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Generate impression based on findings. | Female 56 years old; Reason: pt with history colon cancer c/o left lower quadrant abdominal pain History: Abdominal pain CHEST:LUNGS AND PLEURA: Right greater than left bibasilar atelectasis. Right lower lobe small focal air space disease/consolidation, image 45 series 3, most likely related to discoid atelectasis but attention on followup recommended. MEDIASTINUM AND HILA: Small residual anterior mediastinal soft tissue attenuation, may reflect residual thymic tissue. Small supraclavicular and mediastinal lymph nodes.CHEST WALL: Left chest wall port seen with tip in proximal SVC, tip directed into azygos vein.ABDOMEN:LIVER, BILIARY TRACT: Moderate intrahepatic biliary duct dilatation with tapering of common bile duct noted distally. Large heterogeneous lobulated mass relatively hypoattenuating compared to background liver with scattered punctate hyperdense foci, suspicious for calcifications particularly in setting of mucinous metastatic disease. Mass centered in hepatic segment 6, which extends to level of right lower quadrant colon, underlying colonic invasion not entirely excluded as intervening plane not well seen, image 109 series 3/coronal image 70 series 80276. The hepatic lesion measures 7.8 x 6 cm, image 86 series 3. Focal fatty infiltration suggested along the ligamentum teres. SPLEEN: Small splenules. PANCREAS: Pancreatic duct measures upper limits of normal.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Status post right hemicolectomy with associated postsurgical suture material seen.PELVIS:UTERUS, ADNEXA: Left adnexal simple cystic lesion measuring 5 x 4.3 cm, image 156 series 3, may be a dominant follicle.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. Left adnexal simple cystic lesion, may be physiologic and represent a dominant follicle, likely the etiology of patient's reported left lower quadrant pain. If clinically warranted, may be further assessed with dedicated sonography.2. Hepatic metastatic disease as described. 3. Left chest wall port seen with tip in proximal SVC, tip directed into azygos vein.4. Right greater than left basilar atelectasis as above. |
Generate impression based on findings. | The scout lateral view and the sagittal reformatted images demonstrate the lumbar spine to be in normal alignment, with a normal lumbar lordosis. The vertebral body and disk space heights are well-maintained, although there is a vacuum phenomenon at L5-S1. There is slight prominence of dorsal epidural fat along the lumbar spine.There is no acute fracture.At L3-L4, there is a mild disk bulge diffusely with perhaps moderate central stenosis. There is also moderate bilateral foraminal narrowing. Minimal bilateral facet arthropathy and ligamentum flavum thickening is noted. At L4-L5, there is a mild disk bulge with right foraminal/far lateral prominence. There is mild bilateral facet arthropathy and ligamentum flavum thickening, injury to overall mild central spinal canal stenosis as well as moderate-severe right and moderate left foraminal narrowing. There is likely impingement of the exiting right L4 nerve root along the distal foramen.At L5-S1, there is a mild disk bulge with slight less prominence as well as bilateral facet arthropathy and ligamentum flavum thickening. There is moderate to severe left foraminal narrowing predominantly due to osteophyte formation. There is bilateral facet arthropathy and ligamentum flavum thickening.The axial images do not demonstrate any other significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.Limited views through the retroperitoneum demonstrate no gross abnormalities. | 1. Mild-moderate lower lumbar spondylotic changes, with findings most prominent at L4-L5 where there is a diffuse disk bulge with right foraminal/far lateral prominence resulting in likely impingement of the exiting right L4 nerve root, although MR would better delineate the abnormality. Moderate central spinal canal stenosis as well as moderate-severe right and moderate left foraminal narrowing.2. Additional moderate-severe left foraminal narrowing at L5-S1. |
Generate impression based on findings. | 81 years, Male, Reason: s/p chole c/b CBD injury s/p hepaticoj, look for fluid collections, bile duct injury History: as above. IV contrast only, no po contrast. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with left basilar atelectasis and right basilar atelectasis/consolidation. Thickening and mucosal hyperenhancement of the distal esophagus, which contains fluid.LIVER, BILIARY TRACT: Mild periportal edema. Pneumobilia is likely postprocedural. Portal venous system is patent. Small amount of unorganized fluid in the gallbladder fossa. There is a surgical drain which enters the abdomen and courses along the inferior margin of the liver.SPLEEN: Subcapsular perisplenic collection of water attenuation measures 2.0 cm in thickness.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large left renal simple cyst.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Postsurgical changes of hepaticojejunostomy.There is an organized fluid collection in the retrovesicular space which measures 5.7 x 2.9 cm (3/94). There is scattered edema throughout the mesentery which may be related to prior surgery. There are mildly dilated bowel loops in the midabdomen measuring up to 3.4 cm. The afferent loop is also mildly dilated up to 3.8 cm. The distal ileal loops are relatively collapsed.Barium is seen within the stomach and colon. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: Air in the bladder may be related to prior Foley catheter.BONES, SOFT TISSUES: No significant abnormality noted | 1. Organized fluid collection in the pelvis, suspicious for abscess.2. Mildly dilated mid abdominal bowel loops may be related to ileus, however continued follow up is recommended.3. Splenic subcapsular fluid collection.4. Small amount of unorganized fluid in the gallbladder fossa. Scattered mesenteric edema.5. Thickening and mucosal enhancement of the esophagus may be inflammatory. |
Generate impression based on findings. | The fifth DIP joint is held in flexion and there is an ossific density dorsally. This is most likely secondary to an old mallet fracture. No acute fractures are seen. | No acute fractures or dislocations. |
Generate impression based on findings. | Male 72 years old Reason: mets esophageal cancer, liver mets, on FOLFOX therapy. Pls c/w previous study and evaluate tx response. History: esophageal ca CHEST:LUNGS AND PLEURA: The previously seen nonspecific 5 mm right upper lobe pulmonary nodule seen on previous exam is not clearly visualized and was likely inflammatory/infectious in etiology. Mild bibasilar fibrosis. MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. Moderate atherosclerotic calcifications of the coronary arteries.Enlarged subcarinal lymph node measures 0.8 x 1.6 cm (series 3, image 51), previously 1.0 x 1.7 cm. Enlarged paraesophageal lymph node measures 1.1 x 1.6 cm (series 3, image 69), previously 1.2 x 1.6 cm.CHEST WALL: There is no evidence of enlarged axillary, subpectoral, cardiophrenic or retrocrural lymphadenopathy on the basis of size criteria. There is a right chest port with the tip at the cavoatrial junction. ABDOMEN:LIVER, BILIARY TRACT: There are multiple hypoattenuating lesions scattered throughout the hepatic parenchyma compatible with hepatic metastases. For reference purposes, the right hepatic lobe lesion is significantly decreased in size and measures 2.2 x 3.2 cm (series 3, image 92), previously 4.3 x 5.0 cm. The non-reference lesions appear slightly smaller to stable in size.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate hypoattenuating lesions in the right renal parenchyma are too small to characterize.RETROPERITONEUM, LYMPH NODES: There is a cluster of gastrohepatic nodes. The reference gastrohepatic node now measures 1.0 x 0.9 cm (series 3, image 97), previously 1.1 x 0.9 cm. BOWEL, MESENTERY: Esophageal stent in place with the distal aspect terminating within the body of the stomach, abutting the wall. There is layering debris within the esophagus, however the stent appears patent. Circumferential thickening is present about the gastroesophageal junction, presumably representing the patient's known primary esophageal adenocarcinoma. BONES, SOFT TISSUES: No lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis. Postsurgical changes in the right ventral abdominal wall likely secondary to prior surgical procedure.PELVIS: Beam hardening artifact secondary to the patient's right hip prosthesis limits evaluation of the lower pelvis.PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Status post total right hip arthroplasty. Degenerative changes of the left hip. There are no lytic or sclerotic lesions identified within the imaged axial or appendicular skeleton to suggest osseous metastasis.OTHER: Pelvic ascites which is not significantly changed. | 1.Esophageal wall stent in place without evidence of complication.2.Enlarged mediastinal and gastrohepatic ligament nodes are not significantly changed in size.3.Hepatic metastases, some of which have decreased and others which are stable in size. 4.No new sites of metastatic disease. 5.Nonspecific right upper lobe pulmonary nodule is not definitively visualized on the current exam and likely represents postinfectious/postinflammatory etiology. |
Generate impression based on findings. | Right wrist pain status post fall. Right fifth finger pain status post fall. There is a comminuted but predominantly transverse fracture through the neck of the fifth metacarpal with mild volar and radial angulation of the distal fracture fragment. The phalanges of the fifth finger appear intact. The bones of the wrist appear intact. A small round calcific density dorsal to the carpus may represent a phlebolith. There is a slight negative ulnar variance. | Fifth metacarpal fracture as above. |
Generate impression based on findings. | Status post left total hip arthroplasty The AP view of the hip shows components of a total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of complication. A drain and foci of gas density within the adjacent soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the left. Components of a right total hip arthroplasty device are situated in near anatomic alignment, although the distal extent of the prosthesis is not included on the field of view of this study. Arterial stents overlying the lower lumbar spine and sacrum are poorly visualized on this study. | Postoperative changes of total hip arthroplasty as above. |
Generate impression based on findings. | Male 69 years old Reason: eval sagittal balance, eval scoliosis, possible preop planning for fusion History: back and left leg pain. Severe degenerative disk disease affects the lumbar spine, with relatively mild degenerative disk disease affecting the thoracic spine. Moderate to severe degenerative disk disease affects the cervical spine, although this region of the spine is obscured by overlying anatomy.There is a focal levoscoliosis of the thoracolumbar spine measuring approximately 20 degrees from the superior endplate of T12 to the inferior endplate of L3. There is approximately 2 cm of negative coronal balance. Evaluation of the sagittal balance is limited as C7 is not readily visible on the lateral view; however, we estimate a positive sagittal balance approximately 2.5 cm.Surgical clips in the right upper quadrant are likely from a prior cholecystectomy. | Degenerative disk disease, scoliosis, and other findings as above. |
Generate impression based on findings. | Reason: Pleural mesothelioma. Please compare to prior exam per RECIST criteria History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Redemonstration of diffuse nodular right pleural thickening compatible with a known history of mesothelioma, not significantly changed from the prior exam. Reference measurements are as follows:At the level of the aortic arch (series 3, image 25): The lesion at the two o'clock position measures 7 mm, unchanged. The lesion at the 10 o'clock position measures 4 mm, unchanged.At the level of the right atrial appendage (series 3, image 48): Lesion at the two o'clock position measures 5 mm, unchanged. The lesion at the 4 o'clock position measures 8 mm, unchanged.At the level of the aortic valve (series 3, image 49): The lesion at the 8 o'clock position measures 3 mm, unchanged. The lesion at the 10 o'clock position measures 7 mm, unchanged.Suture material along the right upper lobe.Scattered calcified granulomas. No tumor involvement of the left hemithorax.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.Enlarged mediastinal and hilar lymph nodes, not significantly changed from the prior exam. Reference subcarinal lymph node measures 16 mm (series 3, image 41), unchanged.CHEST WALL: Right chest port, tip at the cavoatrial junction.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: Stable left renal cyst.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: Mild degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | Stable nodular pleural thickening and mediastinal/hilar lymphadenopathy. Reference measurements as above. No new sites of disease identified. |
Generate impression based on findings. | Reason: 42 y.o. M with advanced HF and impella with chest infiltrate, evalute for infection and other abnormalities History: SOB LUNGS AND PLEURA: Multiple small groundglass and air space nodules throughout the lungs, suspicious for infection.Focal consolidation and atelectasis in the dependent portions of the lower lobes, most likely related to aspirated secretions.MEDIASTINUM AND HILA: Marked cardiomegaly with an implant device extending to the left ventricle and and ICD lead and a Swan-Ganz catheter in place.No pericardial effusion.No visible coronary artery calcification.CHEST WALL: Generator device in the left anterior chest wall.Air in the soft tissues superiorly with radiopaque surgical material.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Very limited evaluation. 50 mL left adrenal nodule with fat density consistent with a benign adenoma. | Somewhat limited examination due to streak artifacts from internal and external hardware as well as respiratory motion artifact. Multiple small ill-defined groundglass and air space nodules are present throughout the lungs, compatible with infection, possibly viral or fungal in etiology. Multiple septic emboli are also a possibility. Dependent lower lobe consolidation and atelectasis is consistent with aspirated secretions. |
Generate impression based on findings. | Clinical question: Rule out intracranial abnormalities. Signs and symptoms: AMS. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are patchy periventricular and subcortical low attenuation of white matter which considering patient's stated age of 82 likely representing age indeterminate small vessel ischemic strokes of mild degree.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for age. Moderate bilateral cavernous and supraclinoid carotid vascular calcification is noted.Unremarkable images through the orbits.Large mucus retention cyst in the left maxillary sinus and unremarkable paranasal sinuses otherwise. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | seizure No evidence of acute ischemic or hemorrhagic lesion.Minimal non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | fall, head laceration, No evidence of acute ischemic or hemorrhagic lesion.Focal lacune on the left side basal ganglia, no change since prior scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.No change of left basal ganglia lacunar infarction. |
Generate impression based on findings. | Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early dictation of acute nonhemorrhagic ischemic strokes.There are diffuse patchy foci of subcortical and periventricular white matter as well as bilateral thalami and left pons consistent with age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and assist of the spaces otherwise.Unremarkable calvarium, orbits and mastoid air cells. Large mucous retention cyst in bilateral maxillary sinuses are noted. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes as detailed. |
Generate impression based on findings. | Clinical question: Patient fell a week ago with loss of consciousness and increasing headache since. Signs and symptoms: As above. Nonenhanced head CT:Detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | possible infection, rash, post meningioma resection There is left fronto-temporal craniotomy with left temporal pole and anterior aspect of superior temporal gyrus tissue loss indicate postoperative changes, no change since prior exam.Minimally enhancing soft tissue mass on the left parasellar area (18mm x13mm), no significant interval change since prior exam.No evidence of acute ischemic or hemorrhagic lesion.There is no abnormal enhancement on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. No change of residual left parasellar mass since prior exam.2. No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | Clinical question: Rule-out acute process. Signs and symptoms: Syncope with head trauma. Nonenhanced head CT:Extensive bilateral anterior frontal encephalomalacia secondary to prior gunshot wound is noted. There are multiple small metallic fragments and a small bony fragment in bilateral frontal lobes and left frontal skull. There is a large bony defect of right anterior frontal skull with bony fragments within the right frontal lobe is noted. Images through the calvarium also demonstrates a very thin linear bony defect across the right anterior frontal bone and extending along the floor of right anterior cranial fossa. There is no associated intracranial or soft tissues of the scalp finding which could represent a chronic fracture there are no prior exams for comparison.Streak artifact from metallic hardware obscures the detail. There is however no evidence of acute intracranial process. CT is insensitive for the detection of acute nonhemorrhagic ischemic strokes. Images beyond the area of streak artifact are unremarkable. Ventricular system are mildly dilated anteriorly secondary to parenchymal volume and with maintained midline.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.No detectable acute intracranial process.2.Very thin linear bony defect traversing the right superior orbital ridge and frontal bone along the lateral right anterior cranial fossa without associated intracranial or soft tissues of the scalp findings. Considering prior gunshot wound to the head this finding may represent a chronic fracture.3.Administered prior gunshot wound to the head with large areas of bilateral anterior frontal encephalomalacia containing metallic and bony fragments.4.Large right anterior frontal bony defect secondary to prior gunshot wound. |
Generate impression based on findings. | Clinical question: Intracranial lesion. Signs and symptoms:Set of seizure. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is a focus of encephalomalacia along the medial aspect of right posterior temporal lobe and extending into the right occipital lobe consistent with a chronic ischemic stroke in the distribution of right posterior cerebral artery. Tiny focus of encephalomalacia in the right thalamus is also detected as well within the right PCA territory. There is resultant ex vacuo dilatation of right trigone of lateral ventricle. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium, orbits, mastoid air cells and paranasal sinuses. | 1.No acute intracranial process.2.Chronic right PCA territory ischemic stroke.3.Unremarkable exam otherwise. |
Generate impression based on findings. | follow up of multifocal ischemic stroke No evidence of hemorrhagic transformation on this scan.Multifocal various sized bihemispheric ischemic infarctions are again demonstrated, no change since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | Multifocal various sized acute ischemic infarctions with surrounding edema, no change since prior exam.No evidence of hemorrhagic transformation. |
Generate impression based on findings. | Clinical question: Treatment planning CT. Signs and symptoms: Treatment planning CT. Nonenhanced stealth head CT:This examination is performed as a surgical/treatment planning the study and is not a diagnostic test.The study is performed while a stereotactic device is secured to patient's calvarium. There is no detectable calvarial or soft tissue complication from placement of the halo.There is postprocedural pneumocephalus primarily in the bilateral anterior frontal regions. There is placement of bilateral DBS electrodes entering from bilateral paramedian frontal burr holes, traversing the frontal lobes and the brain parenchyma with the tips of the electrodes overlapping the bilateral cerebral peduncles. There is no detectable parenchymal hemorrhage or edema. The appropriateness of the placement of electrodes should be determined by the referring physician. There is an extra-axial CSF density lesion in the left anterior middle cranial fossa a very subtle bony remodeling of the greater venous sphenoid and highly suggestive of an arachnoid cyst without change since prior MRI exam.Ventricular system remain within normal size and with maintained midline. | Expected postoperative changes of bilateral frontal approach DBS placement as detailed. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion.Mild non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Mild non specific small vessel ischemic disease. |
Generate impression based on findings. | post SAH, IVH, stent assisted coiling for the ruptured right distal ICA aneurysm. SAH, IVH with mild ventriculomegaly, bifrontal ICH (right ventriculostomy track hematoma and the left anterior frontal lobe ICH associated with local SAH), no significant interval change since prior exam.No evidence of new ischemic or hemorrhagic lesion on this scan.Bifrontal approach ventriculostomy tubes were seen and do not show any significant interval change since prior exam. The paranasal sinuses and mastoid air cells are clear. | No interval change of SAH, IVH, ICH, ventriculostomy tube position and mild ventricular enlargement since prior exam.No evidence of new ischemic or hemorrhagic lesion. |
Generate impression based on findings. | Clinical question: Status post left tumor resection. Signs and symptoms: Same. Nonenhanced head CT:Examination demonstrate post operative changes of a left mid temporal craniotomy. A surgical cavity measuring approximately 13 x 17 mm in transaxial dimensions is noted superficially in the left temporal lobe which contains air and a tiny amount of hemorrhage in its dependent segment which is within expected postoperative changes. There is minimal surrounding vasogenic edema and resultant very subtle regional mass-effect. Minimal postoperative pneumocephalus is also within expected postop changes.Unremarkable cerebral cortex, cortical sulci, ventricular system, cisterns and spaces and gray -- white matter differentiation.The posterior edge of the craniotomy reaches the mastoid air cells and there is minimal opacification of left mastoid air cells. | 1.Status post left temporal craniotomy. Minimal left mastoid air cell opacification.2.Expected intracranial postoperative changes of left temporal lobe tumor resection as detailed.3.Unremarkable exam otherwise. |
Generate impression based on findings. | post right frontal lobe mass resection follow up. Re-demonstration of right frontal craniotomy, resection cavity on the right frontal lobe with air and fluid attenuations as well as minimal midline shift toward left side across the incisura indicating postoperative changes, no change since prior exam.There is no evidence of new hemorrhagic or ischemic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear. | Expected post operative findings as described above.No evidence of new hemorrhagic or ischemic lesion. |
Generate impression based on findings. | 58 year old female with history of Billroth II with persistent abdominal pain. ABDOMEN:LUNG BASES: Moderate left and trace right pleural effusions with overlying atelectasis.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Status post cholecystectomy. Hepatic vasculature remains patent. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: There is a 5-mm cystic lesion in the proximal pancreatic body and which was present on the 2006 exam.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right upper pole high attenuation renal lesion is new since 2006 and measures 1.7 x 1.4 cm (series 3, image 38). No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Postsurgical changes of Billroth II. Surgical drain is present in the gastrohepatic region. Oral contrast traverses the stomach, small bowel, and colon without evidence of obstruction. Mildly prominent loops of small bowel suggests mild ileus pattern. The previously seen wall thickening involving the cecum and transverse colon has resolved.BONES, SOFT TISSUES: Mild anasarca.OTHER: Moderate abdominopelvic ascites similar to prior. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes of Billroth II. Surgical drain is present in the gastrohepatic region. Oral contrast traverses the stomach, small bowel, and colon without evidence of obstruction. Mildly prominent loops of small bowel suggests mild ileus pattern. The previously seen wall thickening involving the cecum and transverse colon has resolved.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate abdominopelvic ascites similar to prior. | 1.Postsurgical changes of Billroth II without evidence of enteric contrast extravasation.2.Interval improvement of colonic wall thickening. Mild ileus pattern without obstruction. 3.Cirrhotic liver morphology with moderate abdominopelvic ascites and small left pleural effusion.4.Right upper pole renal lesion is incompletely characterized. Recommend dedicated renal imaging for further evaluation. |
Generate impression based on findings. | Clinical question: Endometrial cancer with progressive disease. Assess for brain metastases. Signs and symptoms: As above. Enhanced head CT:There is no detectable abnormal parenchymal or leptomeningeal enhancement to suggest metastatic disease. It is also no detectable lytic or sclerotic changes of calvarium to suggest osseous metastases.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Images through the orbits demonstrate a chronic left lamina papyracea are not fracture. No detectable retropatellar edematous changes and unremarkable adjacent sinuses.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses and mastoid air cells. | 1.No detectable metastatic lesion.2.Unremarkable enhanced head CT.3.Chronic left-sided lamina papyracea blowout fracture. |
Generate impression based on findings. | 69 years, Female. Reason: Patient s/p cystectomy/Ileal conduit with abdominal pain, bloating and nausea History: as above Bilateral ureteral stents appear unchanged in position compared to prior CT. Pigtail drain projects over the right lower pelvis. Midline pelvic surgical skin staples and suture were material projects over the pelvis and abdomen. Bilateral pelvic surgical clips noted. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 40 year-old female with history of diverticulitis now with lower abdominal and back pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral subcentimeter low attenuation renal lesions too small to characterize but probably benign cysts. Punctate nonobstructive calyceal calculi on the right. No hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bilateral fallopian tube occlusion devices are present.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of diverticulitis. 2.Right renal punctate nonobstructive calyceal calculi without hydronephrosis. |
Generate impression based on findings. | Clinical question: Drowsiness after tumor resection. Signs and symptoms: Not is in its after tumor resection. Nonenhanced head CT:Since prior exam there is evidence of increased high density blood product within the right frontal surgical cavity. Although the finding could represent a small amount of new hemorrhage possibility of redistribution and precipitation of previous blood within the surgical bed cannot be entirely excluded. Recommend closer follow-up.Post operative pneumocephalus demonstrate no significant change since prior exam. There is regional mass effect on the right frontal lobe from subarachnoid air similar to prior study. A subtle mass on the right frontal lobe and with subtle diminution of midline to the left. This appearance is stable since prior study.Unremarkable study otherwise. | 1.Slight interval increased high-density round within the surgical cavity in the right frontal lobe.2.Stable extensive postoperative changes of right frontal tumor resection otherwise and the trace leftward midline shift. |
Generate impression based on findings. | left neck pain, possible dissection. CTA NECKThe right vertebral artery appears to be completely occluded at the level of C7 but the left vertebral artery is robust and open.There is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and left vertebral artery with some wall calcifications on left carotid artery bulb. No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage.Incidental findings of the left maxillary sinus retention cyst, and left thyroid hypodense nodule (1cm). | Right vertebral artery occlusion at its origin otherwise unremarkable neck CTA.Comment: if carotid dissection is clinically suspected, neck MR angiography with dissection protocol can be considered since that study can demonstrate dissection related carotid mural hematoma without creating carotid luminal narrowing. |
Generate impression based on findings. | 57-year-old male with history of pancreatic cancer and recent pulmonary embolism now with abdominal pain and dilated small bowel on plain film, evaluate for obstruction. ABDOMEN:LUNG BASES: Bilateral partially visualized pulmonary emboli and right upper lobe pulmonary infarct. Main pulmonary artery is incompletely visualized though saddle embolus component appears to have resolved. Mild basilar atelectasis/consolidation, new from prior.LIVER, BILIARY TRACT: Biliary stent present with small pneumobilia seen in left hepatic lobe. Overall increase in size of innumerable hepatic metastases. Reference right hepatic lesion measures 2.7 x 3.0 cm (series 3, image 45), previously measured 1.7 x 1.7 cm. Portal vein thrombosis has progressed which now involves the proximal splenic vein and proximal SMV with development of early collaterals. SPLEEN: No significant abnormality notedPANCREAS: Ill-defined lesion involving pancreatic head and uncinate process compatible with neoplasm measuring approximately 5.3 x 5.4 cm (measurements difficult due to ill-defined margins), series 3, image 76. The pancreatic duct is again dilated, stable to slightly increased. Ill-defined soft tissue abuts the SMA, celiac axis, IVC, and second/third portions of the duodenum.ADRENAL GLANDS: Stable bilateral adrenal thickening.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic disease of the abdominal aorta and branches.BOWEL, MESENTERY: Normal caliber small and large bowel without evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine appearing similar to prior. OTHER: Trace abdominopelvic ascites, increased from prior. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber small and large bowel without evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine appearing similar to prior. OTHER: Trace abdominopelvic ascites, increased from prior. | 1.Metastatic pancreatic cancer with interval increase in size of hepatic metastases and progression of portal vein thrombosis.2.Bilateral partially visualized pulmonary emboli and right upper lobe pulmonary infarct.3.No evidence of bowel obstruction. |
Generate impression based on findings. | 14--week-old female with recurrent left chest effusion status post tube placement.VIEW: Chest AP (one view) 3/4/2015 7:38 Left chest tube tip has been retracted and now lies in the left hemithorax. Feeding tube tip coursing below the left hemidiaphragm and extending beyond the inferior margin of the image. Right central line tip in the right atrium.Slightly improved mediastinal shift to the right. Bilateral coarse pulmonary opacities are unchanged. Slightly decreased left pleural effusion. No pneumothorax. | Left chest tube tip now in the left hemithorax. Bilateral coarse pulmonary opacities and slight interval improvement in left pleural effusion. |
Generate impression based on findings. | Female 24 years old Reason: r/o acute process History: abd pain. History of sickle cell disease. ABDOMEN:LUNG BASES: Small areas of focal consolidation in the right middle lobe, right lower lobe, and lingula which may represent infection, edema, or infarction. Favor chronic inflammation. LIVER, BILIARY TRACT: Hepatomegaly with the liver measuring up to 24 cm (series 80268, image 55). Mildly distended gallbladder without acute inflammation.SPLEEN: Heterogeneous enhancement of the splenic parenchyma.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild cardiomegaly. No significant abnormality noted.BOWEL, MESENTERY: Normal appendix. No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Cystic structure in the left adnexa with enhancing rim which likely represents a corpus luteum cyst.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: Small amount of free fluid in the pelvis likely physiologic in nature. | 1.Left adnexal corpus luteum cyst with small amount of free fluid in the pelvis, likely physiologic.2.Hepatomegaly and mild cardiomegaly.3.Areas of focal pulmonary consolidation bilaterally which may represent infection, edema, or infarction. Favor chronic inflammation. |
Generate impression based on findings. | Female, 44 years old.Elevated BMI. No unexpected radiopaque foreign objects. Enteric feeding tube is looped in the stomach with tip projecting over the gastroesophageal junction area. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign objects.Findings communicated via telephone to Dr. Umanskiy at 18:45 hours on 3/3/2015 by Dr. Ramakrishna. |
Generate impression based on findings. | 65 years, Male. Reason: 65M with AMS, DHT for TF, just advanced DHT after report of TF suctioned from throat, ?placement History: 65M with AMS, DHT for TF, just advanced DHT after report of TF suctioned from throat, ?placement Dobbhoff tube tip projects over the proximal gastric body. Two central venous catheter tips project over the superior vena cava and left atrium. Essentially gasless abdomen. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | 14-week-old female, evaluate for interval change in chest tube positioning.VIEWS: Chest AP and cross-table lateral (two views) 3/3/2015 20:34 Left chest tube still crossing the midline with tip retracted from prior now towards the midline along the left side of the trachea. Feeding tube tip in the stomach. Right central line tip in the right atrium.Persistent mediastinal shift to the right. Bilateral coarse pulmonary opacities are increased from prior study. Small left pleural effusion not significantly changed. Interval decrease in size of left sided pneumothorax. | Left chest tube tip slightly retracted from prior study now towards the midline. Interval decrease in left sided pneumothorax. Bilateral coarse pulmonary opacities increased from prior study. Small left pleural effusion. |
Generate impression based on findings. | 26 year old male with abdominal pain, evaluate for hernia. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. No hernias are identified. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. No hernias are identified. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Negative examination. |
Generate impression based on findings. | 64 years, Female. Reason: Please assess NGT position History: s/p NGT placement NG tube tip projects over the pyloric area. Bilateral nephroureterostomy stents are again noted, unchanged. Interval increase in diffuse small bowel dilatation measuring up to 3.4 cm and relative paucity of bowel gas in the colon. Note that the pelvis is excluded from the field-of-view. | NG tube tip projects over the gastric pyloric area. Obstructive bowel gas pattern but given recent surgery, post operative ileus is probable. |
Generate impression based on findings. | 37 year old female with drop in hemoglobin, evaluate for hematoma. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Low-attenuation lesion in the region of the left renal sinus probably renal sinus cyst. Few punctate calcifications in the right kidney thought to be cortical calcifications. No hydronephrosis or obstructing calculi. RETROPERITONEUM, LYMPH NODES: A few nonspecific mildly prominent retroperitoneal lymph nodes are present.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall. Foci of gas within the anterior soft tissues likely related to injections.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter with tip in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No abnormal fluid collections are identified in the abdomen or pelvis.2.Splenomegaly. Few nonspecific mildly prominent retroperitoneal lymph nodes. |
Generate impression based on findings. | 31-year-old male with history of Crohn's disease now with right lower quadrant abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber jejunum and proximal ileum. Wall thickening and inflammatory changes involving the terminal ileum and proximal cecum compatible with active Crohn's disease similar in appearance to recent MRI. The small bowel proximal to inflamed terminal ileum is mildly dilated, stable to slightly increased. No abscesses are identified. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace abdominopelvic free fluid has decreased. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber jejunum and proximal ileum. Wall thickening and inflammatory changes involving the terminal ileum and proximal cecum compatible with active Crohn's disease similar in appearance to recent MRI. The small bowel proximal to inflamed terminal ileum is mildly dilated, stable to slightly increased. No abscesses are identified. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Wall thickening and inflammatory changes involving the terminal ileum and proximal cecum compatible with active Crohn's disease similar in appearance to recent MRI. Ileum just proximal to inflamed terminal ileum is mildly dilated, stable to slightly increased. No abscesses identified. |
Generate impression based on findings. | Female 9 years old Reason: rule out fracture/dislocation History: back pain s/p fallVIEWS: Lumbar spine AP lateral. Sacrum, lateral view. 3/3/15 (3 views) Vertebral body heights and disk spaces are maintained. No evidence of fracture or malalignment. No evidence of spondylolyses. | Normal examination. |
Generate impression based on findings. | Male, 62 years old.Liver transplant surgery over 8 hours. No unexpected radiopaque foreign objects. Two surgical drains and surgical clips project over the right upper quadrant. Enteric feeding tube tip projects over the distal gastric body. Right femoral central venous catheter noted. Expected postoperative pneumoperitoneum as well as air in the soft tissues. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign objects.Findings communicated to the attending physician, Dr. Renz, via telephone at 00:50 on 3/4/2015 hours by Dr. Ramakrishna. |
Generate impression based on findings. | No diffusion restriction to suggest acute ischemia. There are no masses, mass effect, or midline shift. No acute intracranial hemorrhage. Postoperative changes of sub-occipital craniectomy for Chiari decompression with expansion of the thecal sac and exaggerated dorsiflexion of the dens. 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. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. | 1.No findings to suggest acute ischemia.2.Postoperative changes of sub-occipital craniectomy for Chiari decompression. |
Generate impression based on findings. | Reason: pt with LLE swelling off Xarelto x 3-4 weeks with left sided stabbing CP that began last night History: left sided pleuritic CP PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Mild apical predominant paraseptal emphysema, unchanged.Clustered, partially calcified nodules in the lingula are unchanged from the prior exam, decreased in prominence from 08/2011. The largest nodule measures 11 x 8 mm (series 8, image 196), unchanged, using similar measurement technique. No new suspicious pulmonary nodules or masses.Mild bronchial wall thickening, unchanged.Mild dependent atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification. Scattered small mediastinal lymph nodes and mildly prominent right hilar lymph nodes are unchanged, likely reactive.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism or other acute abnormality to account for the patient's symptoms.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 77 years old Reason: LLQ abdominal pain History: above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Prominence of the hepatic fissure with mild contour nodularity likely representing cirrhotic changes. No focal hepatic mass. Unchanged cholelithiasis without acute inflammation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions which are too small to characterize and likely represent cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Prominent portacaval lymph nodes, unchanged. Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No obstruction or intraperitoneal free air. Well-circumscribed, peripherally calcified lesion which is inseparable from the gastric antrum and is slightly enlarged compared to prior exam. The lesion measures 2.9 x 3.1 cm (series 3, image 43), previously 2.4 x 2.9 cm in 2005. Favor low grade gastrointestinal stromal tumor.BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant diverticulosis or evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine. Bilateral fat containing inguinal hernias.OTHER: No significant abnormality noted | 1.No acute abnormality.2.Fissural prominence and mild contour nodularity of the liver suggestive of mild cirrhosis.3.Well-circumscribed, peripherally calcified lesion which is inseparable from the antrum and has slightly increased in size since 2005. Favor low grade GIST. |
Generate impression based on findings. | 36 years, Male. Reason: OG tube placement History: intubated NG tube side-port and tip project over the GE junction and gastric body, respectively. Bilateral, left greater than right, pleural effusions. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube side port projects over the gastroesophageal junction. Slight advancement is recommended. |
Generate impression based on findings. | 13-year-old male with bruising and swellingVIEWS: Left hand, PA, left fifth digit PA and lateral (two is views) 3/3/15 20:26 Soft tissue swelling about the PIP joint. No fracture or malalignment. | Soft tissue swelling without fracture or malalignment. |
Generate impression based on findings. | 81 years, Male. Reason: Dobbhoff History: Dobbhoff Dobbhoff tube tip projects over the proximal gastric body. Diffuse gaseous distention of small and large bowel in an ileus type bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | Right knee painVIEWS: Right knee AP, lateral and oblique on 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. | 46-year-old female with right lower extremity pain. Ankle: Diffuse soft tissue swelling without acute fracture or dislocation. Note is made of a calcaneal heel spur.Tibia/fibula: No acute fracture or dislocation. Alignment is anatomic.Knee: No acute fracture or dislocation. Mild degenerative osteophytes are noted in the medial compartment and along the undersurface of the patella.Femur: No acute fracture or malalignment.Hip: No acute fracture or malalignment. Mild osteoarthritis with acetabular osteophytes. | 1.No acute fractures identified. Diffuse ankle swelling. 2.Mild osteoarthritis of the knee and hip. |
Generate impression based on findings. | 16 year-old male, twisted left ankle, rule out fractureVIEWS: Left ankle, AP, oblique, and lateral (3 views) 3/3/15 22:54 Moderate soft tissue swelling about the ankle. Joint effusion. Alignment is anatomic. No fracture is evident. | Soft tissue swelling and joint effusion without fracture or dislocation. |
Generate impression based on findings. | Male 62 years old Reason: eval for obstruction History: constipation, SBO on KUB ABDOMEN:LUNG BASES: No focal consolidation or pleural effusion. Decreased amount of fluid or pleural thickening along the right major fissure.LIVER, BILIARY TRACT: Subcentimeter low attenuation lesion in segment 6 of the liver (series 3, image 62) is unchanged and too small to characterize. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube with retention device in place without evidence of complication. Bowel is normal in caliber without evidence of obstruction. No free intraperitoneal air or free fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Mildly distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction.BONES, SOFT TISSUES: Degenerative changes of the visualized thoracolumbar spine, most prominent at L5-S1.OTHER: No significant abnormality noted | No evidence of small bowel obstruction. |
Generate impression based on findings. | Please note, no 3-D images were acquired at the time of this interpretation.There is a large right frontoparietal subgaleal hematoma measuring up to 9 mm as noted in coronal series image 39. No underlying depressed calvarial fractures. No acute intracranial hemorrhage. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses are clear. Extensive bilateral mastoid air cell opacification with partial opacification of bilateral middle ears. Findings concerning for bilateral otitis. | 1.Large right frontoparietal subgaleal hematoma without acute intracranial abnormality.2.Findings concerning for bilateral otitis media with extensive opacification of the mastoid air cells.Findings relayed to Dr. McKee in the emergency department over the phone at 0957 hours. |
Generate impression based on findings. | 54 years, Male. Reason: eval NJ tube History: pulled NJ out 10cm Dobbhoff tube tip projects over the proximal gastric body. Interval placement of a gastrostomy tube now projecting over the gastric body. Bilateral pleural effusions, partially loculated on the left. Diffuse pulmonary opacities better evaluated on a prior chest x-ray. Lytic lesion involving the left eighth rib. Minimally displaced right ninth rib fracture. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | Male 54 years old Reason: r/o fx History: fall. We have 3 views of the thoracic spine. We see no fracture or malalignment. There are tiny anterior vertebral body osteophytes.We have 5 views of the lumbar spine. We see no fracture. The alignment is within normal limits. There is, perhaps, mild facet joint osteoarthritis affecting the lower lumbar spine. | Mild degenerative arthritic changes without fracture evident. |
Generate impression based on findings. | 5-year-old male with abdominal discomfort discomfort, assess for foreign bodyVIEW: Abdomen AP (one view) 3/3/15 23:25 Round metallic density within the gastric body. The bowel gas pattern is nonobstructive. | Radiopaque foreign body in the stomach, likely a coin. |
Generate impression based on findings. | Female 23 years old Reason: 2 wk sp lap chole now w epigastric pain, N/V History: above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Interval cholecystectomy with small amount of fluid in the gallbladder fossa which is expected in the postoperative period.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or dilatation. No evidence of bowel obstruction or intraperitoneal free air. BONES, SOFT TISSUES: Mild inflammatory changes in the subcutaneous tissue adjacent to the umbilicus (series 3, image 85) likely postoperative in etiology.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal cyst measuring 3.7 x 3.4 cm (series 3, image 126) which is presumably a functional ovarian cyst. Interval resolution of right adnexal cyst seen on previous exam. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis likely physiologic in nature. | Expected postoperative changes without acute abnormality. |
Generate impression based on findings. | Female 50 years old Reason: post-reduction films History: post-reduction. Evaluation is limited by overlying cast material. The previously seen comminuted fracture of the distal radius has been reduced to anatomic alignment. Ulnar styloid fracture fragment also appears to be in near-anatomic alignment. | Reduction of distal radius and ulnar styloid fractures. |
Generate impression based on findings. | Male; 33 years old. Reason: s/p reduction History: ankle dislocation. Evaluation of bony detail is limited by overlying casting material. There has been interval reduction of the tibiotalar joint which is now in anatomic alignment. No fractures are identified. | Interval reduction of tibiotalar joint. |
Generate impression based on findings. | Female 50 years old Reason: eval for fx, dislocation; FOOSH History: R wrist deformity. Three views of the right wrist show a comminuted fracture of the distal radius that appears to extend to the dorsal aspect of the articular surface of the radiocarpal joint. There is approximately 6 mm of dorsal displacement, as well as dorsal angulation of the distal fracture fragment. There is also a mildly displaced fracture of the ulnar styloid.Two views of the forearm show the aforementioned distal radius and ulnar styloid fractures. The proximal radius and ulna appears intact.Four views of the elbow show no acute fracture, malalignment, or joint effusion. | Distal radius and ulnar styloid fractures as above. |
Generate impression based on findings. | Male; 33 years old. Reason: eval for fx, dislocation History: ankle injury. Complete tibiotalar joint dislocation with lateral displacement of the talus and fibula with respect to the tibia. No definite associated fracture is identified. No ankle joint effusion. | Complete tibiotalar joint dislocation as described above. No fracture identified. |
Generate impression based on findings. | 68 years, Male. Reason: eval og tube History: og pulled back 5cm The lung bases are clear. NG tube side-port and tip project over the gastric cardia and gastric fundus, respectively. Nonobstructive bowel gas pattern. | NG tube tip projects over the gastric fundus. |
Generate impression based on findings. | Male 18 years old Reason: injury History: pain Three views of the right ring finger show a comminuted but nondisplaced fracture of the tuft of the distal phalanx.Three views of the right middle finger show a hairline lucency extending obliquely through the tuft of the distal phalanx that may represent a nondisplaced fracture, but this is equivocal. | Nondisplaced fracture of the tuft of the distal phalanx of the ring finger and possible nondisplaced hairline fracture of the tuft of the distal phalanx of the middle finger. |
Generate impression based on findings. | For the purposes of numbering, there are 5 lumbar type vertebral bodies. Vertebral body heights are maintained. Alignment is maintained. There is no acute fracture. There are degenerative changes throughout the lumbar spine with severe loss of intravertebral disk space at T12-L1, L1-L2, and to a lesser degree at L2-L3, L3-L4, and L4-L5. Adjacent sclerosis and subchondral cyst formation also seen. Vacuum disk phenomena is noted at the T12-L1, L1-L2, L2-L3, and L4-L5 levels.Multilevel degenerative changes are seen, as describe below:At L1-2 there is no significant compromise to spinal canal or neural foramina. Advanced endplate degenerative changes are noted with T2 hyperintensity noted on recent MRI most likely on a degenerative basis.At L2-3 there is no significant compromise to spinal canal or neural foramina. At L3-4 there is no significant compromise to spinal canal or neural foramina at this level. At L4-5 there is no significant compromise to spinal canal or neural foramina at this level. At L5-S1 there is advanced bilateral facet arthropathy. There is no significant compromise to spinal canal or neural foramina at this level. Degenerative changes at the bilateral sacroiliac joints also noted. Cystic lesions are again partially visualized. | Multilevel degenerative changes are again seen including severe endplate degenerative changes at the L1-L2 intravertebral disk level with vacuum disk phenomena, subchondral cyst formation, and endplate sclerosis. These findings correlate with the T2 hyperintensity within the disk space seen on MRI. No findings to suggest infection. Spinal canal stenosis and neural foraminal stenosis better assessed on recent MRI from 3/2/2015. |
Generate impression based on findings. | 15-month-old male with left thumb crush injury, rule out fractureVIEWS: Left thumb, AP, lateral, left hand, PA (two views) 3/4/15 3:46 Soft tissue swelling about the thumb. Irregularity along the medial base of the distal phalanx of the thumb compatible with fracture. Alignment is maintained. | Nondisplaced fracture of the base of the distal phalanx of the thumb. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. There are multiple bilateral benign morphology masses that are only well appreciated on tomosynthesis. Given this is the first study where that technology has been used, there is high likelihood that these masses have been present in the past and were obscured by her dense breast tissue. | No mammographic evidence of malignancy. Bilateral benign morphology masses. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Male 28 years old Reason: chronic back pain, please eval for fracture, subluxation, or other etiology for pain History: chronic back pain. Three views of the thoracic spine show no fracture or malalignment. There is mild narrowing of the intervertebral disk spaces of the upper thoracic spine, suggesting mild degenerative disk disease of questionable clinical significance. A right-sided central venous access device is identified with its tip overlying the cavoatrial junction.Five views of the lumbar spine show no fracture or malalignment. The vertebral body heights and intervertebral disk spaces appear normal. There is an IVC filter anterior to L2. A ringlike artifact overlying the right lower quadrant presumably represents a colostomy apparatus.Three views of the sacrum and coccyx show no fracture malalignment. The sacroiliac joints appear normal. | Mild degenerative arthritic changes of the upper thoracic spine and other findings as above, but we otherwise see no findings to account for the patient's pain. |
Generate impression based on findings. | Male; 39 years old. Reason: Rule out dislocation History: Pain No acute fracture or malalignment. No degenerative changes are noted about the glenohumeral joint. | Normal examination. |
Generate impression based on findings. | Female 70 years old Reason: ? diverticulitis History: RLQ pain and tenderness ABDOMEN:LUNG BASES: Stable bronchiectasis of the left lower lobe. No pleural effusion.LIVER, BILIARY TRACT: No focal hepatic masses or biliary ductal dilatation. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodense lesion in the right upper pole which is too small to characterize and likely represents a cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: Female. Limited exam secondary to beam hardening artifact from metallic fixation hardware.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Significant diverticulosis of the descending and sigmoid colon without evidence of acute diverticulitis. Chronic soft tissue infiltration, similar to prior exam from 2009, most prominent adjacent to the ascending colon which likely represents chronic inflammatory changes and may be secondary to prior episodes of diverticulitis.BONES, SOFT TISSUES: Surgical fixation hardware with metallic screws within the L2 through L5 vertebral bodies.OTHER: No significant abnormality noted | Suboptimal exam secondary to the beam hardening artifact from spinal fixation hardware. Within these limitations, there is significant colonic diverticulosis without acute diverticulitis. |
Generate impression based on findings. | BRAIN No abnormal T2 signal abnormalities. No evidence of optic nerve abnormalities on this non-dedicated exam. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. CERVICAL SPINE:Alignment is anatomic. The vertebral body heights and disc spaces are maintained. There are no fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. There is mild enlargement of right C2 neural foramina with mild enlargement of the nerve root which is nonspecific. No significant central spinal canal stenosis. The visualized paraspinal contents are unremarkable. THORACIC SPINE:There is rightward thoracic curvature. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no masses. There is central spinal cord syrinx that extends from T3 through L10 measuring 1.5 x 2 mm in maximal dimension at T7 (series 3201, image 28). Otherwise, the spinal cord has a smooth contour and is without focal atrophy, edema, or myelomalacia. No significant central spinal canal stenosis. LUMBAR SPINE:There is leftward lumbar curvature. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. No significant central spinal canal stenosis. The visualized intra-abdominal and paraspinal contents are unremarkable. | 1.No abnormal intracranial T2 signal to suggest neurofibromas.2.No evidence of optic gliomas on this non-dedicated examination. Further evaluation with dedicated orbital MRI examination may be considered if clinically indicated.3.No specific findings to suggest spinal neurofibromas or significant central spinal canal stenosis. |
Generate impression based on findings. | Female; 58 years old. Reason: Fall, pain in hip and shoulder. Shoulder: No acute fracture or dislocation. Mild degenerative changes are noted with inferior glenohumeral joint osteophytes.Hip: No acute fracture or dislocation. Severe joint space narrowing with near bone-on-bone apposition, bony sclerosis, and acetabular osteophytes are compatible with advanced osteoarthritis. Small metallic density presumably representing a bullet fragment is again noted overlying the left iliac wing. | Severe left hip osteoarthritis without acute fracture identified in the hip or shoulder. |
Generate impression based on findings. | Images are slightly limited by patient motion. There is a large T1 hypointense and heterogeneously T2 hyperintense slightly irregular but overall oval structure within the left submandibular space with a thick rind of enhancement. The collection measures 2.0-cm transverse by 2.3-cm AP by 2.2 cm CC. There are other smaller peripheral likely loculated areas along the inferomedial aspect of the collection extending into the left submental space and towards the left sublingual space along the left lateral floor of mouth, as well as the superomedial aspect extending into the left parapharyngeal space.There is mild mass effect upon the left base of tongue. There are significant surrounding inflammatory changes, without evidence of discrete abnormal vasculature. Vascularity noted on prior ultrasound is likely in response to reactive changes. No abnormal enhancement or signal seen within adjacent left mandible. There is mild mass effect upon the left aspect of the pharynx which is deviated to the right, without significant narrowing.There are several prominent left level Ia and Ib lymph nodes.PHARYNX/LARYNX: The nasopharynx, oropharynx, and hypopharynx are unremarkable. The larynx is unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The contrast-enhanced appearance of the right submandibular, sublingual, and parotid glands bilaterally is otherwise unremarkable. The thyroid gland is unremarkable. OTHER: The visualized intracranial structures are unremarkable. The left internal jugular vein flow void is not well-visualized and distal to the abscess. There is abnormal intrinsic T1 hyperintensity noted within the left jugular bulb extending down to the level of the abscess. Postcontrast images do not demonstrate definite enhancement of the distal vessel. | 1. Findings consistent with large left submandibular space abscess with surrounding significant inflammatory changes. Mild localized mass effect as detailed above, with minimal extension into adjacent neck spaces.2. Mild likely reactive left-sided cervical lymphadenopathy.3. Likely thrombus versus less likely slow flow in the proximal left internal jugular vein, with nonvisualization of the vessel at and caudal to the level of the abscess.Dr. Yang discussed these findings over the telephone with PICU fellow Dr. Amanda Sebring on 3/4/2015 9:30 AM. |
Generate impression based on findings. | Female 64 years old Reason: evidence of osteomyelitis? History: pt with infected ulcers, DM, want to assess for osteo. Avoiding MRI due to defibrillator. Primarily concerned about 3rd finger of L hand. There is a focal ulceration along the radial aspect of the proximal interphalangeal joint of the middle finger. There is replacement of the underlying subcutaneous fat with soft tissue density, presumably representing edema and/or granulation tissue. This abnormal density extends to the underlying proximal phalangeal head and middle phalangeal base, but we see no osteolysis or other findings to suggest osteomyelitis. There is also loss of soft tissue overlying the tuft of the distal phalanx of the middle finger, but we see no specific features of osteomyelitis. There may also be mild edema of the index finger, but this is equivocal.The remaining digits are unremarkable. Mild osteoarthritic changes affect the hand and wrist. A faint density between the ulna and lunate/triquetrum suggests chondrocalcinosis. | Ulceration and soft tissue swelling of the middle finger; we see no specific radiographic features of osteomyelitis. |
Generate impression based on findings. | Reason: Eval for PE; hx of multiple myeloma History: SOB PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Scattered benign-appearing micronodules and small pleural based nodules measuring up to 9 x 5 mm (series 7, image 70).Moderate right pleural effusion, with mild associated compressive atelectasis. There is evidence of high density component within the fluid collection in the right paraspinal region (series 5, image 192).Mild basilar scarring/atelectasis. No focal airspace consolidation.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.A mildly prominent right paratracheal lymph node measures 10 mm (series 5, image 81).CHEST WALL: Lytic lesions involving multiple posterior ribs, compatible with the known history of multiple myeloma. Healing posterior 9th right rib fracture. Spinal fixation hardware in place.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. Moderate right pleural effusion with layering higher density component in the right paraspinal region, which may be an extension of myeloma into the pleural cavity however blood products within the effusion cannot be excluded. Consider bedside ultrasound in the decubitus position.3. Additional osseous findings of multiple myeloma with surgical changes in the thoracic spine.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, repeat bilateral MLO views 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. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign calcifications are noted in each breast. Previously noted right lateral breast mass is less prominent suggesting an involuting cyst. | 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. | 18 years male with sore throat, fever, voice changes, worsening tonsillar edema. There is hypertrophy of the adenoid and palatine tonsils with associated mild narrowing of the nasopharynx. There is no evidence of fluid collection or abscess. However, there is mild narrowing of the pharyngeal airway. There are mildly prominent cervical lymph nodes, which are most likely reactive. There is partial paranasal sinus opacification. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is loss of the usual cervical lordosis. The osseous structures are otherwise unremarkable. The imaged intracranial structures and orbits are unremarkable. There is a small scar-like opacity in the right lung apex, which is most likely benign. | 1. Findings consistent with tonsillitis with associated mild narrowing of the nasopharynx. No evidence of abscess. 2. Nonspecific paranasal sinus opacification. |
Generate impression based on findings. | 18 year-old male status post foreign body removalVIEW: Abdomen, AP, Chest AP (two views) 3/4/15 3:08 Right PICC tip in the right atrium. ETT below thoracic inlet. The cardiothymic silhouette is unchanged. Low lung volumes and basilar predominant opacities appear similar to the prior exam.A zipper pull is again noted in the gastric body. G-tube unchanged in position. Left pelvic wires and femoral neck fixation again noted.Interval decrease in gaseous distention of the bowel. Moderate to large rectal stool collection is noted. | Interval decrease in bowel dilatation. Unchanged pulmonary opacities. |
Generate impression based on findings. | Female 44 years old Reason: s/p l tsa and fall History: same. Four views of left shoulder and two views of the left humerus are provided. There is anterior dislocation of the humeral component of the patient's total shoulder arthroplasty with respect to the glenoid component. Discontinuity of the greater tuberosity as well as a bone fragment along the medial aspect of the humeral neck presumably represent prior osteotomy and appear similar to the prior study. The distal humerus appears intact. | Anterior dislocation of left total shoulder arthroplasty. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, repeat left CC view and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. A stable asymmetry in the left medial breast is present. This does not persist as a mass on tomosynthesis. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Fever. Increased respiratory rate.VIEW: Chest AP (one view) 3/3/15 at 1711 hrs. Skeletal deformities and spinal hardware are again noted. Cardiac silhouette is non sizable. Small right lung volume is concerning for right lung base atelectases or pneumonia. No effusions or pneumothorax. | Right lung base atelectasis or pneumonia. |
Generate impression based on findings. | 61 years, Female, Reason: endometrial cancer with lung, liver and bone mets History: pre chemo. CHEST:LUNGS AND PLEURA: Innumerable pulmonary nodules are overall significantly increased from the prior exam.Reference left lower lobe nodule measures 1.3 by 1.1 cm (5/23), previously 0.7 x 0.8 cm. Reference right lower lobe nodule measures 1.0 x 1.1 cm (5/36), previously 0.8 x 0.8 cm.MEDIASTINUM AND HILA: Enlarged left supraclavicular node measures 3.7 x 2.9 cm (3/4), previously 3.4 x 2.1 cm. Precarinal node is increased measure 1.5 x 1.4 cm (3/28, previously 1.0 x 1.0 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic metastases are increased. Hepatomegaly.Reference right hepatic lobe lesion measures 1.6 x 1.5 cm (3/84), previously 1.1 x 1.0 cm. Main portal vein is mildly narrowed but patent.SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bulky necrotic left para-aortic lymph node conglomerate is increased measuring 6.2 x 5.0 cm (3/117), previously 5.8 x 4.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: See below.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Multi-septated thick walled left adnexal cystic lesion is stable in size measuring 7.2 x 4.6 cm (3/138), previously 7.0 x 5.1 cm. However, there is now significant dilatation of the endometrial cavity with a cystic component along the anterior uterine wall measuring 9.3 x 6.9 cm (3/160).Multiple fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple sclerotic lesions throughout the spine likely represent osseous metastases. A T10 lesion is increased from the prior examOTHER: No significant abnormality noted. | Overall progression of disease with increased pulmonary metastases, hepatic metastases, lymphadenopathy, cystic pelvic lesion and sclerotic bone lesions. |
Generate impression based on findings. | 61-year-old with intraductal papilloma with atypia in left breast presents for a seed localization. Target mass with marker clip is located in the left breast in the retroareolar region. The procedure, risks including bleeding and infection, and benefits of I-125 seed localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the stereotactic images, and IsoAid preloaded breast localization needle was placed adjacent to the clip. Pre-deployment images confirmed good positioning of the needle with respect to the target. The I-125 seed was then deployed. Then, the needle was withdrawn and the skin entry site was closed with steri strip.The post-deployment films confirmed that the seed was positioned at the site of the clip. A bracelet was placed on the left wrist labeled with the patient's name, MRN, number of seeds placed, left breast and surgical date (3/5/15). Post seed placement instructions were given to the patient. She tolerated the procedure well and left the Breast Imaging area in stable condition.Drs. Abe and Patel performed the procedure. | Successful seed localization of the left breast mass.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 73 year old woman with history of biopsied left fibroadenoma, followup of calcifications seen on prior mammogram. Three standard views of both breasts with additional bilateral MLO and cleavage view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy clip noted in the left upper inner breast. A few groups of bilateral, benign-morphology calcifications have mildly progressed in a benign fashion, likely hyalinizing fibroadenomas. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign-morphology lymph nodes are seen in the left axilla. | 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.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 3 days old History: respiratory distress, tachypnea.VIEW: Chest and abdomen AP (two views) 3/3/15 at 2250 hrs. UVC terminates at the right atrium. Cardiac silhouette size is normal. No focal opacities effusions thorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | UVC terminates at the right atrium.No focal lung opacities.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | RSV and pneumonia. Now with pneumomediastinum. Increasing oxygen apartment.VIEWS: Chest AP/lateral (two views) 03/04/15, 0220 and 0228 Endotracheal tube tip is below thoracic inlet. A gastrostomy tube is present. Left upper extremity PICC has its tip at junction of brachiocephalic veins. Surgical clips are present at the level of the GE junction.Pneumomediastinum continues. Hyperlucency is seen around the consolidated right lung apex. Hazy opacities are noted bilaterally focal opacity is present in left lower lobe. Cardiothymic silhouette size is normal. | Continued pneumomediastinum. Small right pneumothorax. |
Generate impression based on findings. | High-frequency nasal cannula with worsening desaturations.VIEW: Chest AP (one view) 03/03/15, 2124 Endotracheal tube tip is below the thoracic inlet. Left upper extremity PICC tip is in the superior vena cava. A gastrostomy tube is present. Surgical clips are seen at the level of the GE junction.Pneumomediastinum has developed with lucency along inferior aspect of thymus. Right upper lobe consolidation is seen. Some focal opacity persists in left lower lobe and hazy opacity is noted laterally. The cardiothymic silhouette is normal. | Development of pneumomediastinum. |
Generate impression based on findings. | Male 18 years old Reason: Eval lung fields History: PNA with R side pleural effusionVIEW: Chest AP (one view) 3/4/15 at 317 hours. Skeletal deformity and tracheostomy tube again noted. Cardiac silhouette size is normal. Amputation of the right mainstem bronchus with minimal right-sided mediastinal shift and complete opacification of the right lung is concerning for complete right lung atelectasis due to mucous plugging on a background of right-sided pleural effusion. | Right lung atelectasis development likely due to mucous plugging of the right mainstem bronchus. |
Generate impression based on findings. | There is nonspecific mild straightening of the cervical spine in the sagittal plane. There is multilevel degenerative cervical spondylosis with severe disc space narrowing at C4-5 and C5-6 and moderate disc space narrowing at C6-7 with areas of disc calcification. There is also ossification of the right ligamentum flavum at T2. There are scattered atherosclerotic calcifications. There is diffuse enlargement and heterogeneity of the thyroid gland without discrete nodule. Otherwise, the imaged paraspinal soft tissues are unremarkable. | 1. Straightening of the usual cervical lordosis and multilevel degenerative cervical spondylosis that is most pronounced at C4-5 and C5-6. Otherwise, no evidence of cervical spine fracture or spondylolisthesis. 2. Diffusely enlarged heterogeneous thyroid gland, which may be further evaluated with thyroid ultrasound as warranted clinically. |
Generate impression based on findings. | There is tiny focus of opacification involving the left inferior aspect of the frontal sinus. The frontal sinus and frontoethmoidal recesses are otherwise clear. The anterior ethmoid air cells are clear. The posterior ethmoid air cells are clear. The maxillary sinuses are clear. The ostiomeatal units are clear. The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is leftward deviation of the anterior bony nasal septum with mild narrowing of the left nasal passage. Mild mucosal thickening is seen along the right inferior turbinate and the right inferior meatus. Right-sided concha bullosa incidentally noted.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Visualized brain parenchyma and parapharyngeal soft tissues are unremarkable. | 1. No significant paranasal sinus disease.2. Leftward nasal septal deviation. |
Generate impression based on findings. | 74 years, Male. Reason: NGT placement History: post NGT placement Enteric feeding tube tip projects over the pyloric area. Midline skin staples again noted. Nonobstructive bowel gas pattern. Left lower lobe airspace opacity. The pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the pyloric area. |
Generate impression based on findings. | Pneumothorax. Pneumopericardium.VIEWS: Chest AP/lateral (two views) 03/03/15, 2206 and 2212 Endotracheal tube tip is below thoracic inlet. Left upper extremity PICC tip is in superior vena cava. A gastrostomy tube is present. Surgical clips are seen around the GE junction.Pneumomediastinum is again visualized. Air is noted anteriorly and inferior to the thymus.Hazy opacities are present bilaterally with opacification of right upper lobe. Cardiothymic silhouette is normal. | Pneumomediastinum. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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 heterogeneously dense, which may obscure small masses. A round obscured mass is present in the right inner breast. Biopsy clip and benign calcification noted in the left breast. No suspicious microcalcifications or areas of architectural distortion are present. | Right breast mass for which comparison to prior mammograms is needed. If these cannot be submitted, then further evaluation with spot compression and ultrasound will be necessary.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OC - OLD FILM FOR COMPARISON |
Generate impression based on findings. | 68 years, Male. Reason: NGT adjustment History: NGT adjustment Enteric feeding tube tip projects over the pyloric area. Persistent ileus type bowel gas pattern. Suture material projects over the right lower quadrant. Pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the pyloric area. |
Generate impression based on findings. | 53 years, Female. Reason: OG tube placement History: Line placement Enteric feeding tube tip projects over the gastric body. Nonobstructive bowel gas pattern. Surgical clips project over the pelvis. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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 composed of scattered fibroglandular density. A left sided catheter obscures portions of the left axilla on the MLO view.No suspicious masses, microcalcifications or areas of architectural distortion are present. Innumerable bilateral benign calcifications are not significantly changed, many representing vascular calcifications. | 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. | There is no acute intracranial hemorrhage, mass effect, or midline shift. There are mildly prominent bifrontal extra-axial CSF spaces measuring up to 6 mm in thickness which may represent atrophic changes, subdural hygroma, or possibly chronic subdural hematomas. The ventricles, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. Portions of an NG tube are visualized in the oropharynx. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | 1. No acute intracranial hemorrhage or mass effect. No convincing evidence of global anoxic injury. Follow-up CT or MRI can be considered as clinically appropriate. 2. Mildly prominent bifrontal extra-axial CSF spaces measuring up to 6 mm in thickness which may be related to volume loss (favored) or small chronic subdural hematomas. MRI may be helpful to differentiate if clinically indicated. |
Generate impression based on findings. | Reason: r/o PE History: increased pleuritic CP, SOB, hx of PE, missed Lovenox PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery is upper normal in caliber.LUNGS AND PLEURA: Severe apical predominant centrilobular and paraseptal emphysema. Marked biapical pleural scarring.Large left chest wall mass with involvement of the left lung and extensive destruction of the left and sixth ribs, mildly increased in size from the prior exam. A prominent nodular component within the left lung extending from the hilum toward the chest wall measures approximately 2.8 x 2.7 cm (series 10, image 52), previously 2.0 by 1.5 cm.Basilar scarring, unchanged.Tracheobronchial debris, compatible with mucous plugging, with prominent debris at the level of the carina extending into the bilateral mainstem bronchi (series 10, image 57).MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.Scattered calcified mediastinal and hilar lymph nodes, unchanged, compatible with prior granulomatous disease. Mildly prominent left hilar lymph nodes appear similar to the prior exam.CHEST WALL: Left chest wall mass as measured above, with bony destruction of the left fifth and sixth ribs. The anterior lytic component involving the left 5th rib is slightly increased.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Renal hypodensities, unchanged, likely simple cysts. | 1. No evidence of pulmonary embolism.2. Large mucus plug/retained secretions extending over the carina and into the bilateral mainstem bronchi.3. Left chest wall mass, with bony destruction of the left fifth and sixth ribs, increased from the prior exam.4. No new sites of disease identified.5. Severe emphysema and pleural/pulmonary scarring appears unchanged.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. Findings discussed via telephone with Dr Gray at 10:10 AM. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. Beam hardening artifact through the brainstem limits evaluation for subtle abnormalities. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is and mildly atelectatic right maxillary sinus with mild mucosal thickening and thickened walls; these findings suggest chronic right maxillary sinusitis. The skull and extracranial soft tissues are unremarkable. There is a partial empty sella of incidental note. | No acute intracranial hemorrhage or mass-effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion. |
Generate impression based on findings. | Female; 68 years old. Reason: OA History: pain Inferior glenohumeral joint osteophytes as well as subchondral cysts in the humeral head, compatible with mild osteoarthritis. No acute fracture or dislocation. | Mild osteoarthritis without acute fracture evident. |
Generate impression based on findings. | Male 17 years old Reason: reassess obstructive pattern. Generalized abdominal painVIEW: Abdomen AP (one view) 3/4/15 at 615 hours. Surgical plates and right sided ostomy are again noted. Persistent minimal bowel distention concerning for obstruction or ileus. No pneumoperitoneum. | Persistent minimal bowel distention concerning for obstruction or ileus. |
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