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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, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. A few scattered benign calcifications are again noted. There are bilateral areas of inferior asymmetry on the MLO views which not only disperse to normal tissue on tomosynthesis but are also quite similar to old comparison studies, specifically the 2009 comparison study. | 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. | Female 59 years old; Reason: Restaging. 59F with metastatic esophageal cancer. IRB 130074 with Cis/5FU/Herceptin + pertuzumab or placebo, received C2D1 2/18/2015 History: Restaging. Admitted with cellulitis groin and under breasts CHEST:LUNGS AND PLEURA: No pleural effusion. Scattered micronodules, including reference left upper lobe nodule which demonstrates interval decrease in size, measuring 6 x 4 mm, image 21 series 5, previously measured 8 x 7 mm. MEDIASTINUM AND HILA: Moderate to severe calcified coronary artery disease. Moderate to severe distal esophageal circumferential wall thickening containing gaseous foci, likely reflecting patient's known esophageal carcinoma. Degree of wall thickening demonstrates apparent interval improvement, measures 1.2 cm, image 56 series 3, previously measured 1.7 cm. Collapsed bladder, making assessment suboptimal.CHEST WALL: Right chest wall port with tip located near right atrium/IVC junction. Small air around port in right chest wall, likely related to placement and correlation with patient's history recommended.ABDOMEN:LIVER, BILIARY TRACT: Bilobar hepatic metastatic disease. Stable reference segment 8 mass, measuring 7.7 x 6.8 cm, image 75 series 3. At least one lesion demonstrates mild interval increase in size, for example, hepatic segment 2 lesion measuring 2.5 x 2.3 cm, image 59 series 3, previously measured 2.2 x 2 cm. Marked attenuation of hepatic veins as approach IVC and attenuation of distal left portal venous branches seen.SPLEEN: Splenule formation.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable hypoattenuating focus in right kidney, too small to characterizeRETROPERITONEUM, LYMPH NODES: Mildly prominent portacaval, gastrohepatic and retroperitoneal lymph nodes. Stable reference portacaval lymph node measuring 1 x 0.8 cm, image 91 series 3, previously also measured 1 x 0.8 cm. Decreased size of reference gastrohepatic lymph node, measuring 1.4 x 0.6 cm, image 79 series 3, previously measured 1.6 x 1.1 cm. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Colonic diverticulosis without evidence of acute diverticulitis.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Visualized osseous structures stable in appearance with multilevel degenerative changes seen.BONES, SOFT TISSUES: Gaseous foci in ventral subcutaneous tissues, likely sequela from prior injections. | 1. Stable to mild interval increase in size of hepatic metastases as described.2. Stable to mild interval decrease in size of reference left upper lobe lung nodule and prominent upper abdominal lymph nodes as above.3. Mildly improved esophageal wall thickening.4. Right chest wall port with tip located near right atrium/IVC junction. Small air around port in right chest wall, likely related to placement and correlation with patient's history recommended. |
Generate impression based on findings. | 18 year-old male with limited range of motion and swellingVIEWS: Left elbow, lateral, and oblique (two views) 3/3/15 13:59, left shoulder, internal and external rotation (two views) Elbow: Moderate joint effusion. A subtle lucency through the radial head may represent a nondisplaced fracture. Alignment is anatomic.Shoulder: The humeral head articulates normally with the glenoid fossa. No fracture or dislocation. | Elbow joint effusion with subtle lucency suggesting a nondisplaced radial head fracture. Findings discussed with the clinical service. |
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. | 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. | 15 year old male with history of mycobacterium infection now status post allogeneic bone marrow transplant. Neck: There has been further overall slight interval decrease in size of multiple left supraclavicular and cervical partially calcified lymph nodes. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter in position. There is a focus of hypoattenuation inferior to the catheter tip. The airways are patent. There are bilateral probable maxillary sinus retention cysts. The imaged intracranial structures are unremarkable. There is a subcentimeter left mandibular enostosis. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial or mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. Further overall slight interval decrease in size of multiple left supraclavicular and cervical lymph nodes compatible with treated granulomatous disease. 2. A focus of hypoattenuation inferior to the right internal jugular venous catheter tip may represent artifact versus a small amount of clot. A Doppler ultrasound may be useful for further characterization, if clinically warranted. 3. No evidence of intracranial lesions. |
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. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made. The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: Evaluate for PE History: Tachycardia, syncope, chest pain with deep inspiration PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Mild basilar scarring/atelectasis. A small faint area of groundglass in the right upper lobe with local mild bronchial wall thickening may relate to mild aspiration or bronchitis/pneumonitis.No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.A mildly enlarged right paratracheal lymph node measures 10 mm (series 5, image 68).Homogeneous soft tissue density mass within the anterior mediastinum, with smooth contours and convex border on the left. This tissue measures 24 mm in thickness anteriorly (series 5, image 68) and a left lateral thickness of 19 mm (series 5, image 85).The thyroid gland is enlarged bilaterally, extending to the level of the sternum on the left, mildly heterogeneous, without discrete large nodules identified.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. A small faint area of groundglass in the right upper lobe with local mild bronchial wall thickening may relate to mild aspiration or mild focal bronchitis/pneumonitis.3. Thymic hyperplasia versus lymphoid hyperplasia of thymus (autoimmune thymitis), correlate for Graves disease, myasthenia gravis, RA, SLE or scleroderma.4. Enlarged, heterogeneous thyroid. Correlate with lab values and ultrasound imaging if clinically warranted. Thyroiditis cannot be reliably distinguished from other causes of thyroid gland enlargement by CT.5. Differential diagnosis and discrepancy between preliminary and final interpretation was discussed with ED attending at extension 5-6807 at 11:22 a.m. on 3/4/2015.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 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. Motion on the right CC view is not a significant limitation to this study given the performance of the tomosynthesis images.No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable normal-sized lymph nodes project in each axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, repeat right CC view and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign calcifications and parenchymal asymmetries do not appear significantly changed. | 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. | Status post left lumpectomy and re-excision for DCIS in left breast in 2014 followed by radiation therapy, presents today for routine follow up. No current breast complaints. Three standard views of both breasts and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Post surgical seroma with multiple surgical clips is demonstrated in the left breast. Mild skin thickening of left breast is noted likely due to radiation treatment. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: Rule out PE History: Chest pain PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions. MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine, with age indeterminant compression deformities at T7 and T8.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small splenules. | 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. | 83 years, Male. Reason: Dobbhoff placement History: eval for Dobbhoff position Dobbhoff tube tip projects over the proximal gastric body. Ileus type bowel gas pattern. Interval removal of multiple staples. Rectal catheter is noted. Again seen is a 1.9 cm radiodensity likely representing a bladder calculus. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | 40 year old woman with history of colon cancer and Lynch syndrome, recalled from screening mammogram for left breast calcifications. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a group of coarse, calcifications in the left upper outer breast along with scattered, amorphous calcifications throughout the left upper outer breast. No dominant mass or areas of architectural distortion are seen in the left breast. | Grouped coarse and scattered amorphous calcifications in the left breast. As long as the patient's physical examination remains normal, followup with left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | 56-year-old female. Squamous cell lung cancer treated with RT. Evaluate for progression of metastatic disease. LUNGS AND PLEURA: Left peribronchovascular soft tissue thickening and patchy across opacities in the perihilar left lung consistent with lymphangitic spread of tumor. This is similar in appearance to prior.Reference left apical nodule is 9 x 8 mm (series 6, image 12), unchanged.Inferior left upper lobe nodule is 8 x 10 mm (series 6, image 41), unchanged.Mild emphysema with scattered bullae on the right.No new findings.MEDIASTINUM AND HILA: Extensive mediastinal and bilateral hilar lymphadenopathy, overall increased in size and with new necrosis in some lymph nodes.Reference subcarinal lymph node is 15 mm (series 4, image 48), previously 11 mm.Normal heart size. Mild coronary calcification.Necrotic lower cervical lymphadenopathy.Right chest port tip at the cavoatrial junction.Small cardiophrenic lymph nodes, unchanged.Nonspecific multinodular thyroid, unchanged.CHEST WALL: New necrotic enlarged left axillary lymph node that is 18 mm in short axis (series 4, image 21).Ulcerated left supraclavicular cutaneous metastasis is 14 x 26 mm (series 4, image 10), previously 18 x 37 mm.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Refer to separately dictated same day CT abdomen/pelvis report. | 1. Increased size of extensive mediastinal and hilar lymphadenopathy. New left necrotic axillary enlarged lymph node.2. Left lung pulmonary nodules and lymphangitic carcinomatosis, not significantly changed.3. Decreased size of ulcerated left supraclavicular cutaneous metastasis. |
Generate impression based on findings. | 56-year-old female with history of headache and loss of vision. There is moderate periventricular and subcortical white matter hypoattenuation which is nonspecific. There is moderate sulcal prominence and volume loss especially within the cerebellum and bilateral parietal lobes. Additional hypoattenuating foci are present within bilateral insular cortices, appearing similar to prior. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No mass or mass effect. The basal cisterns are intact. The imaged paranasal sinuses and mastoid air cells are clear. Bilateral lens replacement is noted. A lucent lesion in the right parietal bone is stable. The soft tissues are within normal limits. | 1. Moderate periventricular and subcortical white matter hypoattenuation as well as hypoattenuating foci within bilateral insular cortices are nonspecific but may be the sequela small vessel ischemic disease. If there is clinical concern for acute ischemic infarction, an MRI is recommended.2. Prominence of the sulci and volume loss particularly within bilateral parietal lobes and cerebellum is nonspecific. |
Generate impression based on findings. | NSCLC Stage IV, PET to evaluate growing solitary lung nodule.RADIOPHARMACEUTICAL: 11.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 107 mg/dL. Today's CT portion grossly demonstrates multiple mediastinal lymph nodes, including within the right supraclavicular, superior mediastinum, prevascular, right hilar regions and posterior mediastinal para-aortic region. The right hilar mass is again seen. There is a new left upper lobe nodule. Note is made of prominent atherosclerotic calcifications within the coronary arteries. Surgical clips are visualized in the right axilla. A right-sided chest port terminates in the SVC.Today's PET examination demonstrates interval increase in the abnormal increased FDG avid activity of the right hilar mass which now has an SUV max of 9.8 compared to 6.9 previously. There has been decrease in the activity of the right paratracheal lymph node. There has also been a decrease in the size and number of the right hilar lymph nodes. However the right supraclavicular, superior mediastinal and prevascular lymph nodes demonstrating abnormally increased hypermetabolic FDG avid activity are all new and compatible with tumor. There is also new abnormally increased FDG avid activity within a posterior mediastinal para-aortic lymph nodes compatible with tumor. | 1.Overall progression of disease, with increasing activity of the right hilar mass, interval appearance of multiple new lymph nodes and a new contralateral left hypermetabolic lung nodule all consistent with tumor. 2.Interval decrease in size of the right paratracheal and right hilar lymph nodes. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts on 8 images were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is a focal asymmetry in the central right breast. No suspicious microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications and stable asymmetries are present elsewhere bilaterally. | Right breast focal asymmetry for which spot compression and possible ultrasound are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 9-year-old male, left chest tube removalVIEWS: Chest AP/lateral (two views) 3/4/15 8:24 Left PICC tip in the right atrium. The cardiothymic silhouette is normal. Low lung volumes with bilateral basilar opacities and atelectasis appearing similar to the prior exam. Blunting of the costophrenic angles may represent small effusions or atelectasis. Small unchanged residual left pneumothorax. | Unchanged basilar pulmonary opacities and small residual pneumothorax. |
Generate impression based on findings. | Male 54 years old; Reason: Peritoneal mesothelioma, please compare to prior exam. ABDOMEN:LUNGS BASES: Please refer to dedicated CT chest study from same day for additional findings.LIVER, BILIARY TRACT: Status post cholecystectomy. Left hepatic hypoattenuating subcentimeter focus, too small to characterize but likely a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent mesenteric lymph nodes, stable to mildly increased in prominence. Reference lymph node measuring 1.5 x 0.8 cm on image 65 series 7, previously measured 1.3 x 0.7 cm. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Again seen is mild wall thickening involving transverse colon, may be related in part to underdistention or secondary to scarring, additionally seen is mild diffuse wall thickening/underdistention involving the splenic flexure and descending and rectosigmoid colon. Nodularity seen along left hemidiaphragm described as peritoneal disease on an earlier exam but may in fact be redundant diaphragm is not significantly changed, measuring approximately 2.3 x 1.4 cm, image 32 series 7. Mild interval increase in amount of free fluid in right paracolic gutter and intervening between stomach and pancreas. Mildly increased mesenteric fat induration/soft tissue nodularity seen, particularly in left upper quadrant, image 42 series 7, mild haziness also seen in ventral abdomen. Mild adjacent small bowel wall thickening. Mild interval increase in abdominal ascites, stable pelvic ascites. PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Mild interval increase in abdominal ascites, stable pelvic ascites. Mild adjacent small bowel wall thickening. Increased mesenteric fat induration/nodularity, particularly in left abdomen. Mild interval progression of neoplastic disease a consideration. 2. Mildly prominent mesenteric lymph nodes, stable to mildly increased in prominence. 3. Nodularity seen along left hemidiaphragm described as peritoneal disease on an earlier exam but may in fact be redundant diaphragm, not significantly changed. 4. Please refer to concomitant CT chest study for additional findings. |
Generate impression based on findings. | 13-year-old female, rule out hip subluxationVIEWS: Pelvis, AP and frog leg (two views) 3/3/15 17:03 The femoral heads articulate normally with the well formed acetabula. The osseous structures of the pelvis appear normal for the patient's age. | Normal examination without subluxation. |
Generate impression based on findings. | 15-year-old female, assess for pulmonary abnormalityVIEWS: Chest AP/lateral (two views) 3/3/15 19:54 The cardiothymic silhouette is normal. The aortic arch, cardiac apex and stomach are left-sided.Mild bronchial wall thickening, suggesting reactive airway disease or bronchiolitis without focal pulmonal opacity or pleural effusion. | Bronchiolitis without evidence of pneumonia. |
Generate impression based on findings. | 87 year old woman with history of left breast IDC s/p lumpectomy 2007. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Local volume loss, architectural distortion, parenchymal thickening, and surgical clips are noted in the left upper outer breast. Additional bilateral, benign-morphology calcifications are noted. No suspicious dominant mass or microcalcifications are seen in either breast. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 62 years, Male. Reason: NGT placement History: as above Nasogastric tip projects over the gastric body. Swan-Ganz catheter, left IJ central venous catheter, right upper quadrant drains and right upper quadrant surgical clips are noted. Expected improvement of pneumoperitoneum. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Nasogastric tip projects over the gastric body. |
Generate impression based on findings. | Clinical question: Dizziness and protracted headache. On coumadin. Signs and symptoms: As above. Nonenhanced head CT:There is no acute intracranial process. CT however is insensitive for detection of an acute nonhemorrhagic ischemic stroke. Of the cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Evaluate fracture Three views of the right ankle reveal an oblique distal fibular fracture. There's been some bone resorption at the fracture site and callus formation consistent with healing. The bones are in anatomic alignment. | Healing distal fibula fracture |
Generate impression based on findings. | Images are somewhat limited by patient motion, especially coronal T2 weighted images. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified. Myelination is appropriate for age.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is incidental mild disconjugate gaze. | Unremarkable noncontrast MRI brain. |
Generate impression based on findings. | Bilateral knee pain Three views of the right knee reveal marked medial joint space narrowing consistent with osteoarthritis. There are calcifications in the metadiaphysis of the femur consistent with areas of bone infarction.Three views of the left knee reveal marked medial joint space narrowing. Also noted is the area of bone infarction in the distal metadiaphysis of the femur. | Bilateral severe osteoarthritis. Bilateral bone infarctions |
Generate impression based on findings. | There is no intracranial mass or mass-effect. There are no areas of abnormal signal or pathological enhancement. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is moderate opacification of the paranasal sinuses, which is worse since 9/17/2014.There is redemonstration of an enhancing mass in the left superior mediastinum which measures approximately 26 x 18 x 36 mm in the AP, transverse, and craniocaudal dimensions grossly similar to prior. The mass is again intimately related with the proximal upper mediastinal and cervical vessels, with splaying of the proximal left subclavian artery and left common carotid artery. The mass abuts/partially encases the origin and proximal left V1 segment. These flow-voids remain present suggesting patency. The mass is near the left ventral margin of the T1 and T2 vertebral bodies without invasion. There is again no spinal canal or foraminal extension.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Post radiation marrow changes are seen within the cervical and upper thoracic spine. The visualized spinal cord is of normal caliber and signal. There is no new pathological enhancement.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical or thoracic spine. There is bilateral dependent atelectasis. | 1. No evidence of metastatic disease to the brain or calvarium. No evidence of metastatic disease in the cervical or thoracic spine.2. No significant change in size of left superior mediastinal lesion.3. Moderate opacification throughout the paranasal sinuses, which is new since 9/17/2014. |
Generate impression based on findings. | 38-year-old female. Metastatic non small cell lung cancer. Evaluate response to treatment. CHEST:LUNGS AND PLEURA: Patchy bilateral groundglass opacities, greater on the right, are decreased in extent, most notably in the right lung base. Right middle lobe opacity is now completely consolidated due to increased atelectasis, previously was partially groundglass.Diffuse micronodules are also decreased in number.MEDIASTINUM AND HILA: Right supraclavicular lymph node is 12 mm (series 3, image 6), previously 15 mm.Decreased size of mediastinal lymphadenopathy. Reference high right paratracheal lymph node is 14 mm (series 3, image 25), previously 17 mm, and reference right hilar node is 16 mm (series 3, image 44), previously 22 mm.Normal heart size. No visible coronary artery calcification.Left chest port tip at the cavoatrial junction.Multinodular thyroid, unchanged.CHEST WALL: Mild degenerative changes of the thoracolumbar 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: Punctate right adrenal calcifications, unchanged, may be from prior hemorrhage.KIDNEYS, URETERS: Nonobstructive left renal stones.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 changes of the thoracolumbar spine. OTHER: No significant abnormality noted. | Decreased bilateral pulmonary tumor as well as intrathoracic lymphadenopathy. No new sites of disease. |
Generate impression based on findings. | 67-year-old female patient with history of Crohn's disease status post multiple bowel resections and end colostomy with approximately 20 cm of colon remaining. Evaluate for inflammatory or small bowel changes. Patient complaints of dysphagia with sensation of food getting caught in the cervical esophagus. UPPER GI: Scout radiograph demonstrated multiple surgical staples projecting over the abdomen and a nonobstructive bowel gas pattern.Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, provoked gastroesophageal reflux was observed and was cleared spontaneously. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the thoracic inlet with proximal escape, delayed secondary waves and occasional tertiary waves. Silent penetration was seen.The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal.The duodenal bulb and sweep were within normal limits. A 13 mm barium pill was caught in the patient's left vallecula with reproduction of patient's symptoms. After several sips of water, the pill passed into the esophagus and was transiently hung up at the gastroesophageal junction.SMALL BOWEL FOLLOW-THROUGH:Transit time to the end colostomy was 30 minutes. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. The terminal bowel proximal to the end colostomy demonstrated a longitudinal fold pattern and decreased peristalsis. There appear to be haustral markings in a small portion of this segment, suggesting that it is colon. The length of this segment measures approximately 25 cm. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 5:07 + 5:41 = Total of 10:48 minutes | 1.Minor esophageal motility abnormality.2.Barium pill caught in vallecula with reproduction of dysphagia symptoms.3.No evidence of active Crohn's disease.4.Approximately 25 cm of colon proximal to the end colostomy. |
Generate impression based on findings. | 34 y/o with history of palpable right breast mass two days prior to menses. History of biopsy proven left breast fibroadenoma. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Bilateral, benign-morphology calcifications are noted in a regional distribution. No dominant mass, suspicious microcalcifications, or areas of architectural distortion are seen in either breast. SONOGRAPHIC | No mammographic or sonographic evidence of malignancy. Clinical follow up is recommended. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | 15-year-old male with history of mycobacterium infection LUNGS AND PLEURA: No evidence of mycobacterial infection. No focal pulmonary opacity, nodule or pleural effusion.MEDIASTINUM AND HILA: Right central venous catheter extends to the SVC. Low attenuation adjacent to the catheter suggests thrombus or possibly flow artifact. No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: No axillary or supraclavicular lymphadenopathy.UPPER ABDOMEN: The visualized structures of the upper abdomen appear normal. | Normal exam without evidence of mycobacterial infection. Possible thrombus adjacent to the tip of the right central venous catheter. |
Generate impression based on findings. | 15 month old male with bilious emesis and diarrhea. Evaluate for obstruction.VIEWS: Abdomen AP and left lateral decubitus (two views) 3/3/2015 Nonobstructive bowel gas pattern. No pneumatosis intestinalis, pneumoperitoneum or portal venous gas. | Normal examination. |
Generate impression based on findings. | 75 year-old male with history of prostate cancer now with new right lower extremity edema. ABDOMEN:LUNG BASES: Previously seen upper lobe pulmonary micronodules are not included in the field-of-view.LIVER, BILIARY TRACT: Subcentimeter low attenuation lesion within the hepatic dome (series 3, image 17) unchanged since 2013. Cholelithiasis without evidence of active inflammation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Indeterminate adrenal nodules, unchanged. Right adrenal nodule measures 1.4 x 1.4 cm. Left adrenal nodule measures 1.1 x 1.3 cm. KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Mild atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Moderate hiatal hernia. Normal caliber bowel without evidence of obstruction. Mild colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Small fat-containing umbilical hernia. Postsurgical changes to the anterior abdominal wall. Degenerative changes of the thoracolumbar spine appearing similar to prior without suspicious sclerotic lesions.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy by size criteria.BOWEL, MESENTERY: Moderate hiatal hernia. Normal caliber bowel without evidence of obstruction. Mild colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine appearing similar to prior without suspicious sclerotic lesions.OTHER: No significant abnormality noted | 1.Status post prostatectomy.2.No specific evidence of metastatic disease in the abdomen or pelvis. Note that nuclear medicine bone scan is more sensitive for the detection of osseous metastatic disease.3.No pelvic lymphadenopathy to explain patient's right lower extremity edema. Note that this exam is suboptimal for evaluating for DVT.4.Stable bilateral indeterminate adrenal nodules.5.Cholelithiasis. |
Generate impression based on findings. | 49-year-old female. Bronchiectasis. History of calcified lymph nodes. Evaluate lung parenchyma and mediastinum. LUNGS AND PLEURA: Bilateral lower lobe bronchiectasis with extensive mucus plugging, similar to prior.Extensive tree-in-bud opacities and patchy airspace opacities in the lower zones consistent with an infectious bronchiolitis, with new involvement of the lingula. There is post-obstructive atelectasis of the right middle lobe.Previously noted lingular nodule is obscured by the aforementioned infectious process.MEDIASTINUM AND HILA: Tracheostomy tube.Smooth wall thickening and narrowing of predominately the anterior trachea and main bronchi with posterior sparing measuring up to 6 mm, not significantly changed.Small mediastinal and mildly enlarged left hilar lymph nodes, similar to prior.Normal heart size. No visible coronary artery calcification.CHEST WALL: Minimal degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Focal hepatic calcification, unchanged. | 1. Smooth anterior wall thickening and narrowing of the trachea and bronchi without significant interval change. This can see be seen in granulomatous disease and relapsing polychondritis. Amyloidosis is much less likely given lack of calcification and prior negative biopsy.2. Lower zone infectious bronchiolitis with new involvement of the lingula, likely related to partial bronchial obstruction and inspissated mucous. Extensive lower lobe bronchiectasis with mucus plugging and post-obstructive atelectasis of the right middle lobe.3. Previously noted 6 mm lingular nodule is not visible and may be obscured, but is likely benign given the 7 year interval since the previous scan. |
Generate impression based on findings. | 26 year-old female with right lateral malleolus tenderness for 6 days after a fall. Evaluate for fracture. Pain and swelling. I see no fracture or other specific findings to account for the patient's pain. | No fracture or other specific findings to account for the patient's pain are evident. |
Generate impression based on findings. | Female; 75 years old. Reason: Left knee and shoulder pain with decreased ROM s/p fall. Knees: No acute fracture or dislocation is identified in either knee. No significant degenerative changes or joint effusion in either knee. Shoulders: No acute fracture or malalignment in either shoulder. No significant degenerative changes. | Normal knee and shoulder radiographs. |
Generate impression based on findings. | Female; 57 years old. Reason: s/p corpectomy with cage. Cervical spine is visualized to the inferior aspect of C7 on the lateral view. Postsurgical changes status post C5 corpectomy with bone graft/spacer placement. Anterior orthopedic screws fuse the C4 and C6 vertebral bodies which are in anatomic alignment. Thickening/edema of the retropharyngeal tissues is likely postoperative in etiology. No acute fracture or malalignment. The remaining vertebral body heights are preserved. | Postsurgical changes status post C5 corpectomy as described above. |
Generate impression based on findings. | Peritoneal mesothelioma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable serosal soft tissue foci involving the liver surface. A representative serosal lesion involving the dome of the liver best seen on image 20 axial and image 60 coronal, measures 1.6 by 1 cm. SPLEEN: No significant change in peri-splenic/peritoneal soft tissuePANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No change in right renal atrophy.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Accounting for differences in the degree of gastric distention, there has been no significant change in peritoneal based soft tissue thickening involving the anterior aspect of the stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant change in residual soft tissue focus within the pelvic cul-de-sac best seen on image 124 measuring 2.2 x 0.8 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination. No significant change in perihepatic, perigastric, perisplenic, and pelvic cul-de-sac soft tissue |
Generate impression based on findings. | Upper and lower extremity pain. Cervical disk herniation. Evaluate stability of spine. Severe degenerative disk disease affects C4/5. Moderate degenerative disk disease affects C5/6, C6-7 and C7/T1. Alignment is within normal limits and I see no frank instability between the flexion, neutral, and extension views. | Degenerative disk disease without evidence of instability. |
Generate impression based on findings. | Male 79 years old Reason: Pre-kidney transplant candidate. Assess vasculature to support transplant. History: See above ABDOMEN: Limited examination secondary to lack of oral and intravenous contrast. Lack of oral contrast makes evaluation of bowel pathology suboptimal. Lack of intravenous contrast makes solid organ and vascular pathology suboptimal. Within these limitations, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Punctate calcification the liver consistent with prior granulomatous disease. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple hypodense lesions bilaterally favor renal cysts.RETROPERITONEUM, LYMPH NODES: IVC filter in place. Mild to moderate atherosclerotic calcifications of the abdominal aorta. Minimal atherosclerotic calcifications in the bilateral common iliac arteries. No significant atherosclerotic calcifications in the bilateral external iliac arteries. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral fat containing inguinal hernias.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Enlarged prostate. BLADDER: Diffuse bladder wall thickening and trabeculations which may be secondary to the enlarged prostate.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant atherosclerotic calcifications in the bilateral external iliac arteries. Minimal atherosclerotic calcifications in the bilateral common iliac arteries. Mild to moderate atherosclerotic calcifications of the abdominal aorta. |
Generate impression based on findings. | T1N2b right oral cavity squamous cell carcinoma status post treatment. There are stable post-treatment findings in the neck. There is no definite evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria, although assessment is limited due to dental artifacts. The thyroid and remaining salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Stable post-treatment findings in the neck without definite evidence of measurable mass lesions or significant cervical lymphadenopathy, although assessment is limited due to dental artifacts. |
Generate impression based on findings. | Back and upper/lower extremity pain. Degenerative disk disease of the cervical spine has been described in a subsequent cervical spine radiograph report. There is moderate to severe multilevel degenerative disk disease throughout the thoracic spine. Severe degenerative disease affects L5/S1. Moderate degenerative disk disease affects L4/5. Moderate to severe facet joint osteoarthritis affects the lower lumbar spine, and there is a grade 1 anterolisthesis of L4 relative to L5. There is also hypertrophy of the spinous processes of the lumbar spine with associated degenerative changes. I see no scoliosis. There is a positive sagittal balance of approximately 8 cm. The sacral slope is approximately 40 degrees. Pelvic tilt is approximately 22 degrees. Pelvic incidence is approximately 64 degrees. | Degenerative disk disease, facet joint osteoarthritis, and positive sagittal balance as above. |
Generate impression based on findings. | 63 year old woman with history of right breast cancer s/p mastectomy in 1982. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 62-year-old male with history of Frey procedure (post op day 2), now with abdominal pain, fevers, and tachycardia, evaluate for anastomotic leak. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with overlying atelectasis/consolidation. Moderate coronary artery calcifications. LIVER, BILIARY TRACT: Postsurgical changes from recent cholecystectomy and hepatic segment 5 partial resection. No intrahepatic or extrahepatic biliary ductal dilatation. There is a moderate amount of perihepatic fluid both laterally and within the gallbladder fossa which is mildly loculated. Small foci of gas adjacent to the gallbladder fossa are likely postsurgical.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes of Frey procedure including pancreatojejunostomy. Jejunal Roux limb is mildly prominent but considered within normal limits. No specific evidence of leak. The pancreatic duct is less dilated than on the recent M.R.C.P.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are not pathologically enlarged by size criteria. Moderate atherosclerotic disease affects the abdominal aorta and its branches.BOWEL, MESENTERY: Postsurgical changes of pancreatojejunostomy. Roux limb formation with jejunojejunal anastomosis in the left midabdomen. Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall. Mild anasarca. Moderate degenerative changes of the visualized thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above. BONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumbar spine.OTHER: A small amount of loculated fluid is present in the pelvis. | 1.Post-surgical changes of recent Frey procedure, cholecystectomy, and hepatic segment 5 partial resection.2.Moderate amount of nonspecific perihepatic fluid lateral to the liver and within the gallbladder fossa. Though the fluid is mildly loculated, no compelling evidence of abscess at this time.3.Bilateral small pleural effusions with overlying atelectasis/consolidation. |
Generate impression based on findings. | Male; 62 years old. Reason: R hand palmar mass History: non painful Three views of the right hand show no acute fracture or dislocation. Alignment is anatomic. The visualized soft tissues are unremarkable. | Normal examination. |
Generate impression based on findings. | Female; 52 years old. Reason: Evaluation of scapular spine lesion. The previously described scapular spine lesion does not appear significantly changed in size or appearance since the prior study. The lesion is indistinct but again demonstrates central density with peripheral lucency. There are no features to suggest aggressive behavior. No acute fracture or malalignment. | Unchanged scapular spine lesion as described above, most likely benign. |
Generate impression based on findings. | Male; 20 years old. Reason: Evaluate for fracture History: Back pain with sciatica after lifting a pan. Five views of the lumbar spine show no acute fracture or malalignment. Vertebral body heights are preserved. The bilateral sacroiliac joints are within normal limits. | Normal examination. |
Generate impression based on findings. | Right C7 radiculopathy. Evaluate for osteoarthritis. Moderate degenerative disk disease affects C5/6, and mild degenerative disk disease affects C6/7, with anterior vertebral body osteophytes at these levels. There is a slight kyphosis of the cervical spine. There is mild narrowing of the C5/6 neural foramen on the right and mild narrowing of the C6/7 neuroforamen on the left. | Degenerative disk disease and neuroforaminal narrowing as above. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 14-week-old female status post ETT placementVIEW: Chest AP (one view) 3/4/15 10:30 Right central venous catheter tip extends to the right atrium. ETT tip in the right mainstem bronchus. Interval removal left chest tube. The cardiothymic silhouette is normal. Moderate residual left pleural effusion and adjacent atelectasis. Hazy bilateral pulmonary opacities are not significantly unchanged. No pneumothorax. | ETT tip in the right mainstem bronchus. Moderate residual left pleural effusion without pneumothorax. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Numerous bilateral benign calcifications are present. There are symmetric mildly prominent lymph nodes in each axilla. | 1. No mammographic evidence of malignancy in the breasts. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.2. Mildly prominent symmetric axillary lymph nodes. Clinical correlation for any underlying systemic illness is recommended.3. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 60 year old woman with history of benign right breast biopsy. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A biopsy clip is seen in the right upper outer breast. Multiple benign-morphology circumscribed lobulated masses in the posterior right breast are stable. No dominant mass, suspicious microcalcifications or areas of architectural distortion are seen in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Left cheek wound approximately 7mm diameter with tracking toward mandible. There is a persistent defect in the buccal cortex overlying tooth # 19 and diffuse patchy sclerosis of the bone marrow in the left mandibular body. There is also a persistent 10 mm wide soft tissue track that extends from the bone defect to the overlying skin. Otherwise, the regional inflammatory changes have subsided. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The airways are patent. There is scattered paranasal sinus opacification. The imaged intracranial structures and orbits are unremarkable. The imaged portions of the lungs are clear. | Persistent evidence of chronic left mandibular osteomyelitis associated with a diseased tooth # 19 and an indurated sinus track to the overlying skin. Otherwise, the associated inflammatory changes have subsided and no discrete abscess is apparent. |
Generate impression based on findings. | Right shoulder pain. Rule out osteoarthritis. Moderate osteoarthritis affects the acromioclavicular joint, and mild osteoarthritis affect the glenohumeral joint. Mild enthesopathic changes are noted along the greater tuberosity at the expected site of insertion of the rotator cuff. Small lucencies in the humeral head likely represent degenerative cysts. There is mild spurring of the anterior aspect of the acromion process. | Degenerative arthritic changes of the right shoulder as described above that appear to have progressed slightly when compared with the prior study. |
Generate impression based on findings. | Cough/mucus production. Evaluate for bronchiectasis. LUNGS AND PLEURA: Increased mucus plugging in two areas of focal bronchiectasis in the bilateral upper lobes (series 5, image 31 and 32). Otherwise, the bilateral peribronchial wall thickening, patchy areas of bronchiectasis, and centrilobular as well as tree-in-bud opacities are not significantly changed. Right lung base surgical suture. Right basilar subpleural scarring, unchanged.No pleural effusion or focal airspace consolidation.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification.Left thyroid lobectomy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy clips. | Few scattered areas of increased mucus plugging, otherwise the bronchiectasis and tree-in-bud/centrilobular nodules are not significantly changed. |
Generate impression based on findings. | 65 years old Female. Reason: restaging. History: breast cancer restaging. Please compare with Previous PETs outside. RADIOPHARMACEUTICAL: 11.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates a stable small nodule in the left lobe of thyroid. Increased density with multiple lymph nodes are seen in the mesenteric/omentum. Mixed lytic and sclerotic lesions in the T10, L2, L4, L5 and S1 vertebral bodies and pelvis are noted. Postsurgical changes of gastric bypass are noted. There is a moderate-sized hiatal hernia. Today's PET examination demonstrates interval resolution of the three foci of abnormal FDG uptake in the T10, and L2 and L4 vertebral bodies, corresponding to sclerotic/mixed sclerotic and lytic lesions seen on CT. The maximal SUV in the T10 vertebral body lesion is 2.4 ( it was 7.2) (and that in the L4 vertebral body lesion is 2.7 (it was 8.3 on prior study). Several faint foci of increased activity seen on prior study in the bilateral ribs and bony pelvis have also resolved. The dominant pelvic lesion seen on prior study in the right posterior acetabulum has resolved.No definite evidence of increased metabolic activity in the mild infiltrative changes and small lymph nodes in the mesentery and omentum. No abnormal FDG uptake in the nodular density in the left lobe of thyroid. No evidence of FDG avid tumor seen in the breasts. | 1.Interval resolution of FDG avid osseous lesions in the spine, ribs and pelvis.2.Currently, there is no evidence of FDG avid tumor.3.Multiple CT findings as described above. |
Generate impression based on findings. | Female 77 years old Reason: pain History: pain. We have 3 views of the right ankle. Again seen is a lucency in the medial talar dome with a focal depression of the articular surface consistent with an osteochondral defect that has been seen on prior studies. Overall, the defect measures approximately 1.5 cm in the greatest dimension. There is mild diffuse soft tissue swelling. There is a pes planus deformity. Small radiodensities distal to the medial malleolus may reflect prior trauma to the deltoid ligament, but appear unchanged.We have 4 views of the right knee which show severe osteoarthritis with bone on bone apposition of the medial tibiofemoral compartment as seen on the skier's view as well as tricompartmental osteophytes. There is a moderate sized joint effusion. A small ossicle is seen in the soft tissues along the posterior aspect of the proximal tibiofibular jointHardware components of a left total knee arthroplasty device are situated in near anatomic alignment with no radiographic evidence of hardware complication, as seen on the frontal views. | 1. Chronic osteochondral defect of the talar dome and pes planus deformity.2. Severe osteoarthritis of the right knee. |
Generate impression based on findings. | Peritoneal mesothelioma. Compare to previous. LUNGS AND PLEURA: Scattered stable micronodules.No suspicious pulmonary nodules or masses.No evidence of pleural disease.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion.Left chest port tip in SVC.No mediastinal or hilar lymphadenopathy.Moderate coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Refer to separately dictated CT abdomen/pelvis report. | No evidence of intrathoracic disease. |
Generate impression based on findings. | 4-month-old female with history of difficulty threading central lines through bilateral upper extremities. History of LLE DVT noted. Evaluate patency of the central/upper extremity veins bilaterally. LUNGS AND PLEURA: Bibasilar dependent atelectasis. No pulmonary nodules or masses. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No mediastinal or hilar lymphadenopathy.The visualized bilateral subclavian, brachiocephalic and internal jugular veins are patent with no evidence of narrowing or mural thrombus. The superior vena cava is patent. CHEST WALL: Normal with no evidence of axillary lymphadenopathy.UPPER ABDOMEN: Partially visualized central venous catheter tip in the IVC below the diaphragm. | Patent vasculature with no evidence of thrombus or filling defects in the central veins. |
Generate impression based on findings. | Current smoker. Six month follow-up nodules. LUNGS AND PLEURA: Mild centrilobular emphysema.Calcified micronodules consistent with prior infection. The previously noted new micronodules on 1/2014 CT have resolved, and were most likely infectious.No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Scattered small and borderline enlarged mediastinal lymph nodes, unchanged.Normal heart size without pericardial effusion.Mild coronary artery calcification and thoracic aorta calcification.CHEST WALL: Bilateral breast prostheses with extensive capsular calcification, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | The 1/2014 micronodules have resolved, and most likely were infectious/inflammatory. No suspicious nodules remain. |
Generate impression based on findings. | Female 58 years old Reason: pain History: pain. Four views of the right knee show severe tricompartmental osteoarthritis with bone on bone apposition of the medial tibiofemoral compartment and a loose body in the posterior aspect of the joint measuring just under 2 cm. Osteoarthritis has progressed when compared with prior study.Four views of the left knee show severe tricompartmental osteoarthritis with bone on bone apposition of the medial tibiofemoral compartment. Ossicles in the posterior soft tissues likely represent loose bodies in a Baker's cyst. Osteoarthritis has progressed when compared with prior study. | Severe osteoarthritis. |
Generate impression based on findings. | 31 year old woman with history of multifocal left breast IDC s/p mastectomy. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Biopsy clips are noted in the right lower inner breast at anterior and posterior depth. No dominant mass, suspicious microcalcifications, or areas of architectural distortion are seen in the right breast. Benign appearing lymph nodes are projected over the right axilla.Right chest wall port noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 31 years old Reason: r/o dissection History: chest pain radiating to back CT Angiography: Technically adequate exam. The thoracic aorta is normal in caliber. There is no evidence of aortic aneurysm, dissection, or significant stenosis. The origins of the great vessels, celiac axis, and SMA are patent. No evidence of atherosclerotic disease. Main pulmonary artery is normal in caliber. Bolus timing for the study is optimized for the opacification of the aorta and makes evaluation of pulmonary embolus suboptimal. Within these limitations, there is no central pulmonary embolus.CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. No coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Lack of oral contrast makes evaluation of abdominal pathology suboptimal. Within these limitations, there is no significant abnormality noted. | No evidence of aortic dissection or other acute abnormality. |
Generate impression based on findings. | Assess healing Three views of the right hand reveal removal of the K wire. There is some deformity of the base of the fifth metacarpal consistent with the patient's previous fracture. There is some callus formation consistent with healing. | Healing fracture of the base of the fifth metacarpal in anatomic alignment. |
Generate impression based on findings. | 83 years, Male. Reason: eval Dobbhoff tube s/p 5 cm advancement History: Dobbhoff position Slight advancement of Dobbhoff tube with tip projecting over the gastric body. Ileus type bowel gas pattern. Rectal catheter is noted. Again seen is a 1.9 cm radiodensity likely representing a bladder calculus. | Dobbhoff tube tip projects over the gastric body. |
Generate impression based on findings. | Male 19 years old Reason: eval fracture History: pain. We have 3 views of the right hand. Evaluation of fine bone detail is limited by overlying splint. Again seen is a fracture of the distal diaphysis of the fifth metacarpal with slight volar and radial angulation of the distal fracture fragment. There is callus formation along the fracture indicating an attempt at healing. | Healing fifth metacarpal fracture. |
Generate impression based on findings. | Female 86 years old Reason: pain History: pain. We have 3 views of the right knee which show hardware components of a right total knee arthroplasty device. There is slight anterior translation of the femoral component with respect to the tibial component. A 5-mm linear metallic density situated just above the anterior aspect of the tibial tray may reflect a broken peg.We have 3 views of the left knee which show hardware components of a left total knee arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. | Bilateral total knee arthroplasties as described above, with anterior translation of the femoral component of the right knee relative to the tibial component, suggesting implant failure. |
Generate impression based on findings. | 43 years, Female. Reason: Dobbhoff placement History: Dobbhoff placement Dobbhoff tube tip projects over the gastric pylorus area. Cholecystectomy clips are noted. Nonobstructive bowel gas pattern. | Dobbhoff tube tip projects over the gastric pylorus area. |
Generate impression based on findings. | Male 58 years old Reason: shoulder pain History: above. We have 3 views of the left shoulder. There is foreshortening of the distal clavicle compatible with prior surgery. Mild osteoarthritic changes affect the glenohumeral joint. The coracoclavicular interval appears slightly widened but is otherwise unchanged from the prior study. Small foci of heterotopic ossification are seen between the clavicle and coracoid. | Postoperative changes of the distal clavicle and mild glenohumeral joint osteoarthritis. |
Generate impression based on findings. | Images are limited by patient motion. There is significant endplate irregularity with disk space widening at T9-T10, at level of previous suspected diskitis/osteomyelitis. The previous epidural and pre-vertebral abnormal soft tissue prominence has resolved. There is residual heterogeneous marrow signal within these vertebrae.There is STIR hyperintensity throughout the T10 vertebral body as well as along the upper T11 vertebral body, greater on the right side. Abnormal signal extends into the right T11 pedicle and minimally into the superior articulating process. There appears to be Schmorl's node formation along the inferior endplate of T10 on the left. The thoracic spine is in normal alignment, with exaggeration of the normal thoracic kyphosis. There is mild anterior widening of the T6 through T9 vertebral body. There is multilevel disk narrowing and desiccation, although appearing similar to the prior exam except at the T10-T11 level which has progressed. The vertebral body heights are otherwise well-maintained. The spinal cord is of normal caliber and signal.At C6-C7, there is a disk bulge with right paracentral/foraminal prominence. There is mild bilateral foraminal narrowing. There is bilateral uncovertebral hypertrophyAt C7-T1, there is a trace disk bulge with bilateral uncovertebral hypertrophy.At T1-T2, there is a trace disk bulge which effaces the ventral CSF space. There is left facet arthropathy, with mild right and moderate left foraminal narrowing.At T2-T3, there is a mild disk bulge with central prominence partially effacing the ventral CSF space. There is mild ligamentum flavum thickening.At T3-T4, there is a right paracentral disk protrusion superimposed upon a disk bulge.At T4-T5 and T5-T6, there is a trace disk bulge without stenosis.At T6-T7 through T8-T9, there is a trace posterior osteophyte disk complex. There is mild left foraminal narrowing at T8-T9, where there is facet arthropathy and ligamentum flavum thickening.At T9-T10, there is a posterior osteophyte disk complex with moderate right and mild left foraminal narrowing. Bilateral facet arthropathy and ligamentum flavum thickening is noted.At T10-T11, there is a disk bulge progressed since the previous exam. There is prominent bilateral facet arthropathy and ligamentum flavum thickening contributing to overall mild central spinal canal stenosis. There is moderate-severe right foraminal narrowing. There is right-sided facet arthropathy. Bilateral ligamentum flavum thickening is also present.At T11-T12 through L1-L2, there is no significant disk pathology or stenosis.Limited visualization of the retroperitoneum demonstrates numerous T2 hyperintense structures associated with both renal pelves likely representing parapelvic cysts, as well as nonspecific renal parenchymal T2 hyperintense lesions which most likely represent small cysts. | Interval resolution of previously seen acute changes relating to diskitis/osteomyelitis at T9-T10. Progression of degenerative at T10-T11 with now prominent disk narrowing on the right resulting in reactive marrow changes as well as moderate-severe right foraminal narrowing. |
Generate impression based on findings. | Total wrist arthroplasty Three views of the left wrist reveal the corpectomy and total wrist arthroplasty in anatomic alignment. There is also a distal radial ulnar joint arthroplasty. No change is seen from the previous exam of February 2014. | Total wrist arthroplasty and distal radial ulnar joint arthroplasty in anatomic alignment. |
Generate impression based on findings. | 77-year-old female status post sigmoid colon resection with primary anastomosis of the colon and diverting loop ileostomy (12/29/14) here for evaluation prior to ileostomy takedown. A lateral scout film of the pelvis demonstrated suture material likely representing the colon anastomosis site. Barium flowed freely from the rectum to the cecum. Postsurgical changes of a distal transverse colon, descending colon and sigmoid colon resection are seen with end-to-side anastomosis in the pelvis. The anastomosis is approximately 14 mm wide without evidence of anastomotic leak. A small amount of contrast was refluxed into the terminal ileum although contrast was not refluxed into the ileostomy bag. Normal appearance of the colon was visualized in its entirety without evidence of stricture or mass lesions. TOTAL FLUOROSCOPY TIME: 6:53 minutes | End-to-side anastomosis of the transverse and sigmoid colon without evidence of anastomotic leak. |
Generate impression based on findings. | Female 26 years old Reason: Left thumb metacarpal reconstruction after sx for GCT, s/p removal of hardware, evaluate for recurrence, signs of infection History: above . We have 3 views of left hand. Overlying splint material obscures fine bone detail. There is now a plate and screw device affixing the first metacarpal bone graft in near anatomic alignment. We see no hardware complications. We see no specific radiographic features of giant cell tumor recurrence or infection. | Postoperative changes of the first metacarpal reconstruction as described above. |
Generate impression based on findings. | Male 59 years old Reason: s/p left hip hemiarthroplasty, evaluate for hardware complications History: above. Two views of the left hip show hardware components of a left bipolar hemiarthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. A poorly defined lucency within the intertrochanteric region may simply reflect stress shielding, although we cannot entirely exclude the possibility of progression of metastatic disease. | Left hip hemiarthroplasty without evidence of hardware complication. |
Generate impression based on findings. | Female 66 years old Reason: s/p intercalary right endoprosthetic reconstruction with deep infection, evaluate for progressive loosening History: above. Again seen is reconstruction of the proximal femur with a bipolar hemiarthroplasty endoprosthesis device situated in near-anatomic alignment. There are sclerotic changes of the distal femoral diaphysis which may reflect sequelae of prior osteomyelitis, but we see no findings to suggest progressive loosening. Overall, the findings, including additional post operative changes, appear similar to those seen on the prior study. The bones are demineralized and there is diffuse soft tissue swelling about the thigh. | Proximal femur reconstruction and other findings appearing similar to those seen on the prior study. |
Generate impression based on findings. | Mesothelioma. Evaluate EOD. CHEST:LUNGS AND PLEURA: Left nodular pleural thickening consistent mesothelioma, not significantly changed. Reference measurements as follows:1. At the level of the aortic arch 5 o'clock (series 3, image 25): 7 mm, previously 8 mm 2. At the level of the carina adjacent to the aorta at the 8 o'clock position (series 3, image 36): 7 mm, previously 8 mm.3. At the level of the left atrium (series 3, image 66): 14 mm, unchanged.New peripheral left upper lobe/lingula opacity with air bronchograms and associated volume loss, likely representing atelectasis and post-treatment change.No suspicious pulmonary nodules or evidence of contralateral pleural disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size. Severe coronary artery calcification.Nonspecific multiple thyroid nodules, unchanged.CHEST WALL: Large anterior and lateral left chest mass invading the pectoralis muscle and extending down into the anterior abdominal wall is similar to prior exam.It measures 6.3 x 19.5 cm, previously 6.3 x 19.7 cm (series 3, image 67). Adjacent subcutaneous edema and skin thickening, increased from prior.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: Mildly atrophic kidneys. Renal cysts and right nephroureteral stent, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the aorta without aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Intraabdominal extension of left anterolateral abdominal wall tumor is similar to before.Anasarca in the anterior abdominal wall.OTHER: Moderate to severe degenerative disk disease of the lumbar spine. | Stable left hemithorax mesothelioma and large left anterior chest and abdominal wall mass. No new sites of disease. |
Generate impression based on findings. | Female 46 years old Reason: prosthetic assess History: post-op. Two views of the left femur again show an intramedullary rod and screws device affixing the femur and traversing a poorly defined lucent lesion of the distal femoral diaphysis with endosteal scalloping, that appears similar to that seen on the prior study. We see no hardware complications. A small amount of heterotopic mineralization is seen above the greater trochanter. Mild osteoarthritis affects the knee. Skin staples are noted along the lateral aspect of the thigh. There also appears to be endosteal scalloping of the subtrochanteric femur, which may represent an additional metastatic focus, unchanged from the prior study.Two views of the left humerus show an intramedullary rod and screws affixing the humerus in anatomic alignment. Endosteal scalloping along the diaphysis presumably represents metastatic disease. There is a more focal defect along lateral cortex of the distal humeral diaphysis, which is presumably surgical. A linear lucency traversing the anterior cortex at this location may represent an incomplete nondisplaced fracture. | Orthopedic fixation of the left humerus and left femur as described above. |
Generate impression based on findings. | Reason: f/u h/o cavitating MRSA pneumonia. 63M metastatic NSCLC admitted with fevers History: fevers LUNGS AND PLEURA: New small right pleural effusion and new moderate left small loculated effusion.The previously described cavitary lesion in the superior segment of the left lower lobe measures 5.2 x 5 .0 cm (series 4, image 34), similar in size to prior, with mildly increasing invagination, and adjacent consolidation/atelectasis.Left perihilar partially calcified mass with persistent encasement and obstruction of the left upper lobe bronchus, compatible with known tumor, not significantly changed from the prior examLingular nodule measures 13 x 9 mm (series 4, image 56), unchanged from the prior exam dated 02/2015. Left apical linear and nodular scarring appear similar to the prior exam.Upper lobe predominant centrilobular and paraseptal emphysema appears similar to prior. MEDIASTINUM AND HILA: The heart is normal in size. Small pericardial effusion, slightly increased from the prior exam. Severe coronary artery calcification.Mild mediastinal lymphadenopathy, unchanged.CHEST WALL: Bilateral supraclavicular lymphadenopathy appear similar to the prior exam.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Within these limitations, reference gastrohepatic lymph node (series 3, image 97) appears grossly unchanged. Right adrenal nodule measures 2.7 x 1.5 cm (series 3, image 102), unchanged.Gastrostomy tube in place. Ascites cannot be excluded. | 1. Grossly unchanged size and wall thickness of a cavitary lesion in the superior segment of the left lower lobe, with persistent adjacent consolidation ant atelectasis, suggestive of persistence of infectious process. 2. New bilateral pleural effusions, including a loculated left effusion, may relate to active infection or patient's known neoplasm.3. Left perihilar mass, lung nodules, mediastinal/supraclavicular lymphadenopathy are stable from the prior exam dated 02/2015. Grossly stable intra-abdominal disease, including lymphadenopathy and a right adrenal nodule. |
Generate impression based on findings. | Female 40 years old Reason: assess healing History: S/P radial head fracture. Four views of the left elbow again show an intra-articular fracture of the radial head with mild depression of the articular surface, appearing similar to that seen on the prior study accounting for slight positional differences. Elevation of the fat pads is suggestive of persistent joint effusion/hemarthrosis. | Radial head fracture appearing similar to that seen on the prior study. |
Generate impression based on findings. | Newborn with respiratory distressVIEW: Chest AP, abdomen, AP (two views) 8/4/15 11:00 Endotracheal tube tip above the carina. UAC tip at T5. UVC extends peripherally in the right portal vein.The cardiothymic silhouette is normal. Hazy right upper lobe atelectasis. No pneumothorax.Nonobstructive bowel gas pattern. | Misplaced UVC. Subsegmental right upper lobe atelectasis. |
Generate impression based on findings. | Female 53 years old Reason: evaluate right THA History: s/p R THA 6 weeks ago. Two views of the right hip show hardware components of a right total hip arthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. Immature heterotopic bone is noted within the adjacent soft tissues.Three views of the pelvis show the aforementioned right total hip arthroplasty. Severe osteoarthritis affects the left hip and severe degenerative changes affect the visualized lower lumbar spine. | Right total hip arthroplasty and other findings as above. |
Generate impression based on findings. | No intracranial mass, mass effect, or pathologic enhancement to suggest metastatic disease. No hydrocephalus. No extra-axial fluid collections. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. NECK | 1. Post treatment changes within the neck without CT evidence of recurrent tumor or cervical lymphadenopathy.2. No intracranial metastatic disease identified.3. Status post left carotid endarterectomy. Mild to moderate bilateral common, right internal carotid, and vertebral artery narrowing better assessed on prior CT angiogram. 4. Ground glass opacity in the right lung is partially visualized. Please refer to separate report for findings in the chest. |
Generate impression based on findings. | Male; 60 years old. Reason: herniated disc. Two views of the lumbar spine show no acute fracture or malalignment. The vertebral body heights are preserved. The bilateral sacroiliac joints are unremarkable. Mild disk space narrowing is noted at L4/L5 and L5/S1 with associated anterior osteophytes. | Mild degenerative changes of the lower lumbar spine without acute fracture or malalignment. |
Generate impression based on findings. | Female; 24 years old. Reason: R wrist pain. No acute fracture or dislocation. Alignment is anatomic. | Normal examination. |
Generate impression based on findings. | Male; 60 years old. Reason: prosthetic assess History: post-op Three views of the left knee demonstrate hardware components of a total knee arthroplasty device in near anatomic alignment. There is no radiographic evidence of hardware complication or loosening. Moderate degenerative changes affect the right knee as seen on the AP view. | Left total knee arthroplasty as described above. |
Generate impression based on findings. | 60 year-old female with metastatic breast cancer, baseline imaging prior to starting new treatment. CHEST:LUNGS AND PLEURA: Large right pleural effusion with atelectasis of much of the right lung. There is increased soft tissue along the right hilum (series 5, image 39) which may represent metastatic disease. There is a scattered nodularity along the right pleura suspicious for metastatic disease. No additional discrete pulmonary nodules or masses are identified, however evaluation is limited by the large pleural effusion. MEDIASTINUM AND HILA: There is mild mediastinal shift to the left. Left-sided central venous port with catheter tip at the SVC atrial junction. Supraclavicular, mediastinal, and hilar lymphadenopathy is present. Some of the enlarged lymph nodes are partially calcified which may be related to prior granulomatous disease and/or treatment effect. For reference, noncalcified left upper paratracheal lymph node (series 3, image 23) measures 1.2 x 1.3 cm. CHEST WALL: No axillary lymphadenopathy by size criteria. Postsurgical changes to the right breast and axilla. Nonspecific skin thickening of the right breast. Subcentimeter low-attenuation thyroid nodules.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Enlarged portacaval and upper retroperitoneal lymph nodes. For reference, left periaortic lymph node (series 3, image 96) measures 1.2 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine. In addition, several scattered sclerotic lesions in the thoracolumbar spine vertebral bodies are suspicious for metastases.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine. In addition, several scattered sclerotic lesions in the thoracolumbar spine vertebral bodies are suspicious for metastases.OTHER: No significant abnormality noted. | 1.Large right malignant pleural effusion. 2.Supraclavicular, mediastinal, and upper abdominal lymphadenopathy.3.Probable scattered metastatic osseous lesions in the thoracolumber spine. Please see accompanying nuclear medicine bone scan which is more sensitive for detection of osseous metastatic disease. |
Generate impression based on findings. | Female; 70 years old. Reason: Knee pain. Four views of the right knee demonstrate no acute fracture or dislocation. Alignment is anatomic. Minimal medial compartment joint space narrowing is noted. The left knee is unremarkable as seen on the frontal views. | Minimal medial compartment osteoarthritis. |
Generate impression based on findings. | Female; 58 years old. Reason: Evaluate for fracture History: pain Nondisplaced medial patellar fracture with indistinct fracture lines indicative of healing. No new fracture or dislocation. Mild osteoarthritis affects the right knee, as well as the left knee as seen on the frontal views. | Healing patellar fracture without new acute abnormality. Mild osteoarthritis. |
Generate impression based on findings. | 63 years, Male. Reason: eval g tube placement History: 63 m with malfunctioning g tube. attempted replacement, Gastrostomy tube tip projects over the gastric fundus. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Gastrostomy tube tip points towards the gastric fundus. |
Generate impression based on findings. | CHEST:LUNGS AND PLEURA: Left pleural mesothelioma with reference lesions as follows, measured in a similar fashion:1. At the level of aortic arch (series 4/35), 42-mm at 10 o'clock, previously 27 mm. 56-mm at 7 o'clock, previously 52 mm.2. At the level of the pulmonary artery (series 4/53), 36-mm at 9 o'clock, previously 30 mm. 18-mm at 4 o'clock, previously 11 mm.3. At the level of the left ventricle (series 4/68), 20 mm at 2 o'clock, unchanged. 36-mm at 8 o'clock, previously 25 mm.Visceral pleural thickening has significantly increased since the previous study, with accompanying atelectasis in the lower lobe and lingula. At the level of the esophageal hiatus, tumor in the mediastinum extends to the visceral pleural surface of the right lung in the posterior cardiophrenic angle (4/83). Segmental airways of the lung are attenuated, with areas of subsegmental extrinsic compression by tumor.MEDIASTINUM AND HILA: Reference" AP window" lymph node no longer distinguishable from adjacent pleural tumor due to infiltration of the subpleural fat plane, approximately 12 mm compared to 9-mm previously (4/39). Bilateral mediastinal lymphadenopathy. Tumor extension near the esophageal hiatus crosses the midline to extend into the right visceral pleura in the azygoesophageal recess region. Pericardial and mediastinal invasion by tumor. Further rightward deviation of the superior mediastinum by tumor. Main pulmonary artery appears enlarged, consistent with development of pulmonary hypertension. Left subclavian pacemaker.CHEST WALL: Nodular tumor extension into the left lateral chest wall (4/77 for example), increased compared to the previous study. Anteriorly, tumor extends into intercostal spaces. Left internal mammary lymphadenopathy has increased. Tumor extends into the left paravertebral fat plane at multiple levels.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified gallstones.SPLEEN: Left diaphragm is invaded by tumor with absence of intervening fat plane between the spleen and the diaphragm consistent with localized tumor extension, but there is no definite invasion into the spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Confluent lymphadenopathy in the left upper quadrant (4/92), new from previous, inseparable from the posterior margin of the stomach.. Pancreatic and left paravertebral lymphadenopathy, the latter was present previously and is only minimally larger. Atherosclerotic disease of the aorta and its branches. Tumor extends through the esophageal hiatus.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Lymphadenopathy/tumor not readily separable from the posterior gastric margin.BONES, SOFT TISSUES: Diffuse mesenteric soft tissue stranding is mild, poorly assessed given paucity of intra-abdominal fat. Right iliac lymphadenopathy has increased.OTHER: No significant abnormality noted. | Pleural mesothelioma with reference measurements increased as provided in the body of the report. Tumor is now evident in the chest wall and upper abdomen.. |
Generate impression based on findings. | Revision of total hip arthroplasty Single portable view of the pelvis reveals partial construction of the right hip arthroplasty. No acute abnormalities. | Visualization of a partially assembled right total arthroplasty in the operating room. |
Generate impression based on findings. | Female; 60 years old. Reason: R thumb basilar joint arthritis History: base of thumb pain Three views of the right thumb demonstrate no acute fracture or malalignment. Joint space narrowing at the basilar joint is indicative of mild osteoarthritis. | Mild basilar joint osteoarthritis. |
Generate impression based on findings. | Left hypopharyngeal malignant peripheral nerve sheath tumor, treated with surgical resection 8/20/13 and chemo/XRT. There is persistent diffuse pharyngeal mucosal swelling with mild narrowing of the hypopharyngeal airway. Otherwise, there is no definite evidence of discrete mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unchanged. There is a left subclavian venous catheter. The major cervical vessels are patent. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. There are new patchy opacities in the partially-imaged right lung. | 1. Persistent supraglottic mucosal swelling with mild narrowing of the hypopharyngeal airway is likely treatment-related. Although no discrete mass lesion is discernible, follow up with MRI may be useful.2. New patchy opacities in the partially-imaged right lung may be infectious or inflammatory in nature. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is an old left occipital lobe infarct with encephalomalacia, and ex vacuo dilatation of the left occipital horn. There are mild nonspecific changes in the white matter most likely representing age indeterminate small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is atherosclerosis in the bilateral intracranial vertebral and cavernous carotid arteries. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.No acute intracranial hemorrhage or mass-effect. CT is insensitive for detection of early nonhemorrhagic stroke.2.Age indeterminate small vessel ischemic changes.3.Old left occipital infarct with encephalomalacia. |
Generate impression based on findings. | Male; 65 years old. Reason: Evaluate for fracture History: pain Thin lucency in the distal radial metaphysis is again seen and compatible with a nondisplaced fracture, unchanged. Mild soft tissue swelling is noted about the wrist. | Unchanged distal radius fracture as described above. |
Generate impression based on findings. | Assess hardware Two views of the left hip reveal a short trochanteric femoral nail bridging an intertrochanteric fracture. There is more callus formation and the fracture line is indistinct when compared to the previous exam | Healing intertrochanteric fracture in anatomic alignment. |
Generate impression based on findings. | Female 2 years old Reason: evaluate progression of pneumothorax History: pneumothorax after bagging and intubation in patient with RSV and pneumoniaVIEW: Chest AP (one view) 3/4/15 at 1132 hrs Gastrostomy tube , left upper abdominal surgical clips, central line with its tip in the SVC an ET tube are again noted. Cardiac silhouette size is normal. Remarkable improvement in right upper lobe atelectasis, right-sided pneumothorax and pneumomediastinum with persistent left lower lobe opacity. | Interval improvement in right upper lobe atelectasis, right-sided pneumothorax and pneumomediastinum. |
Generate impression based on findings. | 36 year old woman with history of bilateral breast pain x 6 months. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended at the age of 40. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | History of probable achalasia, with profound weight loss (160 lbs April 2014, 113 lbs December 2014). Evaluate for occult malignancy or other etiology of profound weight loss. CHEST:LUNGS AND PLEURA: Nonspecific micronodule in the right middle lobe best seen on MIP image 37. Additional micronodule seen along the right major fissure (5:43) may represent an intrapulmonary lymph node.MEDIASTINUM AND HILA: Esophagus is fluid filled with oral contrast.CHEST WALL: No significant abnormality noted.ABDOMEN:Paucity of intra-abdominal fat somewhat limits evaluation.LIVER, BILIARY TRACT: Scattered, subcentimeter centimeter hypodensities are too small accurately characterize, but likely cysts or hemangiomas. A larger hypodensity in the caudate lobe measures fluid attenuation, and in this patient age group favors cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 4-mm nonobstructing stone in the mid left kidney.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast does not opacify most of the small bowel. No obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate to large stool burden.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No CT evidence of overt malignancy.2.Nonobstructing left nephrolithiasis.3.Moderate to large stool burden.4.Dilated esophagus filled with oral contrast could be related to questionable history of achalasia, but correlate clinically. |
Generate impression based on findings. | Peritoneal mesothelioma LUNGS AND PLEURA: 6-mm nodule at the right apex (6/14) appears unchanged. No new or suspicious nodules. No pleural fluid. Thickening of the left hemidiaphragm with blunting of the costophrenic angle. The lateral parietal pleural surface is very mildly thickened on the left, visible only due to loss of fat planes and measuring up to 4-5 mm. MEDIASTINUM AND HILA: Right chest port with tip at the cavoatrial junction. No visible coronary artery calcifications. Normal heart size. Poorly defined 10-mm mildly enhancing right paracaval/inferior pulmonary ligament lymph node (4/76), unchanged the most recent previous study and decreased from the exam of 5/19/2014 where it was even less well-defined measuring 17-mm and associated with small adjacent paraesophageal lymph nodes.Punctate residual right cardiophrenic lymph node (4/79) decreased in size from in the outside exam of 5/19/24 seen where it can be seen on series 3 image 19 of that study.CHEST WALL: Unsharp borders and loss of fat planes between chest wall musculature and soft tissues in the left lateral chest wall at the level of the spleen inconclusive at this time and should continue to be monitored.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left quadrant peritoneal tumor in fluid will be discussed in a separately abdominal CT. Left diaphragmatic thickening indistinguishable from parietal pleural thickening at the left lung base. Nodular diaphragmatic thickening on the right compressing the hepatic capsule. | 1. Indeterminate, very mild parietal pleural thickening in the left costophrenic angle which and could be reactive due to to adjacent diaphragmatic/abdominal tumor but should continue to be monitored as it may be a very early indication of pleural disease.2. Mildly enlarged right inferior pulmonary ligament lymph node, probably unchanged allowing for differences in scan variability compared to the most recent previous scan and decreased when compared to the exam of 5/9/2014. This most likely reflects residua of localized extension of tumor through the diaphragmatic hiatus. There is also a very small (<4mm) residual right cardiophrenic lymph node.3. Upper abdominal tumor will be reported previously under separately reported abdominal CT. |
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