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Generate impression based on findings. | LP shunt revision.VIEWS: Abdomen AP/lateral (two views) two Intraspinal catheter tip is at T8/T9 level. The catheter exits the spinal canal at the L3 level. The programmable valve is set at 120 mm of water. The distal tubing is intact and has its tip in the left lower quadrant. Bowel gas pattern is disorganized. | Valve set at 120 mm of water. |
Generate impression based on findings. | Female 30 years old Reason: eval for additional fractures History: fall on R hand and wrist, known colles fx. Overlying casting material obscures fine bone detail. There is interval casting of the right hand and wrist. The previously seen distal radial fracture is again seen on this examination appears to be in near-anatomic alignment. There is no new fracture or dislocation. | Distal radial fracture in near-anatomic alignment, unchanged from the prior exam without evidence of a new fracture or dislocation. |
Generate impression based on findings. | Female 42 years old; Reason: scoliosis? History: LBP Frontal and lateral views of the spine were obtained using scoliosis technique. There is approximately 12 degrees of cervicothoracic levoscoliosis as measured from the superior endplate of C6 to the inferior endplate of T6. There is approximately 15 degrees of thoracolumbar dextroscoliosis as measured from the superior endplate of T6 to the inferior endplate of L2. There is approximately 1 cm of positive coronal balance. The sagittal balance is normal.Mild degenerative disk disease affects the C5/C6 level. Moderate degenerative disk disease affects the L5/S1 level. Mild to moderate facet joint osteoarthritis affects the lower lumbar spine. | Degenerative disk disease and scoliosis, as described above. |
Generate impression based on findings. | Male 33 years old; Reason: septic emboli? 33M with NK lymphoma, HLH, neutropenic s/p chemo with strep mitis bacteremia History: neutropenic fever, oral ulcer with pain, strep mitis bacteremia. LUNGS AND PLEURA: There is a new focal dense atelectasis/consolidation in the superior right lower lobe. No pleural effusion or pneumothorax is seen. MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. There is no significant mediastinal or hilar lymphadenopathy. There are no visible coronary artery calcifications. CHEST WALL: A right chest port catheter terminates at the superior atriocaval junction. There is no axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Multiple subcentimeter hypoattenuating liver lesions are too small to characterize but unchanged. There is periportal edema which can be seen with aggressive IV hydration. There is a new wedge-shaped hypoattenuating area within the spleen which is most consistent with a new splenic infarct. There is moderate splenomegaly. There is a prominent gastrohepatic lymph node. | 1. New right lower lobe atelectasis/consolidation which is likely related to aspiration. 2. New splenic infarct. |
Generate impression based on findings. | Reason: Hx base of tongue CA with lung lesions. Status post chemo, compare to previous scan and measurements pls. History: none CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules, presumed to be metastatic, are no longer seen on this exam, now with small, extremely thin-walled air filled cysts at these locations. For reference, a right lower lobe cyst (series 5, image 229) has no measurable solid wall.A small triangular nodule along the left fissure (series 4, image 56) is compatible with a lymph node.The previously described right upper lobe groundglass nodule is resolved, likely inflammatory in etiology, possibly secondary to aspiration.No new suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.The ascending aorta is ectatic, measuring approximately 4.0cm, unchanged.No mediastinal or hilar lymphadenopathy.CHEST WALL: Left chest port, tip in the SVC.Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable simple renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube in place. Barium within the bowel from recent prior exam.BONES, SOFT TISSUES: Mild degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | Interval resolution of multiple presumed metastatic pulmonary nodules, with residual thin walled cysts without any measurable solid component, compatible with response to treatment. No other acute changes or new sites of disease. |
Generate impression based on findings. | 2-year-old female, evaluate for hip subluxationVIEW: Pelvis AP and frog leg (two view) 3/3/2015 12:44 Bilateral coxa valga is again noted. The femoral heads are well directed into the acetabula. There is lateral uncovering of the femoral heads, 20% on the left and 10% on the right.Small to moderate colonic fecal burden. | Bilateral coxa valga and lateral uncovering of the femoral heads, left greater than right. |
Generate impression based on findings. | Fracture.VIEWS: Right elbow AP/lateral (two views) 03/03/15 The cast has been removed. Two K wires continue in place in the distal humerus. Alignment is anatomic. Periosteal reaction encircles the distal humerus. | Healing distal humeral fracture. |
Generate impression based on findings. | Male; 65 years old. Reason: esoph/GEJ carcinoma on FOLFOX chemo with liver mets check response to chemo, NEED TRIPLE PHASE for liver mets. CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified pulmonary micronodules, not significantly changed. No suspicious nodules or masses. No pleural effusions or focal areas of consolidation. Mild to moderate centrilobular emphysema is unchanged.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Moderate coronary artery calcifications. New mediastinal lymphadenopathy is noted. Enlarged prevascular lymph node measures 1.6 x 1.1 cm (series 12, image 23). Enlarged pretracheal lymph node measures 1.6 x 1.4 cm (series 12, image 31). Both of these nodes demonstrate internal low density suggestive of necrosis.Distal esophageal mass with extension to the gastric cardia and adjacent postsurgical changes are stable. However, the previously seen gastrohepatic lymph node has enlarged and now measures 1.6 x 1.5 cm (series 12, image 100). CHEST WALL: Right chest port tip at cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions are again seen in the liver, overall stable in appearance. Some of these lesions are compatible with cysts and unchanged. Reference segment 8 lesion measures 3 mm, unchanged (series 12, image 95). Small hypodense lesion in segment 6 is indeterminate but not significantly changed (series 12, image 121). No new suspicious lesions or biliary ductal dilatation. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged mild soft tissue stranding in the right perinephric space. No suspicious renal lesions or hydronephrosis. RETROPERITONEUM, LYMPH NODES: Please see above discussion.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.New mediastinal and gastrohepatic lymphadenopathy with measurements above, compatible with progression of metastatic disease. 2.No significant interval change in scattered hypodense liver lesions as described above, including segment 8 metastasis. Please note that for follow up imaging studies, single portal venous phase CT will be adequate to assess these lesions. |
Generate impression based on findings. | Reason: 59 Y.O. F with HPT History: HPT There are several nodules present in the soft tissues of the lower neck . Their locations and serial Hounsfield units on dynamic CT or listed below along with some density units of normal structures:Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):7x2.5mm nodule between trachea and left common carotid artery C7 vertebral body level (image # 273-274 (coronal image 38 ):: 57.3HU, 185HU, 109 HU, 77.5HULeft Carotid artery (image # 276 ):: 51.4HU, 285HU, 174HU, 107HULeft Jugular vein (image # 276 ):: 49.6HU, 262HU, 148HU, 144HURight submandibular gland (image # 126 ): 30.1HU, 66.4HU, 102HU, 96.2HURight sternocleidomastoid muscle: (image # 126): 56.5HU, 66.0HU, 75.7HU, 77.2HULymph node (image # 136 ): 51.0HU, 73.4HU, 94.8HU, 99.4HUCT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland has been removed.The airway appears patent.The visualized intracranial structures which include the interior most aspect of the posterior fossa are intact. The visualized portions of the maxillary sinuses are intact with some mucosal thickening. The visualized portions of the mastoid air cells are clear. The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There degenerative changes present with uncovertebral osteophytes at the C5-6 where there is a narrowing of the left neural foramen.The esophagus at the level of the thyroid bed takes a sharp leftward turn.Parathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):Inferior vena cava: 99FEMORAL VEIN: 109SUPERIOR VENA CAVA: 256INNOMINATE VEIN JUNCTION: 316LEFT INNOMINATE VEIN: 220LEFT INTERNAL JUGULAR VEIN, LOWER: 376LEFT INTERNAL JUGULAR VEIN,MID: 184LEFT INTERNAL JUGULAR VEIN, UPPER: 172RIGHT INTERNAL JUGULAR VEIN, LOWER: 133RIGHT INTERNAL JUGULAR VEIN, MID: 113RIGHT INTERNAL JUGULAR VEIN, UPPER: 107 | 1.There is a 7x2.5mm nodule between trachea and left common carotid artery at the C7 vertebral level which is suspicious for a parathyroid adenoma.2.Parathyroid venous sampling suggests location of parathyroid adenoma in the left lower neck. |
Generate impression based on findings. | Female 96 years old; Reason: evaluate for fx, infection. History: L hand and wrist swelling LEFT WRIST: There is soft tissue swelling about the wrist, particularly over the distal radius. Moderate osteoarthritis affects the basilar joint. Chondrocalcinosis is present in the left wrist, and there is calcification adjacent to the basilar joint which may reside within a tendon. We see no fracture, dislocation, or findings to suggest infection.LEFT HAND: Again seen are the aforementioned findings in the wrist. Mild osteoarthritis affects the interphalangeal joints. We see no fracture, dislocation, or findings to suggest infection. | Soft tissue swelling and degenerative arthritic changes, as described above, including chondrocalcinosis of the wrist and periarticular calcification along the basilar joint. The possibility of pseudogout is considered. |
Generate impression based on findings. | Female 30 years old Reason: lower ext pain History: r/o cystic mass. A well-defined homogenous appearing mass with perhaps slight rim enhancement is seen along the medial aspect of the left lower extremity extending from the level of the patellar joints to the mid tibial diaphysis. It is situated between the subcutaneous fat in the medial muscles of the lower extremity without definite extension into either of the planes. This mass measures 4.8 x 2.6 cm (series 80375, image 119) and appears to be lower in attenuation than the surrounding musculature, which is suggestive of fluid rather than solid component. There are no internal calcifications and because of its low attenuation, tumor is less likely.The visualized bones are within normal limits. | Mass within the medial soft tissues of the lower leg is most likely fluid filled. Possibilities include a hematoma, abscess, or posttraumatic fluid collection such as a Morel Lavallee lesion. Tumor is thought to be less likely given the low attenuation and lack of internal calcifications or septations, but cannot be entirely excluded. |
Generate impression based on findings. | BRAIN: There are greater than 10 supratentorial T2/FLAIR hyperintense foci including the pericallosal and periventricular white matter with the largest left lateral periventricular focus measuring 19 x 15 mm (series 801, image 19). An additional larger focus adjacent to the left lateral ventricle measures 9 mm (series 804, image 17). There is one infratentorial lesion involving the right cerebellum. There are 3 focal regions of contrast enhancement corresponding to the two aforementioned lesions (series 2801, images 17, 19, 20); the aforementioned two lesions also demonstrate restricted diffusion. Findings suggestive of a demyelinating process with active disease. No significant brain parenchymal volume loss. There is no mass effect or midline shift. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position.The pituitary gland is normal in size. Major vessels are patent. The paranasal sinuses and mastoid air cells are clear. CERVICAL SPINE: The cervical cord is normal in signal without lesions to suggest demyelinating disease. No abnormal enhancement. The cervicomedullary junction is normal. Vertebral body heights are normal. Alignment is grossly maintained. The marrow signal is benign. There is minimal disc bulge at C4-5. No significant spinal canal or neural foraminal stenosis at any level. The visualized paraspinal contents are unremarkable. | 1. Greater than 10 T2/FLAIR hyperintense lesions in the supratentorial and one in the infratentorial white matter consistent with known demyelinating disease. There are two lesions with enhancement as detailed above consistent with active demyelination. 2. No lesions within the cervical cord or abnormal enhancement. |
Generate impression based on findings. | Left hip pain Severe osteoarthritis affects the left hip. Additional ossific densities overlying the left hip could represent loose bodies or heterotopic ossification. Scattered arterial calcifications are noted. | Severe osteoarthritis. |
Generate impression based on findings. | Reason: head and neck cancer recurrence, evaluate right upper lung nodule History: head and neck reucrrence eval for mets CHEST:LUNGS AND PLEURA: Patchy nodular air space and groundglass opacity in the right upper and right lower lobe consistent with aspiration.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.Severe coronary artery calcification.Moderately large hiatal hernia.CHEST WALL: Hemangioma in the T10 vertebra.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left renal cysts.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. | Air space and groundglass opacities in the right lung consistent with aspiration.No evidence of metastases. |
Generate impression based on findings. | Male 56 years old; Reason: metastatic head and neck cancer, compare to previous with measurements. CHEST:LUNGS AND PLEURA: There is no significant change in a moderate right pleural effusion. A loculated left subpulmonic effusion is unchanged. Apical scarring is compatible with post radiation change. A left upper lobe pulmonary nodule has increased in size measuring approximately 16 x 11 mm (image 33, series 5), previously 10 mm. An adjacent none reference nodule is also increased in size. Additional scattered pulmonary nodules are similar in size including a right middle lobe nodule. A pleural-based nodule in the anterior left hemithorax has increased in size 11 mm in thickness (image 52, series 4), previously 10 mm. MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. There is mediastinal and hilar lymphadenopathy. A reference lymph node in the AP window/prevascular region is unchanged in size measuring 14 mm (image 41, series 4). However, there is interval increase in a precarinal lymph node measuring approximately 14 mm in the short axis (image 45, series 4), previously 9 mm. No visible coronary artery calcifications. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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. | Interval increase in size of left upper lobe pulmonary nodules and a left pleural based nodule with new mediastinal lymphadenopathy, consistent with progression of disease. |
Generate impression based on findings. | Low back pain Three views lumbar spine demonstrate slight rightward curvature of the lumbar spine. There is bilateral spondylolysis at L4 with a grade 1 anterolisthesis of L4 on L5. Mild to moderate degenerative disk disease affects the L4/L5 level. Mild facet joint osteoarthritis affects the lower lumbar spine.Surgical clips are noted in the abdomen. | L4 spondylolysis and spondylolisthesis, and degenerative changes as described above. |
Generate impression based on findings. | Pain. Preoperative. Severe osteoarthritis affects the left knee. There is approximately 11 degrees of varus angulation with respect to the neutral mechanical axis of the left lower extremity. | Osteoarthritis and varus deformity. |
Generate impression based on findings. | Reason: nodules in past History: COPD LUNGS AND PLEURA: Moderately severe diffuse centrilobular emphysema.Scattered micronodules and focal scarring, unchanged.Diffuse bronchial thickening consistent with bronchitis.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.Mild coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Bronchitis and emphysema. No suspicious nodules.. |
Generate impression based on findings. | 74 year old female status post left lumpectomy in 1997 for breast cancer, presents today for routine follow up. Patient received radiation and hormonal 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 in the scar overlying the upper slightly outer left breast with mild subcutaneous distortion, underlying postsurgical changes, and dystrophic calcifications. These findings are unchanged when compared to prior examination. Stable asymmetry is present within the upper right breast on the MLO view. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 40 years old; Reason: spondylosis? History: LBP after lifting The vertebral body heights are within normal limits. Small osteophytes project off the anterior aspects of the L1 and L2 vertebral bodies. Mild degenerative disk disease affects the L1/L2 level, appearing similar to prior. The remaining intervertebral disk spaces are within normal limits. We see no fracture. | Mild degenerative disease at L1/L2, appearing similar to prior. |
Generate impression based on findings. | Male 20 years old with left hand BB pellet x 2 months. Shot self with gun. Right hand injured 5th metacarpal 2 months ago. Punched a brick. Tenderness. 3 views of the left hand: A metallic foreign body is seen in the soft tissues between the second and third metatarsal heads. There is no acute fracture or dislocation. There is no soft tissue swelling.3 views of the right hand: There is no fracture or dislocation. Specifically, the 5th metacarpal bone and metacarpophalangeal joint appear normal. | Metallic foreign body in soft tissues of the left hand likely reflects BB bullet per patient's history. No acute fracture or dislocation in the bilateral hands. |
Generate impression based on findings. | Female 47 years old; Reason: fusion status. History: s/p ACDF Evaluation of the C7/T1 level is limited due to overlying anatomy.Again seen is an anterior fixation device with screws entering the C7 and T1 vertebrae, with intervertebral disk spacer at C7/T1. There may perhaps be some bony bridging at this level, however this is equivocal.Again seen is an anterior plate and screw device with screws entering the C6 and C7 vertebral bodies, with an intervertebral disk spacer at C6/C7. The bony bridging at this level appears similar to the prior study.Small osteophytes project from the anterior aspects of the C4 and C5 vertebral bodies. | Postoperative changes of ACDF appearing similar to those seen on the prior study. |
Generate impression based on findings. | Reason: suspected dermatomyositis, evaluate for ILD History: suspected dermatomyositis, evaluate for ILD LUNGS AND PLEURA: Small scar at the left costophrenic angle.No sign of diffuse interstitial lung disease.No pleural effusions.No significant airtrapping on the expiration scan.MEDIASTINUM AND HILA: No significant lymphadenopathy.No pericardial effusion.No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No sign of interstitial lung disease or other significant pulmonary abnormalities. |
Generate impression based on findings. | Male 57 years old; Reason: obstruction History: abdominal distention, pain A stent projects over the right upper abdomen.There is mild gaseous distention of the stomach. There are a few air-filled dilated small bowel loops measuring up to 3 cm. Supine view is inadequate to evaluate for free air or air-fluid levels.Degenerative changes affect the lumbar spine and hips. | 1.Dilated small bowel loops suggestive of an obstruction |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is a possible group of faint calcifications in linear distribution seen in the right breast at approximately 9'o clock position. No additional suspicious masses, microcalcifications or areas of architectural distortion are present. | Possible faint calcifications in the right outer breast for which spot magnification views and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EA - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female 38 years old back pain with radiation to the hips. Known moderate DID of L-Spine. There is no acute fracture or dislocation. The lumbar vertebral body heights and intervertebral disk spaces are preserved. The alignment is anatomic. A tiny anterior vertebral body osteophyte is seen at L3. Otherwise, there are no specific findings to account for patient's symptoms. | Unremarkable lumbar spine with no specific radiographic findings to account for the patient's symptoms. |
Generate impression based on findings. | Male 72 years old; Reason: Pain between the 2nd and 3rd metatarsals on the left. Evaluate for Morton's neuroma. The bones are demineralized, suggesting osteopenia.We see no soft tissue mass, however we cannot exclude the possibility of a Morton's neuroma on conventional radiographs.Minimal osteoarthritis affects the forefoot, within normal limits for the patient's age.A small metallic density projects over the soft tissues of the fifth toe, which may represent a foreign body or artifact. | 1. No specific radiographic features of a Morton's neuroma. If further imaging evaluation is clinically warranted, ultrasound or MRI may be considered. 2. Other findings as described above. |
Generate impression based on findings. | Male 55 years old Reason: fall onto knee s/p arthroscopy History: pain. 4 views of the right knee show slight joint space narrowing of the medial compartment. There is a small effusion and small osteophyte formation at the patellofemoral compartment. There is no acute fracture or dislocation. | Mild osteoarthritis without evidence of acute fracture or dislocation. |
Generate impression based on findings. | BRAIN: There is stable diffuse parenchymal volume loss, which appears advanced for age. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no midline shift or herniation. The imaged mastoid air cells are clear. MAXILLOFACIAL: There are chronic fracture deformities involving the bilateral zygomatic arches, right lamina papyracea, bilateral nasal bones, and nasal septum with mild displacement. The maxilla, mandible, sphenoid boned, hard palates, pterygoid plates, and TMJs are intact. The cribriform plate, fovea ethmoidalis and left lamina papyraceae appear normal. Rightward nasal septal deviation. Mild opacification of the ethmoid sinuses. SPINE: No significant interval change in the reversal of the normal cervical lordosis. There are no acute fractures or subluxations. Again noted are anterior osteophytes C4 through C7 levels. There are disk osteophyte complexes at C4/C5 through C6/C7, worst at C5/C6 where there is moderate central spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis at C5-6 and moderate bilateral at C6-7. | 1.No acute intracranial abnormality.2.Chronic maxillofacial fractures without evidence of acute fracture of the maxillofacial structures or the cervical spine.3.Multilevel cervical spondylosis. |
Generate impression based on findings. | Instability. Rheumatoid arthritis. CERVICAL SPINE: Minimal anterolisthesis (less than or equal to 1 mm) of C3 on C4 on flexion views, with minimal retrolisthesis of these levels on extension views is of doubtful clinical significance. We see no gross instability. The vertebral body heights and disk spaces are normal. The C1/C2 articulation appears normal.LUMBAR SPINE: An interspinous fixation device is present at L4 and L5. Superiorly, the space between the plates is narrower and the plates may be situated posterior to the L4 spinous process. Bone graft material is present anterior to this device between the L4 and L5 spinous processes.Moderate degenerative disk disease affects the L4/L5 and L5/S1 levels. There is grade 1 anterolisthesis of L4 on L5. Moderate facet joint osteoarthritis affects the lower lumbar spine. The vertebral body heights are preserved. | Postoperative and degenerative changes of the lumbar spine as described above. |
Generate impression based on findings. | 13 year old female with right knee injury. Evaluate for medial meniscus tear, possible patellofemoral dislocation. MENISCI: The menisci are intact with no evidence of tear.ARTICULAR CARTILAGE AND BONE: The articular cartilage is normal. Along the anterior lateral surface of the patella, a 0.5 cm area of increased signal intensity is noted on PD and T2.LIGAMENTS: Linear areas of inflammation are present in the subcutaneous tissues superficial to the medial retinaculum. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Medial patella contusion. |
Generate impression based on findings. | 81 years, Male. Reason: Determine if barium still in abdomen History: as above Persistent barium in the gastric fundus, colon and rectum is unchanged from prior examinations. Dilated loops of small bowel may represent ileus versus small bowel obstruction. Drain, surgical clips, and skin staples project over the right hemiabdomen. | Persistent barium in the gastric fundus, colon and rectum is unchanged from prior examinations. Dilated loops of small bowel may represent ileus versus small bowel obstruction. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Maternal aunt with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Focal asymmetry with calcifications in the right breast at 9'o clock position. No additional suspicious microcalcifications or areas of architectural distortion are present in either breast. | Focal asymmetry with calcifications in the right breast. Comparison should be made to prior study, otherwise spot compression views with possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Left hand and thumb pain.VIEWS: Left hand AP, lateral and oblique 3/3/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 10 years old Reason: injury VIEWS: Right ankle AP, lateral and oblique 3/3/15 (3 views) There is no evidence of acute or healing fracture, malalignment, joint effusion or soft tissue swelling. Distal tibial physis lucency with metaphyseal sclerotic margin is normal variant (Kump hump). | Normal examination. |
Generate impression based on findings. | Female, 59 years old, with history of metastatic thyroid cancer. Neck:Since the prior examination, a right carotid endarterectomy has been performed with significant improvement in the luminal caliber. There is, however, a large hypoattenuating fluid collection tracking along the right carotid space from the level of the brachiocephalic-carotid junction up to the level of the parotid gland. This collection extends for 9.8 cm in the craniocaudal dimension and measures up to 3.7 cm in thickness.Again seen are findings consistent with thyroidectomy. A reference lesion in the left thyroid bed measures up to 7 mm (image 56 series 7), previously 7 mm. A right paratracheal nodule measures up to 5 mm (image 63 series 7), previously 6 mm. No new lesions are detected in the thyroid bed.A left level 4 lymph node measures 10 x 8 mm (image 59 series 7), previously 10 x 8 mm. No evidence of any new or progressing adenopathy is detected in the neck.Asymmetric positioning of the aryepiglottic folds and of the size of the piriform sinuses is seen, nonspecific findings which may reflect vocal cord dysfunction. Asymmetric fatty replacement of the left parotid gland is unchanged. Salivary glands are otherwise unremarkable. Mild to moderate noncalcified atherosclerotic plaque affects the origin and the distal aspect of the left common carotid artery. No concerning osseous lesions are detected.Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. | 1. Stable reference lesions with no findings to suggest thyroid cancer progression.2. Findings compatible with right carotid endarterectomy with significant improvement in vascular luminal caliber. However, there is a sizable postoperative fluid collection tracking along the right carotid space which may represent a seroma or chronic hematoma. Discussed with K. Salminen at 4:30 PM on 3/3/15.3. No evidence of intracranial metastases. |
Generate impression based on findings. | Male 27 years old Reason: bilateral knee pain History: bilateral knee pain. 4 views of the right knee show no joint effusion, fracture, or dislocation. The knee appears unremarkable. 4 views of the left knee show no joint effusion, fracture, or dislocation. The knee appears unremarkable. | Normal appearing knees without evidence of fracture or dislocation. |
Generate impression based on findings. | Female 64 years old Reason: left knee pain History: left knee pain. Mild degenerative arthritic changes affect the left knee, including small osteophyte formations along the undersurface of the patella. There is a small joint effusion. | Mild osteoarthritis. |
Generate impression based on findings. | Status post LVAD. Chronic VAD drive line infection. Evaluate for fluid collection. Worsening drive line drainage. CHEST:LUNGS AND PLEURA: No focal airspace opacity, pleural effusion, or pneumothorax. Mild paraseptal emphysema. Minimal bibasilar atelectasis/scarring.MEDIASTINUM AND HILA: There is a intrathoracic LVAD with cannulas within the left ventricle and the ascending aorta. There is no pericardial effusion, mediastinal fluid collection, or discrete fluid collection around the intrathoracic LVAD given limitations due to streak artifact within this region. There is an aortic valve prosthesis and cardiomegaly. There are moderate coronary artery calcifications. There is filling defect within the right cannula consistent with thrombus which appears to reduce the lumen size by slightly more than 50%; this partially imaged on a 2011 CT study and appears increased since then.CHEST WALL: There is increased soft tissue density and inflammatory change within the subcutaneous tissues around the VAD drive line from the right rectus muscle to the skin surface. Right chest wall AICD. Status post median sternotomy. There is a prominent right axillary lymph node.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.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increased soft tissue density and inflammatory change around the VAD driveline within the subcutaneous soft tissues is compatible with infection. No specific evidence of a mediastinal or intraperitoneal fluid collection.2. Thrombus within the efferent cannula of the LVAD which decreases the lumen size by slightly more than 50%; this has increased since a 2011 CT study. |
Generate impression based on findings. | Female 62 years old Reason: BL knee pain History: BL knee pain. 4 views of the right knee show calcifications along the superoanterior aspect of the patella suggestive of calcific tendinopathy of the quadriceps tendon. There is severe osteoarthritis with joint space narrowing and bone on bone apposition of the medial, lateral, and patellofemoral compartments; as well as tricompartmental osteophytes. A large well corticated ossicle in the posterior aspect of the knee likely represents a large loose body.4 views of the left knee show calcifications along the superoanterior aspect of the patella suggestive of calcific tendinopathy of the quadriceps tendon. There is severe osteoarthritis with joint space narrowing and near bone on bone apposition of the medial, lateral, and patellofemoral compartments; as well as tricompartmental osteophytes. | Severe osteoarthritis of the knees, right greater than left. |
Generate impression based on findings. | Male 72 years old Reason: R hand thumb/4th/5th digit pain and limited ROM History: R hand thumb/4th/5th digit pain and limited ROM. The right hand appears normal without fracture or dislocation. There are no radiographic findings to account for the patient's pain. | Normal appearing hand without radiographic findings to account for the patient's pain. |
Generate impression based on findings. | Frontal sinuses: Frontal sinuses are underpneumatized but clear. Anterior ethmoid sinuses: Mild mucosal thickening of the anterior ethmoid sinuses. Maxillary sinuses: Mild opacification of bilateral maxillary sinuses. The ostiomeatal units are patent bilaterally.Posterior ethmoid sinuses: Minimal mucosal thickening of the posterior ethmoid sinuses. Sphenoid sinuses: Sphenoid sinuses are clear.The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The anterior nasal septum is mildly deviated to the right. Bilateral orbits and the posterior nasopharynx appear unremarkable. No sclerosis of the sinus walls to suggest chronic sinusitis. | Mild sinus disease as above without specific findings to suggest chronic sinusitis. |
Generate impression based on findings. | Please note that dedicated orbit images were not requested. No definite optic nerve enhancement or abnormal signal is appreciated on dedicated axial brain images. Coronal T2 whole brain images suggest mild expansion of the proximal post-chiasmatic left optic nerve, with questioned T2 hyperintensity on 201/17.There is irregularity of the margins of the right lateral ventricle, with subtle increased somewhat nodular FLAIR hyperintensity along the lateral ventricular margins, most evident along the anterior body of the left lateral ventricle. Postcontrast imaging demonstrates discontinuous irregular as well as minimally nodular enhancement along the lateral ventricular margins. 3-D T1 post contrast images are severely degraded by patient motion. There is also a single small area of ill-defined T2/FLAIR hyperintensity in the left dorsal pons, seen on 6/20. There is decreased extent of minimal focal FLAIR hyperintensity in right posterior frontal deep white matter on 6/11 compared to the outside images. There is no ventricular enlargement. The basal cisterns remain patent. There is no midline shift or mass effect. 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. Incidental note is made of a stable rounded focal T1 hypointense defect along the internal aspect of the dorsal clivus which may representing normal developmental variant.SPINE | 1. Extensive cervical and thoracic cord signal abnormality, with patchy enhancement becoming more confluent from C7-T1 down to T6-T7 as well as mild diffuse cord expansion with effacement of CSF space within the thecal sac most conspicuous along the upper to midthoracic spine. The findings are progressed since previous outside MRI, and compatible with known diagnosis of NMO, although transverse myelitis could also have this appearance.2. New periventricular irregular FLAIR abnormality with corresponding irregular and minimally nodular enhancement which may also relate to minimal acute intracranial findings of NMO. New nonspecific nonenhancing left pontine lesion.3. Dedicated orbital images not requested, with questioned abnormality only in the immediate post chiasmatic left optic nerve, as detailed above.4. Heterogeneously enhancing 1.8 cm left thyroid lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated. |
Generate impression based on findings. | Total hip arthroplasty One view of the pelvis and one view of the hip obtained in the recovery room and time-stamped 1156 at 1153, respectively, demonstrate hardware components of a left total hip arthroplasty device situated in near-anatomic alignment. We see no radiographic evidence of hardware complication. Surgical drain and foci of soft tissue gas reflect recent surgery.Mild osteoarthritis affects the right hip and moderate degenerative arthritic changes affect the lower lumbar spine as seen on the frontal view. | Left total hip arthroplasty, as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal cousin with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Right knee pain Four views of the right knee demonstrate tricompartmental osteophytes indicating mild osteoarthritis. A moderate-sized joint effusion is present. Mild osteoarthritis affects the left knee as seen on the frontal views. | Osteoarthritis and joint effusion. |
Generate impression based on findings. | 62-year-old female with multiple abdominal surgeries for ventral hernia with question of enterocutaneous fistula and partial small bowel obstruction. The scout film shows surgical sutures in the left hemiabdomen with gas distended small bowel loops. Cholecystectomy clips in the right upper quadrant.Manual injection of water-soluble contrast demonstrated opacification of a loop of small bowel, likely jejunum, at the site of prior anastomosis. Poor peristaltic activity was demonstrated. Delayed spot films demonstrated slight migration of the injected contrast into the distal bowel. No specific evidence of leak into the peritoneal cavity.TOTAL FLUOROSCOPY TIME: 4:08 minutes | Enterocutaneous fistula to loop of jejunum at the site of prior anastomosis as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast core biopsy in 2007. Two standard digital views of both breasts, bilateral additional MLO, cleavage view, and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A biopsy clip is seen in the left outer breast. Bilateral benign-morphology calcifications are noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Assess fracture Three views of the right wrist reveal a density a sideplate and multiple screws the distal radius. The fracture line is indistinct consistent with healing. The bones are in anatomic alignment. Note is made of an ununited ulnar styloid fracture. | Distal radial fracture in anatomic alignment. No change from previous. |
Generate impression based on findings. | Female 66 years old Reason: history of SI joint fusion. assess integrity of fusion History: pain. The right sacroiliac joint is traversed by two orthopedic screws, unchanged from the prior exam. but there is no bony fusion seen. Vacuum phenomena are seen in the bilateral sacroiliac joints, suggesting that there is no fluid and this is unchanged from the prior exam. The joints appear to be in anatomic alignment without acute fracture. Again seen is severe multilevel degenerative disk disease and fusion of the facet joints. There is grade 1 anterolisthesis of L3 on L4. There is partial sacralization of L5 vertebral body and vacuum phenomena seen at the L5/S1 level. Mild osteoarthritic changes affect the bilateral hips. | Postoperative and degenerative changes as described above, without evidence of bony fusion in the right sacroiliac joint. |
Generate impression based on findings. | Female 86 years old; Reason: S/p Rt TKA Two views of the right knee obtained in the recovery room and time-stamped 1208 and 1209 demonstrate hardware components of a total knee arthroplasty device situated in near-anatomic alignment. We see no radiographic evidence of hardware complication. Skin staples, surgical drain, and foci of soft tissue gas reflect recent surgery. | Right total knee arthroplasty, as above. |
Generate impression based on findings. | Bilateral knee pain Four views of the left knee demonstrate tiny osteophytes indicating minimal osteoarthritis, essentially within normal limits for the patient's age.A tiny density projecting along the intercondylar eminence of the tibia may represent a small loose body or simply ligamentous calcification. We see no fracture or malalignment. | Minimal osteoarthritis. |
Generate impression based on findings. | Blurry vision and decreased sensation of the left lower and upper extremity. Evaluate for stroke. There is no evidence of acute intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the right ethmoid sinus and a small air-fluid level in the right maxillary sinus. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No acute intracranial hemorrhage or mass effect. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern, MRI of the brain is recommended.2. Air-fluid level in the right maxillary sinus. Please correlate for sinusitis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right cyst aspiration in 1993. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Bilateral scattered, benign-morphology calcifications are stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral, benign-morphology calcifications. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Status post TPA for acute stroke. Evaluate for bleed. There is evolution of a now declared acute left middle cerebral artery territory infarct with a mildly hyperdense left middle cerebral artery likely relating to thrombus. There are small focal chronic infarcts in the right cerebellar hemisphere. There is no evidence of intracranial hemorrhage. There is now mild mass effect with partial effacement of the left lateral ventricle. There is trace left to right midline shift measuring 1-2 mm. There is no acute intracranial hemorrhage.There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. There is mild age-related volume loss. Moderate vascular calcifications of the bilateral cavernous carotid arteries noted. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants. | 1. Evolution of recent left middle cerebral artery territory infarct. Mild mass effect on left lateral ventricle and trace left to right midline shift measuring 1-2 mm. No acute intracranial hemorrhage. 2. Chronic infarcts in the right cerebellar hemisphere. |
Generate impression based on findings. | Access fracturesTECHNIQUE 3 views left hand Three views of the left knee reveal a nondisplaced radial styloid fracture. There's also an nondisplaced fracture through the base of the third metacarpal. The bones are in anatomic alignment. No change from previous. | Fractures of the distal radius and third metacarpal in anatomic alignment. |
Generate impression based on findings. | 24 years old Male. Reason: in remission - any PET avidity? History: history of lymphoblastic lymphoma with mediastinal mass and left cervical adenopathy now in remission. RADIOPHARMACEUTICAL: 13.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion grossly demonstrates opacification of the right maxillary sinus. There is a soft tissue density in the anterior mediastinal region.Today's PET examination demonstrates a focus of increased activity in the skin thickening in the umbilicus with SUVmax of 2.5, which is a nonspecific finding. There is no abnormal FDG uptake in the opacification of the right maxillary sinus, suggesting sinusitis. There is no abnormal FDG uptake in the anterior mediastinal soft tissue density which is most likely to post-therapy change.Minimal FDG uptake is seen in the right hip subcutaneous tissue, which is most likely due to inflammatory change.Curvilinear areas of increased activity are seen in the neck and chest wall which are most likely due to brown fat.Physiologic activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.No definite evidence of FDG avid tumor.2. Hypermetabolic skin thickening in the umbilicus, which is most likely due to infection. Suggest clinical correlation.3.Right maxillary sinusitis.4. Inflammatory change or post procedural change in the right hip. |
Generate impression based on findings. | Evaluate progression of ILD, history of RA. Now worsening shortness of breath and hypoxia. Brown sputum. LUNGS AND PLEURA: There is redemonstration of lower lobe predominant peripheral subpleural reticulation, septal thickening, and mild traction bronchiectasis. There are scattered small subpleural cysts suggestive of honeycombing. There is new focal subpleural consolidation within the left lower lobe. No pleural effusions. MEDIASTINUM AND HILA: Scattered prominent mediastinal lymph nodes are not significantly changed. The heart size is normal without pericardial effusion. There are no visible coronary artery calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Punctate hepatic calcifications compatible with prior granulomatous disease. | 1. Stable RA associated interstitial lung disease.2. New left lower lobe focal subpleural consolidation likely related to aspirated secretions. |
Generate impression based on findings. | Male; 65 years old. Reason: HCC, s/p Therasphere administration. CHEST:LUNGS AND PLEURA: There is apical predominant centrilobular and paraseptal emphysema. No suspicious pulmonary nodules or masses. New moderate left pleural effusion. MEDIASTINUM AND HILA: Normal heart size without significant pericardial effusion. Severe coronary artery calcifications. No mediastinal or hilar lymphadenopathy on the basis of size criteria.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver morphology. Dominant mass demonstrating heterogenous arterial enhancement and washout in the posterior right hepatic lobe is compatible with the patient's treated HCC and measures 4.2 x 3.8 cm, previously 4.6 x 4.3 cm (series 9, image 34). Additional region of heterogeneous arterial enhancement in the right hepatic lobe measures 1.3 x 1.1 cm, unchanged, and presumably represents the treated lesion (series 9, image 29). No significant interval change in additional scattered hypodense lesions. The hepatic arteries are patent. Nonocclusive thrombus is again noted in the proximal portal vein. The left portal vein and posterior division of the right portal vein are patent. However, the anterior division of the right portal vein is not visualized and presumably occluded, with resultant perfusion anomaly of the associated liver parenchyma seen on the noncontrast images. Extensive portosystemic collateral vessels are again identified. Cholelithiasis and nonspecific mild gallbladder wall thickening are unchanged.SPLEEN: Stable splenomegaly. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic aortic calcifications. BOWEL, MESENTERY: No significant abnormality noted. Embolization coils in the expected location of the gastroduodenal artery are again identified. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large volume of abdominal and pelvic ascites, progressed since prior CT. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There are degenerative changes of the lower lumbar spine.OTHER: Large volume of abdominal and pelvic ascites, progressed since prior CT. | 1.Post-treatment changes and new occlusion of the anterior division of the right portal vein. The recently treated arterially enhancing mass in the right liver remains stable in size. 2.Mild interval decrease in size of dominant right hepatic mass representing the patient's more remotely treated HCC. However, there remains evidence of viable tumor within this lesion as described above. 3.Cirrhotic liver morphology with interval progression of large volume abdominopelvic ascites. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of grandmother with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 18 year-old female with chronic abdominal pain particularly after meals with bloating and vomiting. Patient experienced approximately 20 pounds of weight loss over the two years she has been having abdominal pain. Scout radiograph demonstrated an air-fluid level in the stomach. Limited single contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated grossly normal primary peristaltic wave.An elongated, J-shaped stomach is noted with residual fluid in the stomach. Spontaneous emptying of contrast was noted into D1 and D2 segments of the duodenum with slight to and fro motion and minimal delay but eventual passage past midline. There was no significant proximal distention. Eventual transit of contrast into normal appearing jejunum and ileum is noted without evidence of obstruction.TOTAL FLUOROSCOPY TIME: 8:46 minutes | 1.Elongated, J-shaped stomach with residual fluid in the stomach may reflect chronic delayed gastric motility. 2.Slight to and fro motion and minimal delay but eventual passage of contrast past midline. |
Generate impression based on findings. | 57-year-old female with a history of Marfan's syndrome, multiple CVAs, CHF, carotid endarterectomy and visual disturbances. CT head without contrast: There is no evidence of acute intracranial hemorrhage. Encephalomalacia within the right posterior temporal/occipital lobe and right basal ganglia appears similar to prior. Chronic small infarct within the frontal periventricular white matter is also stable. There is mild periventricular and some cortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. There is advanced volume loss for age. No evidence of midline shift or mass-effect. The paranasal sinuses and mastoid air cells are calvarium and soft tissues are within normal limits.CT angiography: The aortic arch shows a normal configuration, although there is evidence of a prior ascending aorta repair. The origin of the right vertebral artery is mildly attenuated. The right internal carotid artery is completely occluded just distal to the bifurcation. The age of this occlusion is unknown although we suspect that it is chronic given the well established collateral intracranial circulation. The distal right ICA is reconstituted by an intact circle of Willis. There is a 2 x 2 mm saccular outpouching of the communicating segment of the left internal carotid artery just distal to the PCOM which may represent an aneurysm or anterior choroidal infundibulum although no clear vessel is appreciated arising from it. There is narrowing of the left mid PCA and right MCA distal to the bifurcation. There is a persistent left fetal circulation with a hypoplastic left P1. The ACOM artery is large and fenestrated or duplicated.Mild to moderate degenerative disease affects the cervical spine. Surgical clips are present in the right aspect of the neck. There is mild basilar atelectasis/edema which is incompletely evaluated. | 1. Complete occlusion of the right internal carotid artery of unknown age, although likely chronic. Reconstitution of the distal right ICA from an intact circle of Willis. Mildly attenuated right vertebral artery at its origin.2. 2 x 2 mm saccular outpouching of the left paraclinoid internal carotid artery distal to the PCOM may represent a tiny aneurysm or infundibulum although no clear vessel is seen arising from it. This can be confirmed with angiography if clinically warranted.3. Narrowing of the left mid PCA and right MCA distal to the bifurcation.4. Multiple bilateral chronic cerebral infarctions and global volume loss appearing similar to prior. |
Generate impression based on findings. | Stenosis in cervical region. Follow-up. There is an anterior plate with screws entering the C4, C5, and C6 vertebrae. The head of one of the C6 screws is not flush with the underlying plate, but this is comparable to that seen on prior CT scans and hence may not be of any current clinical significance. There is bony fusion of the C4, C5, and C6 vertebral bodies. The patient has also undergone multilevel laminoplasty. Mild degenerative disk disease affects the C6/7. Alignment is within normal limits, and I see no frank instability between flexion, neutral, and extension views. | Postoperative changes of cervical spine fusion and laminoplasty as above. |
Generate impression based on findings. | 78-year-old female with history of right facial droop. There is asymmetric volume loss, left greater than right. There is no evidence of acute intracranial hemorrhage. There is mild periventricular and subcortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. The gray-white differentiation is preserved. The basal cisterns are intact. There is opacification of the right maxillary sinus, likely chronic, with an ovoid opacity extending into the right aspect of the paranasal sinus which may represent a polyp. There is prominence of the right inferior turbinate. There is partial opacification of the ethmoid air cells. The calvarium and scalp are within normal limits. | 1. No evidence of acute ischemic infarction. CT is insensitive for the detection of an acute nonhemorrhagic infarction. If patient care warrants further imaging, an MRI may be obtained.2. Mild chronic small vessel ischemic disease.3. Opacification of the right maxillary sinus, likely chronic, with an ovoid opacity extending into the right aspect of the paranasal sinus which may represent a polyp. A dedicated sinus CT may be considered if clinically warranted. |
Generate impression based on findings. | Clinical question: Rule out fracture. Signs and symptoms: Neck pain. Nonenhanced cervical CT:There is no evidence of a fracture and the alignment of the vertebral column is within normal. There is no perispinal abnormality.Mild degenerative changes of the cervical spine are present without suggestion of spinal or neural foraminal compromise.visualized lower calvarium and the mastoid air cells and middle ear cavities are unremarkable. | No fracture or malalignment. |
Generate impression based on findings. | Prostate cancer with bone metastases. Multiple foci of radiotracer activity in the axial and appendicular skeleton are redemonstrated. The L1 vertebral body lesion appears more confluent although less intense. The L5 lesion appears improved. The right T1 posterior paraspinal rib appears improved. The T8 posterior rib lesion, right humeral neck lesion and pelvis lesions appear stable. No new foci of radiotracer uptake to suggest new lesions are identified. | Overall stable exam without new lesions. |
Generate impression based on findings. | 13-year-old male with right leg painVIEWS: Right tibia and fibula, AP and lateral (two views), right knee, AP, oblique, and lateral (3 views) 3/3/15 15:18 Knee: Soft tissue swelling obscures the patellar ligament. No fracture or dislocation. Small corticated ossicle is noted anterior to the tibial plateau.Tibia and fibula: Alignment is anatomic. The tibia and fibula are intact. | Anterior soft tissue swelling obscures the patella ligament, suggesting injury. No fracture or malalignment. Further evaluation with MRI may be considered if clinically warranted. |
Generate impression based on findings. | History of pathological fracture through breast-cancer metastasis. Two views of the right humerus reveal a mid diaphyseal pathological fracture fixed with a long internodular. The fracture appears in anatomic alignment. There is no change in position from the previous exam of December. | A right humerus pathological fracture internally fixed in anatomic alignment. |
Generate impression based on findings. | 58-year-old female with iron deficiency anemia. The scout film shows a nonobstructive bowel gas pattern. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. The bowel loops were freely mobile during fluoroscopically monitored palpation. Transit time to the terminal ileum was 45 minutes. Spot films of the terminal ileum were within normal limits. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. The ascending colon was grossly normal. TOTAL FLUOROSCOPY TIME: 4:46 minutes | Normal examination of the small bowel and proximal colon. |
Generate impression based on findings. | 52 year old female who was recalled from screening mammogram for right breast calcifications. No family history of breast cancer. Family history of ovarian carcinoma in her maternal grandmother. An ML view and two spot magnification 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. There is redemonstration of a cluster of calcifications within the upper outer right breast, which are not significantly changed from 2013, and have minimally progressed in a benign fashion dating back to 2008. No dominant masses or areas of architectural distortion are present in the right breast. | High probability benign calcifications within the upper outer right breast. As long as the patient's physical examination remains normal, right 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. | 58-year-old female status post Billroth II one month ago with bile return via abdominal JP drain. Limited single contrast evaluation demonstrated postsurgical anatomy reflecting a Billroth II. Contrast opacification of the stomach, proximal biliary limb and enteric limb was obtained without extravasation of contrast noted at the gastrojejunostomy site. Incomplete contrast opacification of the biliary limb thus a leak at the duodenal stump cannot be excluded. TOTAL FLUOROSCOPY TIME: 4:08 minutes | No specific evidence of leak at the gastrojejunostomy site. Incomplete contrast opacification of the biliary limb thus a leak at the duodenal stump cannot be excluded. |
Generate impression based on findings. | 42 year old woman with history of palpable right breast lump associated with smoking, currently not palpable. 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. Oval, circumscribed masses in the outer right breast and outer left breast fluctuate in size on review of prior examinations but are benign in morphology and compatible with lymph nodes. No suspicious dominant mass, microcalcifications, or areas of architectural distortion are seen in either breast. SONOGRAPHIC | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.If the palpable areas of concern return, additional targeted ultrasound should be performed. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 54 years old Reason: r/o fx History: fall. We have 3 views of the right ankle. There is mild soft tissue swelling about the ankle, but we see no acute fracture. Note is made of osteoarthritis of the first metatarsophalangeal joint. There are arterial calcifications in the soft tissues of the ankle. Please note that we cannot assess the Achilles due to overlying artifact.We have two views of the cervical spine. The lower cervical spine is not well seen due to overlying anatomy. Given this limitation, we see no fracture. The cervical spine is slightly kyphotic. There is, perhaps, mild degenerative disk disease at C4/C5. Note is made of impacted mandibular molars. | Limited study showing no fracture. |
Generate impression based on findings. | Male, 45 years old, history of long-standing seizures with increased seizures after head trauma. Asymmetry of the gyri recti is seen with suspected encephalomalacia on the right. No evidence of mass effect, parenchymal edema or loss of gray-white distinction is seen. There is no evidence for acute intracranial hemorrhage. The cerebellum is small with prominence of the posterior fossa CSF spaces. The ventricles are normal in size and morphology. The osseous structures of the skull are intact and the paranasal sinuses are clear. | 1. Suspected encephalomalacia of the right gyrus rectus is of uncertain significance relative to the patient's presenting complaint. Correlation with prior history, particularly the timing of the head trauma, and comparison with prior imaging would be helpful.2. No other intracranial abnormality or other specific findings to explain the patient's increased seizures.3. Apparent volume loss of the cerebellum may reflect long-term treatment with anti-epileptic medication, among several other possible etiologies. |
Generate impression based on findings. | Fell on elbow on February 28. Pain; cannot fully extend. There is a prominent enthesophyte projecting from the dorsal aspect of the olecranon. A linear lucency traverses the base of this enthesophyte, perhaps representing a fracture that is nondisplaced. There is minimal associated soft tissue swelling. The triceps silhouette extends to the posterior aspect of the olecranon. I see no joint effusion. Small spurs project from the lateral condyle of the distal humerus likely representing additional enthesophytes. | Possible nondisplaced fracture through an olecranon enthesophyte as described above. This finding was relayed directly to Dr. Altkorn by phone at the time of dictation. |
Generate impression based on findings. | Female 44 years old Reason: left arm pain question of cyst in neck region on vascular ultrasound History: left arm pain. We have two views of the forearm. The radius and ulna appear normal. The soft tissues appear normal. We see no findings to account for the patient's arm pain.We have 6 views of the cervical spine. Moderate degenerative disk disease affects the C6/C7 and C5/C6 levels. There is mild diffuse loss of height of C6 that appears chronic in etiology and may not be of any current clinical significance. There is loss of the normal cervical lordosis. The neuroforamina appear patent bilaterally. We see no soft tissue masses. | Degenerative disk disease and other findings as described above, we see no masses. If further imaging is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Two year-old female, assess fractureVIEWS: Left forearm, AP and lateral (two views) 3/3/15 15:20 Cast obscures underlying osseous detail. Sclerosis along the distal diaphyses of the radius and ulna, consistent with healing fractures with mild dorsal angulation of distal radial fragment. | Healing distal forearm fractures. |
Generate impression based on findings. | Male 59 years old Reason: right hip pain History: r hip pain. We have two views of the right hip and an AP view of the pelvis. Severe osteoarthritis affects the right hip with bone on bone apposition superiorly. There appears to be mild lateralization of the femoral head. There is prominence of the anterior lateral aspect of the femoral head and neck junction, perhaps due to osteophyte formation. Moderate osteoarthritis affects left hip. Mild degenerative arthritis also affects the pubic symphysis and there is calcification of the arteries of the pelvis.We have 4 views of the right knee. There is sharpening of the tibial spines and small patellar osteophytes indicating mild osteoarthritis. Small foci of mineralization likely reside in the quadriceps tendon or less likely represent loose bodies in the suprapatellar pouch. Arterial calcifications and surgical clips in the posterior soft tissues are noted. Mild osteoarthritis also affects the left knee as seen on the frontal views. | Osteoarthritis as above. |
Generate impression based on findings. | There is mild left lateral malar superficial subcutaneous soft tissue stranding, and left preseptal soft tissue swelling. No acute facial bone fracture is identified. The temporomandibular joints are intact. No orbital fracture is identified. The globes are intact. There is no evidence of intraorbital hematoma or stranding. There is opacification of a single left ethmoid air cell. The visualized paranasal sinuses and mastoid air cells are last clear. There are concha bullosa bilaterally in the middle turbinates. The nasal septum is minimally deviated to the left. There is a carious right mandibular molar tooth.The visualized intracranial structures are within normal limits. | Mild left malar and preseptal soft tissue swelling without acute maxillofacial fracture. |
Generate impression based on findings. | Status post extraction right tooth number 3. Evaluate for bone destruction Single Panorex view of the mandible reveals no gross bone destruction | No gross bone destruction |
Generate impression based on findings. | Male 14 years old Reason: fracture History: fractureVIEWS: Left hand AP, lateral and oblique 3/3/15 (3 views) Cast material obscures fine bone detail. Healing buckle fracture of the metaphysis of the first metacarpal bone is in anatomic alignment. | Healing fracture in anatomic alignment after cast placement. |
Generate impression based on findings. | 67 years old with a history of colorectal cancer, status chemotherapy.RADIOPHARMACEUTICAL: 9.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates several enlarged anterior mediastinal lymph nodes. There is a soft tissue density in the right cardiophrenic angle. There is a nodular density in the left lingular lobe. Extensive lymphadenopathy is seen in the retroperitoneal cavity and portocaval space in the abdomen. Diffuse calcifications are seen in the coronary arteries. Today's PET examination demonstrates intense FDG uptake in the anterior mediastinal and right pericardial lymph nodes with SUVmax 4.2. Intense FDG uptake in the lymphadenopathy in the retroperitoneal cavity and portocaval space is also noted. The SUVmax in the portocaval lymph nodes is 4.4. There is a focus of increased activity with SUVmax of 2.2 in the soft tissue density in the posterior mediastinum adjacent to the IVC.Several foci of increased activity in the bilateral level 2 cervical normal-sized lymph nodes with SUV Max of 2.6 in the right cervical level 2 lymph nodes. Mild asymmetrical increased activity is seen in the right palatine tonsil. Minimal FDG uptake is seen in the nodular density in the left lingular lobe.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Extensive hypermetabolic lymph nodes in the mediastinum, portocaval space and retroperitoneal cavity in the abdomen, which can be due to nodal metastasis, lymphoma, sarcoidosis or granulomatous disease.2.Mild FDG uptake in the cervical normal-sized lymph nodes, which are nonspecific.3.Mildly increased metabolic activity in the right palatine tonsil, suggest clinical correlation.4.Nodular density with minimal FDG uptake in the left lingular lobe which is most likely due to inflammatory change. |
Generate impression based on findings. | Postoperative changes are seen from previous posterior and anterior surgical fusion of L5-S1, with resultant susceptibility artifact from the instrumentation limiting evaluation of surrounding structures. There is minimal 3-mm grade 1 anterolisthesis of L5 on S1. The lumbar spine is otherwise in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is no pathological enhancement. The distal spinal cord and conus are within normal limits with the conus terminating at the L2-L3 level, low normal.At L4-L5, there is a trace disk bulge with flattening of the ventral thecal sac. There is bilateral facet arthropathy and ligamentum flavum thickening. There is mild central spinal canal stenosis.At L5-S1, the foramina are incompletely evaluated due to the artifact although there does not appear to be high grade stenosis. The central spinal canal appears widely patentThere is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the lumbar spine. There are several small oval T2 hyperintense lesions partially visualized associated with the left kidney which are nonspecific but most likely represent cysts. There are also extrarenal pelves bilaterally. | Postoperative changes L5-S1 with minimal grade 1 anterolisthesis. Within limitations of susceptibility artifact from spinal instrumentation, no significant foraminal narrowing with limited evaluation of L5-S1. Mild central spinal canal stenosis at L4-L5 due to mild spondylotic changes. |
Generate impression based on findings. | Neck pain. Back pain. Two views of the cervical spine reveal marked right carotid artery calcification. There may be fusion of C4-5. There is a first degree anterolisthesis of C6 on C7. No evidence is seen of compression fractures. Three views 30 thoracic spine reveal marked scoliosis and kyphosis. No definite compression fractures are seen. | No definite compression fractures are seen |
Generate impression based on findings. | 10-year-old male, status right foot painVIEWS: Right foot, AP and lateral (two views) 3/3/15 15:36 Alignment anatomic. No fracture or other specific finding to account for patient's symptoms. | Normal examination. |
Generate impression based on findings. | Pain RIGHT KNEE: Sharpening of the tibial spines indicates minimal osteoarthritis, essentially within normal limits for the patient's age. There may be a small joint effusion, however this is equivocal.LEFT KNEE: Sharpening of the tibial spines indicates minimal osteoarthritis, essentially within normal limits for the patient's age. There may be a small joint effusion, however this is equivocal.LUMBAR SPINE: Minimal degenerative disk disease affects the L3/L4 level. Small osteophytes project off the anterior aspects of the L3 and L4 vertebral bodies. Minimal facet joint osteoarthritis affects the lower lumbar spine, essentially within normal limits for the patient's age. The vertebral body heights are preserved. The alignment is within normal limits. | Minimal degenerative arthritic changes, as described above. |
Generate impression based on findings. | History of trauma. Beckwith Wiedemann syndrome.VIEW: Pelvis AP standing (one view) 03/03/15 Bilateral coxa valga is present. Lateral uncovering of both femoral heads seen. The left femoral head is approximately 30% uncovered on the right 25%. The acetabula are mildly dysplastic.A moderate amount of feces is seen in the rectum. | Bilateral coxa valga. |
Generate impression based on findings. | Evaluate for fracture of the ischium Single AP view of the pelvis reveals mild degenerative changes in the hips. No evidence of any fractures or dislocations. | No fractures or dislocations. |
Generate impression based on findings. | Reason: mets lung cancer, s/p chemo and RT, on ABT-700 + Erlotinb. pls c/w previous study and evaluate tx response. History: lung ca LUNGS AND PLEURA: Postsurgical changes of a right upper lobectomy, and radiation fibrosis, similar to the prior exam. Prominent left upper lobe bulla.Moderate pleural effusions, similar to the prior exam.No new suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: The heart is normal in size, with small pericardial fluid/thickening, unchanged. Moderate coronary artery calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: Stable anterior wedge deformity of the T8 vertebral body, with unchanged patchy sclerosis, may represent treated metastasis.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. A left adrenal nodule is stable from the prior exam, and significantly decreased from old exams, likely representing treated metastasis. | Stable post-treatment findings, pleural effusions, and likely treated metastases including unchanged vertebral body and left adrenal lesions. No new sites of disease identified. |
Generate impression based on findings. | Female 56 years old; Reason: Evaluate for progression of metastatic disease. Compare to previous exam, if available History: Pelvic discomfort ABDOMEN:LUNGS BASES: Please refer to concomitant CT chest exam for additional findings.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable left greater than right nodular adrenal thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe aortobiiliac atherosclerotic disease with narrowing of infrarenal abdominal aorta, similar to prior exam.. BOWEL, MESENTERY: Moderate to large stool without evidence of obstruction.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Mild spinal degenerative disease. Ventral abdominal subcutaneous nodularity and emphysema, likely sequela from prior injections. Unchanged left posterior back 10 by 8 mm subcutaneous nodular focus on image 59 series 7. | 1. Stable indeterminant left flank soft tissue focus, nonspecific but metastatic disease not entirely excluded.2. Please refer to concomitant CT chest exam from same day for additional findings. |
Generate impression based on findings. | History cirrhosis with vasculitis and lower extremity edema, weight loss, and night sweats CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology again noted without mass. Cholelithiasis without acute inflammation or ductal dilatation.SPLEEN: Worsening splenomegaly which is now moderate. Associated with splenic infarct.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval appearance of contour defects involving the right kidney suggestive for infarcts.RETROPERITONEUM, LYMPH NODES: Abdominal aortic ectasia. Stable mildly enlarged portacaval lymph nodes.BOWEL, MESENTERY: New mild ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mild ascitesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Cirrhotic morphology again noted without mass or ductal dilatation. Worsening portal venous hypertension manifest by interval appearance of moderate splenomegaly and mild ascites.Splenic infarct.Multifocal contour deformities involving right kidney; favor infarcts. |
Generate impression based on findings. | There are areas of scattered diffusion restriction along the peripheral right frontal, temporal, and occipital lobes with associated susceptibility, corresponding to areas of previously seen contusion/parenchymal hemorrhage on the outside CT. The largest confluent area involves the right mid to inferior frontal lobe, where there is extensive encephalomalacia. Additional FLAIR hyperintense areas of gliosis are noted in the right temporal and occipital lobes in the areas of previous trauma. There is ex vacuo dilatation of portions of the right lateral ventricle. There are also corresponding areas of intrinsic T1 hyperintensity in these areas of chronic blood products. Minimal scattered susceptibility is seen within the right frontal lobe sulci, consistent with sequela of previous subarachnoid hemorrhage. There is questioned slight prominence of the extra-axial space along the frontal lobes, left greater than right side, which may represent trace residual subdural collections which are essentially isointense with CSF. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There is extensive abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may represent underlying chronic small vessel ischemic changes as well as demyelinating lesions provided the patient's history. Overall, the pattern is similar with perhaps slight increased confluence compared to the prior exam, and many of these demonstrate corresponding T1 hypointensity. There is no pathological enhancement. There is no diffusion abnormality. No large extra-axial fluid collection is identified. There is stable focal prominence of the extra-axial space along the medial aspect of the right cerebellum which may represent a small retrocerebellar cyst.Normal flow-voids are demonstrated in the major intracranial vascular structures. The corpus callosum has a mildly irregular appearance, likely relating to demyelinating disease. The midline structures and craniocervical junction are within normal limits. There is severe fluid opacification right mastoid air cells. There is scattered ethmoid air cell opacification. There are small mucosal retention cysts in the maxillary sinuses. | 1. Expected evolution of previously seen posttraumatic findings, including now extensive areas of encephalomalacia and gliosis evidence of hemosiderin deposition involving the right frontal, temporal, and occipital lobes, with ex vacuo dilatation of portions of the right lateral ventricle.2. Evidence of previous right frontal subarachnoid hemorrhage and questioned trace bilateral subdural collections essentially isointense to CSF.3. Extensive periventricular as well as subcortical white matter abnormality slightly and recent confluent since the previous exam, likely representing demyelinating disease and possible underlying chronic small vessel ischemic changes. Moderate T1 and T2 burden of demyelinating disease.4. Persistent severe right mastoid air cell fluid opacification, which is nonspecific and for which clinical correlation is recommended. |
Generate impression based on findings. | Reason: lung cancer, on chemotherapy, assess response. History: fatigue. CHEST:LUNGS AND PLEURA: Severe apical predominant paraseptal emphysema. Prominent bullae near the apices, right greater than left.No focal airspace consolidation. No pleural lesions.Scattered calcified pulmonary micronodules.The right paraspinal mass has a small amount of subpleural extension near the right apex (series 8, image 22).A small amount of tracheobronchial debris.MEDIASTINUM AND HILA: Streak artifact from metallic spinal fixation hardware somewhat limits evaluation.The heart is mildly enlarged, with a pericardial effusion. No visible coronary artery calcification. Calcified aortic valve.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: The right paraspinal mass is not easily measurable within limitations of extensive streak artifact, but the intrathoracic component measures approximately 3.3 x 1.8 cm on series 7, image 23, and appears significantly decreased from recent prior PET/CT and comparison chest CT dated 07/2014. There is local destruction of the adjacent vertebral bodies and posterior ribs and probable invasion of the spinal canal.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic hypodensity, likely a benign cystSPLEEN: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal masses, new from the prior exam dated 07/2014, and new/increased from recent prior pet imaging, compatible with metastatic disease. The right adrenal mass measures 4.6 x 3.1 cm (series 7, image 93), not significantly changed in total dimension from prior PET imaging, but with new areas of necrosis, compatible with progression of disease. The left adrenal nodule measures 2.8 x 2.5 cm (series 7, image 94), new from prior imaging.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: A round lytic lesion in the left iliac bone measures approximately 8mm (series 7, image 153), is partially visualized, similar to the prior exam, suspicious for additional metastasis.OTHER: No significant abnormality noted. | 1. A right paraspinal mass with local destruction of the adjacent vertebral bodies and posterior ribs appears decreased from the prior exam, compatible with changes of interval treatment.2. Bilateral adrenal masses, new from 07/2014, and increased from 10/2014, compatible with progression of metastases.3. A round lytic lesion in the left iliac bone is suspicious for an additional site of metastasis. |
Generate impression based on findings. | Female 43 years old Reason: stone History: L flank pain; s/p stent removal ABDOMEN: Exam is limited secondary to lack of intravenous and oral contrast. Lack of intravenous contrast makes evaluation of solid organ and vascular pathology suboptimal. Lack of oral contrast makes evaluation of pathology suboptimal. Within these limitations, these observations can be made: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: Mild right hydronephrosis and relatively hypoattenuated appearance of right kidney which may represent asymmetric edema. No left hydronephrosis. No definitive obstructing calculus. Nonobstructing renal stones bilaterally with the largest in the left kidney measuring up to 6 mm (series 3, image 45). Chronic cortical scarring of the left kidney.RETROPERITONEUM, LYMPH NODES: IVC filter in place with a metallic curvilinear structure which cannot be separated from the filter. Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Normal appendix. No evidence of bowel obstruction or intraperitoneal free air. Tubular structures lateral to the right kidney which likely represent varices (series 3, image 71). These are only seen in the right abdomen.BONES, SOFT TISSUES: Subcutaneous varices in the right abdomen (series 3, image 77).OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Enlarged uterus which may be secondary to fibroids. Tampon suggested.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: Surgical fixation hardware/metallic screws. | 1. Lack of intravenous contrast makes evaluation of solid organ and vascular pathology suboptimal. Within the limitations, there is mild hydronephrosis and asymmetric right renal parenchymal edema, which could be secondary to a recently passed stone/pyelonephritis or vascular compromise, IVC filter in conjunction with right-sided varices may indicate a component of vascular compromise. Correlation with patient's clinical history and urinalysis/laboratory values recommended.2. Bilateral nonobstructing renal stones as above.3. Cortical scarring of the left kidney without evidence of hydronephrosis. |
Generate impression based on findings. | Female, 75 years old, history of left breast cancer now with left supraclavicular fullness. Scarring and dystrophic calcifications or perhaps surgical material is partially visualized in the left axilla. More superiorly, in the supraclavicular fossa, no concerning lesions are seen.No pathologic adenopathy is detected in the neck. The aerodigestive mucosal surfaces are smooth and free of lesions. The salivary glands are unremarkable. There are numerous heterogeneous nodules in the thyroid gland, particularly involving the isthmus and right lobe, some of which contain calcifications.The cervical vessels enhance normally. Lung apices are clear. No concerning osseous lesions are detected. | 1. Scarring in the left axilla is partially visualized and presumably postsurgical in nature.2. No concerning findings are seen within the left supraclavicular fossa to account for the reported increased fullness. No pathologic adenopathy or any other definite evidence of active neoplastic disease is seen in the neck.3. Nonspecific thyroid nodules would be better assessed on dedicated thyroid ultrasound. |
Generate impression based on findings. | 13 year-old female with injuryVIEWS: Right ankle, AP, oblique, and lateral (3 views) 3/3/15 16:14 Marked soft tissue swelling about the lateral malleolus without underlying fracture or malalignment. | Soft tissue swelling without fracture or dislocation. |
Generate impression based on findings. | Reason: head and neck cancer History: as above CHEST:LUNGS AND PLEURA: Innumerable subcentimeter pulmonary nodules are increased in number and size when compared to the prior exam dated 08/2014. The reference right lower lobe pulmonary nodule measures 5 mm (series 4, image 69), now solid without a perceptible cavitary component.No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, with a pericardial effusion. Severe coronary artery calcification. Direct origin of left vertebral artery from the aortic arch, a normal variant.Reference retroesophageal lymph node measures 9 mm (series 3, image 65) not significantly changed from the prior exam. Additional small mediastinal and hilar lymph nodes are unchanged.Partially visualized soft tissue mass in the right neck. See same day CT neck for additional details.CHEST WALL: Degenerative disease of the thoracic spine. Status post median sternotomy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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. | Subjective increase in number and size of multiple very small metastatic pulmonary nodules when compared to 08/2014, although the reference nodule is not significantly changed in dimension. Additional findings are unchanged. |
Generate impression based on findings. | Male 37 years old Reason: assess for stone History: flank pain ABDOMEN: Exam is limited secondary to lack of intravenous and oral contrast. Lack of intravenous contrast makes evaluation of solid organ and vascular pathology suboptimal. Lack of oral contrast makes evaluation of pathology suboptimal. Within these limitations, these observations can be made: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: There is mild left perirenal fat stranding and mild prominence of the left renal collecting system. Punctate, nonobstructing renal stones bilaterally. There is also an area of stippled calcifications in the left midpole, nonspecific but may represent milk of calcium.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Appendix is normal in caliber without evidence of periappendiceal fat stranding to suggest appendicitis. There is a calcification within or adjacent to the tip of the appendix.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Limited study due to lack of intravenous contrast making evaluation of solid organ pathology suboptimal. Within the limitations, there is mild left perirenal fat stranding and mild prominence of the left renal collecting system which may represent a recently passed stone or pyelonephritis. Please correlate clinically with patient's clinical history and urine analysis.2.Bilateral nonobstructing nephrolithiasis. |
Generate impression based on findings. | Again demonstrated is a vascular right thigh mass of homogeneous echogenicity measuring 8.3 x 4.8 x 5.9, not significantly changed compared with the prior exam, although there were differences in measuring technique. Multiple feeding vessels and draining veins are again noted.DOPPLER | Vascular right thigh mass consistent with the history of Kaposiform hemangioendothelioma, not significantly changed from the prior exam. |
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