorta is of normal caliber. CHEST WALL: There are multilevel degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of an acute pulmonary embolus or other specific finding to account for the patient's symptoms. 2. Suboptimal evaluation for aortic pathology without gross evidence of thoracic aortic dissection.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 78 year old female status post right mastectomy in 2007 for DCIS, presents today for routine follow up. Patient received hormonal therapy. No current breast complaints. No given family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 12 y/o F w/ L femur osteosarcoma, eval for metastases LUNGS AND PLEURA: No suspicious pulmonary nodules. No focal consolidation, pleural effusion, or pneumothorax. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal with no pericardial effusion. Left central venous catheter tip extends to the cavoatrial junction.CHEST WALL: No focal osseous lesion is identified. Left chest wall port.UPPER ABDOMEN: No significant abnormality is identified in the upper abdomen. Note is made of renal contrast excretion from recent MRI. | Normal exam without evidence of metastatic disease. |
Generate impression based on findings. | Reason: mets lung cancer, ALK+, on Ceritinib now. pls c/w previous study and evaluate tx response. History: lung ca LUNGS AND PLEURA: Moderate bilateral pleural effusions, mildly increased from the prior exam.The left upper lobe calcified perihilar mass (series 6, image 41) is unchanged, without measurable residual soft tissue tumor.Left apical scarring along the fissure appear similar to the prior exam.Basilar atelectasis/scarring.A cluster of small nodules in lateral left upper lobe measuring up to 6 mm (series 5, image 114), slightly more prominent compared to the prior exam.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. No visible coronary artery calcification. Enlarged right hilar lymph node measures 19 mm (series 4, image 47) not significantly changed from the prior exam. No mediastinal lymphadenopathy.CHEST WALL: Reference right axillary lymph node measures 7 x 6 mm (series 4, image 41), unchanged.Sclerotic lesions in the ribs and right clavicle and multilevel sclerotic vertebral body metastases, with compression deformity of L1, not significantly changed from the prior exam.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable splenic infarct and punctate splenic granulomas. IVC filter. | 1. Clustered small nodules in lateral left upper lobe are slightly more prominent compared to the prior exam. Nonspecific and may be postinfectious in etiology, but continued close interval followup is recommended.2. Mildly increased pleural effusions.3. Additional findings, including osseous metastases, are stable from the prior exam. |
Generate impression based on findings. | Metastatic melanoma.RADIOPHARMACEUTICAL: 13.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 97 mg/dL. Today's CT portion grossly demonstrates right lower lobe linear atelectasis, unchanged. Coronary arterial calcifications are present. Postsurgical changes from a cholecystectomy and a left nephrectomy are again seen.Today's PET examination again demonstrates a small moderately hypermetabolic distal esophageal focus which is nonspecific and has an SUV max of 4.2 compared to 5.1 previously. Normal sized right paratracheal lymph node has minimally increased activity which is also nonspecific. Curvilinear increased activity within the right shoulder represents likely degenerative arthritis.Otherwise no suspicious FDG avid lesion is identified elsewhere on whole body PET. | 1.No suspicious FDG avid lesion.2.Stable to decreased nonspecific activity in the distal esophagus. |
Generate impression based on findings. | Status post fall. Unable to bear weight. Three views of the right ankle reveal lateral soft tissue swelling. There is also a joint effusion. No osseous abnormalities. No fractures or dislocations. | Soft tissue swelling laterally but no evidence of any fractures or dislocations |
Generate impression based on findings. | 58-year-old male with prostate cancer status post prostatectomy with rising PSA. Assess for metastatic disease. ABDOMEN:LUNG BASES: No Significant abnormality seen.LIVER, BILIARY TRACT: Punctate segment 7 hypodensity most likely benign cyst. No other parenchymal abnormalities are seen. Gallbladder and biliary tract appear normal. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter cortical hypodensities bilaterally too small to characterize but most likely benign cysts. No other abnormalities.RETROPERITONEUM, LYMPH NODES: No adenopathy seen -- no other significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy without other abnormality in the prostate bed seen.BLADDER: No significant abnormality notedLYMPH NODES: No adenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No skeletal lesions seen to suggest metastatic disease -- nuclear medicine bone scan is a more sensitive indicator of activity of potential skeletal metastatic disease.OTHER: No significant abnormality noted | 1. Status post prostatectomy. 2. No evidence for metastatic disease seen. |
Generate impression based on findings. | Female 68 years old; Reason: pancreatic ca s/p July Whipple procedure History: re-staging CHEST:LUNGS AND PLEURA: Small left base atelectasis, mild interval improvement in small left pleural effusion with trace residual fluid seen. Mild emphysema.MEDIASTINUM AND HILA: Mild to moderate calcified coronary artery disease.CHEST WALL: Right chest port with tip in distal SVC.ABDOMEN:LIVER, BILIARY TRACT: Stable pneumobilia, particularly in left hepatic lobe. Hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: Status post Whipple surgery with interval increase in amount of air in pancreatic duct.ADRENAL GLANDS: Stable diffusely and asymmetrically enlarged left adrenal gland.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Moderate to severe calcified aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Transverse colon containing ventral abdominal hernia, hernia sac measures 5.3 cm in transverse dimension, defect measures approximately 4.1 cm. Moderate to large stool seen throughout colon.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Ventral umbilical/periincisional hernia as above. Visualized osseous structures stable in appearance with multilevel degenerative disease of spine, most pronounced at L5/S1 level. Stable heterogeneity of upper thoracic vertebral bodies, particularly T2 and T3 vertebral bodies, may be degenerative in etiology but nonspecific. | 1. Stable pneumobilia. Status post Whipple surgery with interval increase in amount of air in pancreatic duct.2. Moderate to large stool seen throughout colon, correlate clinically for constipation. Ventral abdominal hernia as above.3. No definite evidence of recurrent or metastatic disease. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is minimal patchy periventricular and subcortical white matter hypoattenuation which is nonspecific, likely representing trace age indeterminate microvascular ischemic changes. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage or mass-effect. CT is insensitive for detection of early nonhemorrhagic stroke. |
Generate impression based on findings. | Male 65 years old; Reason: 65M with AMS post-extubation, DHT in place but now with secretions that smell like TF per RN, ?DHT positioning History: 65M with AMS post-extubation, DHT in place but now with secretions that smell like TF per RN, ?DHT positioning Paucity of bowel gas.Enteric tube projects in the left upper abdomen in the region of the gastric body. Catheter projects adjacent to the right heart border. | 1.Enteric tube projects in the region of the gastric body. |
Generate impression based on findings. | 15 year old male with recurrent pain, no swelling, normal exam. VIEWS: Left knee AP, Oblique, Lateral (3 views) 3/3/2015 11:47 Alignment is normal. No joint effusion or soft tissue swelling. No fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Retractions. Respiratory rate in the 90s.VIEW: Chest AP (one view) 03/03/15, 11:30 Lung volumes are large. Mild peribronchial thickening is noted. Subsegmental atelectasis is present bilaterally.Cardiothymic silhouette is normal. The aortic arch, cardiac apex, and stomach are left-sided.The stomach is distended with gas. | Bronchiolitis/reactive airways disease pattern. |
Generate impression based on findings. | Prior L2-S1 fusion and pain pump. Lumbar puncture to evaluate for infection. The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained. The patient was placed in the prone position and the inferior back was prepped with Betadine, draped and anesthetized with 1% lidocaine subcutaneously and into the deeper soft tissues. After anesthetization with 1% lidocaine and using fluoroscopic guidance, a 22 gauge x 3.5 inch spinal needle was localized into the thecal sac at the L5-6 level, below the level of the catheter from the pain pump. There was immediate return of clear cerebral spinal fluid, approximately 12 mL of which was collected into three sterile tubes and provided to the clinical service. The stylette was replaced, the needle removed, and hemostasis achieved with manual compression. The patient tolerated the procedure well with no immediate complications. Fluoro time: 0.6 min. | Successful fluoroscopic guide lumbar puncture without immediate complications. |
Generate impression based on findings. | Multiple abdominal surgeries with colectomy and ileostomy. Bilious emesis.VIEWS: Abdomen AP/left lateral decubitus (two views) 03/03/15 A right lower quadrant stoma is present. Cholecystectomy clips are identified. Multiple fine staple lines are seen.Many dilated small bowel loops are present containing air-fluid levels. No free peritoneal air is present. | Obstructed bowel gas pattern. |
Generate impression based on findings. | Reason: eval chiari History: slurred speech, BLE weakness 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. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | History of base of tongue cancer with lung nodules. Status post chemotherapy. Again seen are post-treatment findings in the neck, including asymmetric volume loss of the right tongue base, without evidence of tumor in this location. There are bilateral tonsilloliths. There is no evidence of significant cervical lymphadenopathy based on size criteria, including a partially calcified subcentimeter right level 2 lymph nodes, which were previously enlarged and necrotic. The thyroid and major salivary glands are unremarkable. There is a left subclavian venous catheter. The major cervical vessels are patent. There is cervical degenerative spondylosis, most pronounced at C5-6 and C6-7. The airways are patent. The imaged intracranial structures are unremarkable. Please refer to separate report for findings in the chest. | Post-treatment findings in the neck without evidence of local tumor recurrence or significant cervical lymphadenopathy. Please refer to separate report for findings in the chest. |
Generate impression based on findings. | Prominence of spine. Scoliosis.VIEWS: Spine standing PA/lateral (two views) 03/03/15 No fusion or segmentation abnormalities are seen. Right curve between L1 and L4 measures 12 degrees. The right iliac crest may be slightly lower than the left. The lateral view is normal.A moderate amount of feces is present in the rectosigmoid. | Right lumbar curve of 12 degrees. |
Generate impression based on findings. | 41-year-old female with history of colectomy with ostomy, presenting with right upper quadrant, epigastric pain. No history of gallbladder disease. Please evaluate for etiology. Better today but on morphine p.r.n. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Normal appearing gallbladder without excessive distention. No gallbladder wall thickening. No internal debris there gallstone seen. No pericolic cystic fluid. No intrahepatic or extra hepatic biliary duct dilatation. No tenderness to palpation with the ultrasound probe, however patient is on morphine.PANCREAS: Pancreas is well visualized without abnormality seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted. | Normal right upper quadrant ultrasound examination. |
Generate impression based on findings. | Reason: stroke History: left sided weakness There is redemonstration of small hypodense foci in the left cerebellar hemisphere associated with the volume loss. There is redemonstration of encephalomalacia along the left occipital pole.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.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.No evidence for acute intracranial hemorrhage mass effect or edema.2.Foci of encephalomalacia are present in the left cerebellar hemisphere and the left occipital lobe. Could very well be vascular related.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Fracture.VIEWS: Left femur AP/lateral (two views) 03/03/15 A cast obscures bone detail. Oblique fracture of the proximal mid femoral diaphysis is again seen. Overlap and medial displacement of the distal fracture fragment is unchanged. Callus formation surrounds the fracture. | Healing femoral fracture. |
Generate impression based on findings. | Ankle and foot pain. Evaluate for fibular fracture. Status post fall.VIEWS: Left ankle AP, lateral and oblique 3/3/15 (3 views) Soft tissue swelling and small ankle joint effusion with no evidence of fracture or malalignment. | Soft tissue swelling and small joint effusion, as described. |
Generate impression based on findings. | 59 year-old male with prostate cancer with pain and bone metastases. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Scattered sclerotic lesions are seen in the ribs and vertebral bodies unchanged from 12/30/14.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered small subcentimeter periaortic and aorta caval lymph nodes are again seen and unchanged. These do not meet size criteria for lymphadenopathy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic foci seen throughout the skeletal system indicative of metastatic disease are seen with similar distribution and appearance.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic enlargement with prominent low density seminal vesicles.BLADDER: No significant abnormality notedLYMPH NODES: The left pelvic sidewall lymph node mass has slightly increased in size and measures 5.5 x 2.3 cm (series 3, image 176) comparison by 2.1-cm previously. No enlarged pelvic lymph nodes are seen bilaterally in the external iliac chain (series 3 come image 175, right external iliac node measures 1.1 x 2 .1 cm, previously 1.0 x 0.6 cm). More proximal lymph nodes in the left common iliac chain have increased as well. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered sclerotic foci seen throughout the skeletal system indicative of metastatic disease are seen with similar distribution and appearance. Left inguinal hernia containing only mesenteric fat unchanged. Soft tissue nodular changes in the subcutaneous fat about the right and maximus are again seen at several levels unchanged. These presumably related to injection sites.OTHER: No significant abnormality noted | 1. Increasing pelvic lymphadenopathy has delineated and measured above. Numeral and multiple scattered sclerotic foci of skeletal metastases -- these appear stable and CT examination but medicine bone scintigraphy is a more accurate estimate of activity of skeletal metastatic disease. 3. Stable appearing nodular soft tissue changes in the subcutaneous fat about the buttocks that is most likely these relate to prior injection sites. |
Generate impression based on findings. | Female, 58 years old, history of metastatic breast cancer with progression of disease on CT scan. Assess for brain metastases. No definite evidence of any parenchymal mass, mass effect, edema or pathologic enhancement is seen to suggest the presence of intracranial metastatic disease. Mild periventricular hypoattenuation is a nonspecific finding. No intracranial hemorrhage or any abnormal extra-axial fluid collection is present. The ventricles are normal in size morphology.The osseous structures of the skull are intact. The visualized paranasal sinuses and mastoid air cells are clear. | 1. No evidence of intracranial metastatic disease, but please note that even with contrast, CT is insensitive for small lesions. If clinically warranted, MRI may be considered for a more definitive assessment.2. Nonspecific periventricular hypoattenuation may reflect age indeterminate small vessel ischemic disease or a treatment related effect. |
Generate impression based on findings. | There is minimal mucosal thickening involving the left frontal sinus, improved since 4/1/2013. Frontal sinuses are otherwise clear. There is minimal mucosal thickening lining the bilateral ethmoid cavities. There is minimal mucosal thickening involving the right maxillary sinus. There is moderate mucosal thickening involving the left maxillary sinus similar to prior. Bilateral ostiomeatal units are patent. Extensive postsurgical changes include bilateral uncinectomies, bilateral ethmoidectomies, and left middle and superior turbinectomy. Minimal mucosal thickening involving the sphenoid sinus is improved since prior. There are subtle frothy secretions within the left sphenoid sinus which are new since prior. The nasal cavity is patent. The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Previously seen mucosal thickening involving the left frontal and right sphenoid sinuses is improved. There are mild frothy secretions within the left sphenoid sinus which are new since 4/1/2013. Otherwise, there is no significant change to suggest acute sinusitis. Again seen is evidence of chronic sinusitis with mild to moderate mucoperiosteal thickening involving the left maxillary sinus, similar to prior. Extensive postsurgical changes are again seen. |
Generate impression based on findings. | Pain in knees.EXAMINATION: Right knee AP/lateral (two views), left knee AP/lateral (two views) 03/03/15 There may be a right joint effusion. The bones are normal in appearance. No fracture or destruction is seen. | Possible right joint effusion. No bone abnormality. |
Generate impression based on findings. | 70 year-old male -- rule-out portal vein thrombosis. LIMITED ABDOMENLIVER: Heterogeneous appearance to liver parenchyma seen consistent with fatty infiltration and/or underlying cirrhosis. No focal mass lesions are identified. See vascular section below.BILIARY TRACT: Gallbladder not visualized. No intrahepatic or extrahepatic biliary duct dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted.OTHER: Ascites. Right pleural effusion. | 1. Main and right portal veins intraluminal occlusive thrombus with surrounding collateral flow and increased arterial flow. In retrospect this was identified on CT examination of 2/23/15. 2. Tardus parvus waveform in the hepatic and splenic artery distributions suggestive of celiac artery stenosis. |
Generate impression based on findings. | Male 76 years old; Reason: Evaluate for SBO History: pancreatic ca, h/o SBO, abdominal pain, vomiting, no BM, no flatus ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hypoattenuating subcentimeter liver parenchymal foci, too small to characterize. Scattered hepatic calcified granulomata. Occluded SMV near level of confluence.SPLEEN: Status post distal pancreatectomy and splenectomy with associated postsurgical clips. Indeterminant 0.9 by 0.7 cm apparently enhancing soft tissue focus in left upper quadrant, may be a lymph node or splenule.PANCREAS: Status post distal pancreatectomy and splenectomy with associated postsurgical clips. Hypoattenuating structure seen in expected region of pancreatic body, located left lateral to surgical clips, measures 4.1 x 1.6 x 2.4 cm in craniocaudal dimension, may be a postoperative collection/seroma or phlegmon. No internal gaseous foci seen. Alternatively, structure could correspond to tubular structure/fluid collection previously seen but considered less likely given interval period of time. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left renal collecting system prominence, nonspecific. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Ulcerative plaque seen diffusely, placing patient at increased risk for embolic disease. Again seen is focal bulging of infrarenal abdominal aorta, measuring 2.4 cm. Aneurysmal right common iliac artery, measuring 2 cm, ectatic left common iliac artery measuring 1.8 cm. Moderate to marked narrowing of right external iliac artery. Right femoral graft present. Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Mildly thickened gastric folds. Stomach particularly distal body and antrum not well distended. Descending colon not well distended but rectosigmoid and descending colonic wall thickening suggested with mild mucosal enhancement, particularly distally. Contrast did not extend into colon, likely due in part timing of contrast study. Small amount of contrast seen in stomach. Small bowel measures up to 2.2 cm. No abnormal small bowel dilatation seen to suggest small bowel obstruction. Diffuse mesenteric edema. No secondary signs of acute appendicitis. PELVIS:PROSTATE/SEMINAL VESICLES: Prominent prostate, measuring 5.1 cm. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative spinal disease. Incompletely imaged scrotal heterogeneity, nonspecific and correlation with patient's clinical history and physical exam recommended to exclude cellulitis or underlying infectious process. | 1. Status post distal pancreatectomy and splenectomy with associated postsurgical clips. Hypoattenuating structure seen in expected region of pancreatic body, located left lateral to surgical clips, measures 4.1 x 1.6 x 2.4 cm, may be a postoperative collection/seroma or phlegmon, abscess a consideration, no internal gaseous foci seen, underlying neoplasm not excluded but correlation with patient's surgical and clinical history recommended.2. Descending colon not well distended but rectosigmoid and descending colonic wall thickening suggested with mild mucosal enhancement, particularly distally, suspicious for colitis.3. Indeterminant 0.9 by 0.7 cm apparently enhancing soft tissue focus in left upper quadrant, may be a lymph node or splenule.4. Incompletely imaged scrotal heterogeneity, nonspecific and correlation with patient's clinical history and physical exam recommended to exclude cellulitis or underlying infectious process. 5. Atherosclerotic disease as above. |
Generate impression based on findings. | Left tonsillectomy and chemoradiation for tonsillar squamous cell carcinoma, HPV+. Lung nodules. Neck: There are post-treatment findings in the neck including left tonsillectomy, left lymph node dissection, and the effects of radiation therapy. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The left internal jugular vein has been sacrificed. The other major cervical vessels are patent. There is minimal degenerative cervical spondylosis. The airways are patent. There is a partially visualized enlarged AP window/left prevascular mediastinal lymph node. Again seen are nodules within the left lung and right pleural effusion. Please refer to separate report for findings in the chest.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 mild mucosal thickening within the maxillary sinuses. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. Post-treatment findings in the neck without measurable mass lesions or significant cervical lymphadenopathy based on size criteria. 2. Partially-imaged pulmonary nodules, right pleural effusion, and mildly enlarged upper mediastinal lymph nodes. Please refer to the separate chest CT report for additional details.3. No evidence of intracranial metastases. |
Generate impression based on findings. | Male, 69 years old, with history of T4aN2b squamous cell carcinoma of the left alveolar ridge status post composite resection, rim mandibulectomy, bilateral selective neck dissection, and supraclavicular island flap and cervical rotation flap reconstruction in October, 2013, followed by chemoradiation completed February, 2014. The course was complicated by abscess formation to the surgical site and bone exposure at the left mandibular ramus, and osteoradionecrosis. Redemonstrated are findings related to prior surgery including resection of the left mandibular alveolar ridge, resection of the left buccal soft tissues with flap reconstruction, and bilateral neck dissection.Ill-defined soft tissue along the left mandibulectomy bed is not significantly changed. No evidence to suggest locally aggressive tumor is seen. A small superficial fluid collection seen on the prior examination at the margin of the buccal space flap has completely or nearly completely resolved. No new fluid collections or areas of skin ulceration are seen.The left mandibular body remains discontinuous with respect to the ramus. The portions of the mandible adjacent to the resection margins are mildly sclerotic and irregular, but the appearance is not significantly changed from prior. No new osseous erosions are detected.No pathologic adenopathy is detected in the neck by size criteria. The left submandibular gland has been resected and the left parotid gland is smaller than the right, all stable findings. No concerning lesions are seen within the thyroid. The cervical vessels enhance normally.No concerning or destructive osseous lesions are seen within the cervical region. Redemonstrated is significant ossification of the posterior longitudinal ligament which contributes to at least moderate spinal canal stenosis from C4 through T1. | 1. Complete or near complete resolution of a small superficial fluid collection within the left facial soft tissues at the level of the mandibulectomy. 2. The residual portions of the left mandible remain slight sclerotic and irregular along the surgical margins, but without significant interval change.3. No evidence to suggest locally recurrent disease or pathologic adenopathy is seen. |
Generate impression based on findings. | Metastatic lung carcinoma ABDOMEN:LUNG BASES: Please see separate chest report.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable reference left adrenal nodule best seen on image 52 of series 7 measuring 2.3 x 1.2 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T8 compression fracture unchangedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Diffuse bladder wall thickening unchanged.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination. |
Generate impression based on findings. | 58 years old Male. Reason: evaluate for metastatic disease. History: head and neck recurrence. This study was performed for restaging.RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 122 mg/dL. Today's CT portion of the neck and pelvis demonstrates soft tissue fullness in the right tongue base, right pharyngeal/laryngeal wall. The prostate is enlarged. Please see diagnostic CT reports for details of the chest and abdomen.Today's PET examination demonstrates intense FDG uptake in the soft tissue prominence of the right tongue base and right pharyngeal/laryngeal wall with SUVmax of 11.4. This finding is consistent with the recurrence of disease.Multiple scattered areas of increased activity with SUVmax of 2.5 are seen in the right lung, corresponding to the patchy and nodular densities seen on CT. There is also mild FDG uptake in the right hilum without definite CT correlation.Mild FDG uptake is seen in the enlarged prostate gland.The FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1. Increased metabolic activity in the right tongue base and right pharyngeal/laryngeal wall, consistent with local recurrence of the head/neck cancer.2. No definite evidence of FDG avid nodal or distant metastasis.3. Patchy and nodular opacities in right lung and the right hilum, which are most likely due to infection/aspiration. However metastatic disease cannot be entirely excluded.4. Prostate enlargement with mild FDG uptake, which is most likely benign. Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | The paranasal sinuses are clear. There are no air-fluid levels or significant mucosal thickening. The mastoid air cells are clear. There is a chronic right lamina papyracea fracture with herniation of extraconal intraorbital fat, however, the extraocular muscles are intact without herniation. The nasal septum is minimally deviated to the left. The ostiomeatal complexes are patent. The sphenoethmoidal recesses are patent. The carotid canals are covered by bone. The cribriform plate and lateral lamellae demonstrate areas of thinning but grossly intact. The globes, extraocular muscles, intraconal fat are otherwise unremarkable without stranding or mass. | 1.Paranasal sinuses are clear.2.Chronic right medial orbital blowout fracture with medial herniation of orbital fat.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 62 years old; Reason: Rule out obstruction History: Constipation, abdominal distension Multiple air fluid levels are noted in the small bowel on the upright view. There is scattered gas within the colon.A percutaneous gastrostomy catheter projects over the left upper abdomen and kidneys in the region of the gastric body. | 1.Multiple air fluid levels on the upright view suggestive of a mechanical small bowel obstruction. |
Generate impression based on findings. | History of CHF on IABP and DAH. Evaluate for change. LUNGS AND PLEURA: There has been significant interval improvement in areas of bilateral patchy ground glass opacity and consolidation. Interval resolution of small bilateral pleural effusions. There is mild centrilobular emphysema.MEDIASTINUM AND HILA: The heart size is stable without pericardial effusion. There are severe coronary artery calcifications. Multiple prominent mediastinal and hilar lymph nodes are again noted. A Swan-Ganz catheter terminates in the right main pulmonary artery.CHEST WALL: A right subclavian IABP device is in place with the proximal marker at the level of T7 just below the aortic arch. A left chest IACD is in place. A left internal jugular central venous catheter terminates in the SVC. There are multilevel degenerative changes of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Significant interval improvement in bilateral ground glass opacities and consolidation and resolution of pleural effusions compatible with resolving diffuse alveolar hemorrhage. |
Generate impression based on findings. | Male 19 months old Reason: Any evidence of trauma, fracture History: Limping on left leg per historyVIEWS: Left tibia-fibula AP and lateral 3/3/15 (two views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Clinical question: Hydrocephalus. Signs and symptoms:SAH Unenhanced head CT:Examination redemonstrates enlarged supratentorial ventricular system without convincing evidence of any interval change in size. Multiple measurements at the level of temporal horns, frontal horns and the anterior third ventricle are nearly identical studies. Tiny acute blood products in the dependent portion of right occipital horn also remains stable since prior study. Paucity of cortical sulci remain similar to prior exam. Basal cistern remains widely patent similar to prior exam. There is revisualization of a stable appearing left supraclinoid internal carotid stent. Foci of cortical low attenuation in the left anterior frontal lobe similar to prior exam. Patchy additional foci of cortical low attenuation along the interhemispheric aspect of bilateral inferior frontal lobes similar to prior exam. Findings are suggestive of ischemic processes. | 1.No evidence of an acute or new finding since prior exam.2.Stable enlarged supratentorial ventricular system and minute right occipital horn hemorrhage.3.Region of cortical low-attenuation/ ischemic changes in the left anterior frontal lobe and along the interhemispheric aspect of bilateral inferior frontal lobes similar to prior exam. |
Generate impression based on findings. | Papillary renal cell carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Contour deformity involving left kidney consistent with partial nephrectomy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination without acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Shortness of breath, hypoxia. Question of PE. PULMONARY ARTERIES: No evidence of an acute pulmonary embolus. The main pulmonary artery is not enlarged.LUNGS AND PLEURA: There is dependent atelectasis. No specific evidence of infection. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: There is no significant mediastinal or hilar lymphadenopathy. There is no pericardial effusion. There are mild coronary artery calcifications. The heart is enlarged. CHEST WALL: There is a posterior right eighth rib fracture.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of an acute pulmonary embolus or other specific finding to account for the patient's symptoms.2. Right eighth rib fracture.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 57 years old; Reason: look for cancer source History: brain biopsy showing adenocarcinoma CHEST:LUNGS AND PLEURA: New left upper lobe lung lesion, measuring 1.9 x 1.6 cm image 21 series 4. Remainder of exam similar to earlier study with patchy bilateral mid to lower lung predominant ground glass opacity and subpleural reticulation visualized. Bilateral lower lobe traction bronchiectasis present. No pleural effusion.MEDIASTINUM AND HILA: Mild prevascular and paratracheal adenopathy. Reference 10 x 9 mm pretracheal lymph node, image 19 series 4, previously measured 16 x 9 mm. Incompletely imaged heterogeneous thyroid gland with a dominant nodule measuring up to 1.2 cm in the left lobe seen. Distended esophagus containing contrast, may reflect gastroesophageal reflux.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic hypoattenuating lesions seen with dominant focus visualized in hepatic segment 2/4A with associated Hounsfield units compatible with simple fluid and likely a hepatic cyst, additional hypoattenuating hepatic lesions too small to characterize.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal nodularity, measuring 1.1 x 1 cm, image 81 series 4, incompletely imaged on earlier study but may be unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small upper abdominal and retroperitoneal lymph nodes.BOWEL, MESENTERY: Descending/sigmoid colon diverticulosis without evidence of acute diverticulitis.PELVIS:UTERUS, ADNEXA: Atrophic uterus suggested, but correlation with patient's surgical history recommended as well. BLADDER: Foley catheter seen with air in collapsed bladder.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. New left upper lobe pulmonary lesion, suspicious for primary lung malignancy.2. Mild mediastinal adenopathy, stable to mildly improved from prior study, nonspecific. 3. Indeterminate left adrenal nodularity.4. Partially imaged heterogeneous thyroid gland.5. Distended esophagus containing contrast, may reflect gastroesophageal reflux. |
Generate impression based on findings. | Nausea and gastro-paralysis. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 76.4 % of peak activity (normal >70 %)1 hour: 47.9 % of peak activity (normal 30-90 %) 2 hours: 18.8 % of peak activity (normal <60 %) 4 hours: 3.9 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | Patient with cystic fibrosis, admitted with fevers and increased sputum production. Assess for cavitary lesions and abnormality seen on chest radiograph. LUNGS AND PLEURA: There is redemonstration of extensive upper lobe predominant bronchial wall thickening, bronchiectasis, and mucus plugging compatible stated history of cystic fibrosis. There is interval increase in peribronchial consolidation most predominantly within the bilateral lower lobes. A new area of consolidation within the left upper lobe has numerous internal foci of air which possibly represents cavitation vs ectatic bronchi (image 56, series 4). There is are scattered areas of tree in bud opacities. There is no pleural effusion or pneumothorax.MEDIASTINUM AND HILA: There is redemonstration of mediastinal and hilar lymphadenopathy. A paraaortic lymph node measures 21 mm in short axis (image 33, series 3). There is no pericardial effusion. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. There are numerous punctate pancreatic calcifications compatible with chronic pancreatitis. A cystic lesion in the body of the pancreas is unchanged in size. The spleen is mildly enlarged. | New areas of consolidation and possible cavitation suggestive of infection superimposed on background lung changes of cystic fibrosis. |
Generate impression based on findings. | Urothelial carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrectomy site clear.RETROPERITONEUM, LYMPH NODES: Prominent retroperitoneal lymph nodes stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Unremarkable neobladderLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination without acute, inflammatory, or metastatic process. |
Generate impression based on findings. | 59 year old female status post right mastectomy in 2011 for IDC and DCIS, presents today for routine follow up. Patient received Arimidex. History of left breast reduction mammoplasty. No current breast complaints. Family history breast carcinoma in her mother at age 60, sister at age 45, and maternal grandmother at age 63. Three standard and two spot magnification views of the left breast 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 new cluster of calcifications is present within the lower central left breast, which appear circumferential and coarse on spot magnification views, suggestive of oil cyst formation. These calcifications appear very similar morphologically to the biopsy proven benign calcifications seen on prior mammogram in 2014. An X-shaped biopsy clip is present within the far posterior, lower slightly inner left breast. No dominant mass or areas of architectural distortion in the left breast. Benign appearing lymph nodes are projected over the left axilla. | High probability benign calcifications in the lower central left breast. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Metastatic breast cancer. No abnormal osseous foci are identified to indicate metastatic disease. Degenerative changes are noted in the bilateral shoulders, sacroiliac joints and knees. | Degenerative changes without evidence of bone metastases. |
Generate impression based on findings. | Multiple myeloma.RADIOPHARMACEUTICAL: 15 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 86 mg/dL. Today's CT portion grossly demonstrates multifocal stable lytic osseous lesions, most notably in the right ischium. Healing rib fractures are seen in the left third anteriorly and right 10th postero-laterally. Compression fractures are noted at T4 and T9. Linear atelectasis is seen in the left lung base.Today's PET examination demonstrates interval reduction in the FDG avid activity within the lymph nodes within the neck bilaterally. For reference a right level 2 lymph node has an SUV max of 3.4 compared to 7.3 last time. A right inguinal lymph node activity also has decreased which now has an SUVmax of 2.0 compared to 2.5 last time. The thoracic spine lesions have increased in FDG avid activity. The T4 lesion has an SUV max 5.3 compared to 4.6 last time. The T9 lesion has an SUV max of 5.2 compared to 3.3 last time. The right lower rib reference lesion has mildly increased compared to previously which now has an SUV max of 3.9. A new left anterior rib lesion is identified and is suspicious for tumor. The right facial lesion within either the subcutaneous tissues or the maxillary bone has an SUV max of 7.0 compared to 5.2 previously. This lesion does not have a CT correlate and is nonspecific but could represent tumor. | 1.Mixed response with progression of activity within the osseous lesions and improvement within the lymph nodes.2.Increased activity within the nonspecific focus of activity in the right facial region which could represent tumor. |
Generate impression based on findings. | Female 70 years old Reason: please evaluate disease prior to starting clinical trial. Please provide bidimensional measurements per RECIST v1.1 History: Renal cell carcinoma CHEST:LUNGS AND PLEURA: Pulmonary and pleural based neoplastic disease. Multiple bilateral lung nodules suspicious for metastatic disease which have significantly progressed since prior exam from 2013. Reference right upper lobe lung nodule measures 1.0 x 0.9 cm (series 5, image 41). Reference left upper lobe lung nodule measures 1.2 x 1.3 cm (series 5, image 48). Large left pleural effusion with left lower lobe collapse. MEDIASTINUM AND HILA: Mediastinal and cardiophrenic lymphadenopathy. Reference left cardiophrenic lymph node measures 1.5 x 2.0 cm (series 3, image 73). There is nodularity along the left pericardium which may be contiguous with the collapsed left lower lobe (series 3, image 61). Normal heart size with moderate pericardial effusion.CHEST WALL: Mass within the left scapula with cortical destruction measuring 3.4 x 5.4 cm (series 3, image 39) which was not within the field of view on prior exam. Left humeral prosthesis likely from previous pathologic fracture.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. Common bile duct is mildly prominent measuring up to 8 mm in diameter but tapers distally. No radiopaque stone is visualized. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval decrease in size of the left lower pole renal mass measuring 1.1 x 1.3 cm (series 3, image 105) previously 2.0 x 2.3 cm. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Intrathecal pain pump device in the right ventral abdominal wall with associated beam hardening artifact. The catheter is seen traversing the posterior body wall and appears to enter the thecal sac at the L2/L3 level. There is subcutaneous emphysema and possibly small fluid deep to the L2 spinous process. Please correlate with patient's procedural history.PELVIS: FemaleUTERUS, ADNEXA: The uterus is not definitively seen which may be secondary to prior hysterectomy.BLADDER: No significant abnormality notedBOWEL, MESENTERY: Moderate to large stool burden. Nonspecific mild wall thickening of the transverse colon.BONES, SOFT TISSUES: Extensive osseous lytic vertebral body and sacral lesions, similar in extent but increased in size since study from 2013. There are compression deformities of the T12, L3, and L5 vertebral bodies, which are not significantly changed. Surgical hardware in the left femoral head likely secondary to prior pathologic fracture.OTHER: Small pelvic ascites. | 1.Marked interval increase in diffuse lung, pleural, and mediastinal involvement as above.2.Large left pleural effusion with complete collapse of the left lower lobe.3.Extensive osseous lytic vertebral body and sacral involvement which is similar in extent but increased in size since study from 2013. |
Generate impression based on findings. | Prostate cancer. A focal region of increased activity is noted in the frontal region of the skull which is nonspecific and could represent a focal irregularity of the bone or an adjacent soft tissue abnormality. There is also abnormal increased activity within the body of one of the mid cervical spinal vertebrae. This is nonspecific and could represent degenerative changes or a metastatic lesion. No definite abnormal osseous foci are identified elsewhere to indicate metastatic disease. | Abnormal activity within the frontal region of the skull and mid cervical vertebral body which are nonspecific but can be further evaluated with a head and neck CT. |
Generate impression based on findings. | Ankle fracture.VIEWS: Left ankle AP/lateral/oblique (3 views) 03/03/15 A cast obscures bone detail. Alignment is anatomic. There appears to be periosteal reaction around the fibula. The fracture line of the fibula is well seen. The fracture line of the tibia is not well seen. | Healing fractures of distal tibia and fibula. |
Generate impression based on findings. | History of left breast cancer with increased thickening near the surgical scar Three standard views of the left breast and left laterally exaggerated CC view 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. The degree of post-surgical density and distortion is similar to the prior study. Surgical clips are again noted. Innumerable benign calcifications are present, including calcifying oil cysts. Skin thickening compatible with radiation therapy is seen. | No mammographically concerning finding, though the patient left our department before a targeted ultrasound could be performed for her area of increasing thickening. She should return to have a targeted ultrasound. A message was left on the patient's home phone notifying her of this recommendation by Carla Razor, mammography technologist. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Postoperative changes from previous left transfrontal biopsy are again seen, with minimal chronic hemosiderin deposition along the surgical tract. There is further decreased intrinsic T1 hyperintensity with minimal, if any, residual superimposed lace-like enhancement involving the left frontal corona radiata, globus pallidus, and ventral thalamus. There is associated T2/FLAILR hyperintensity, the extent of which appears slightly progressed cranially, likely posttreatment related. There is again volume loss of the left cerebral peduncle.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There are few stable scattered foci of T2/FLAIR hyperintensity within the subcortical and periventricular white matter which are nonspecific but may represent mild chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a persistent mildly T1 hyperintense and enhancing left parietal calvarial lesion which remains unchanged, possibly an atypical hemangioma. | 1. Expected evolution of post treatment changes with very minimal wispy enhancement remaining along the left frontal corona radiata extending to the midbrain.2. Slight increased cranial extent of associated T2 hyperintensity in the area of the previous enhancing mass likely representing posttreatment changes and gliosis. |
Generate impression based on findings. | No structural lesions are appreciated within the brain parenchyma. Sulcation and myelination appear within normal limits. Posterior fossa and midline structures including the corpus callosum appear within normal limits. No evidence of infarct, intracranial mass, or mass effect. No hydrocephalus. No extra-axial collections. Sella and orbits are grossly unremarkable. Flow voids are present within the major vessels indicating patency. High resolution 3D T2 sequence demonstrates essentially symmetric bilateral seventh and eighth cranial nerves. There is moderate opacification of the left middle ear cavity and mastoid air cells. | 1. No intracranial structural abnormalities are appreciated.2. Moderate opacification of the left mastoid air cells and middle ear cavity, which is new since prior CT of the temporal bones from 12/2/2014. |
Generate impression based on findings. | Pain, tenderness and shortness of breath. Follow-up of NSCLC. The comparison chest CT performed on 3/2/2015 demonstrates no focal areas of consolidation or pleural fluid. Matched ventilation perfusion defects in much of the right lung and smaller matched ventilation perfusion defects in the left lung.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 94% (upper lung 22.7%; Middle lung 46.9%; lower lung 24.4%)Right lung: 6% (upper lung 2.4%; Middle lung 2.7%; lower lung 0.8%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 91.3% (upper lung 24.3%; Middle lung 43.2%; lower lung 23.7%)Right lung: 8.7% (upper lung 2.6%; Middle lung 4.5%; lower lung 1.6%) | 1.Matched ventilation perfusion defects in much of the right lung and smaller matched ventilation perfusion defects in the left lung. 2.The vast majority of ventilation and perfusion in left lung with minimal contribution from the right lung. |
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