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Generate impression based on findings. | Scoliosis in braceVIEW: Abdomen and chest AP (two views) 3/4/15 at 1147 hrs Gastrostomy tube, cholecystectomy clips, central line with it tip at the SVC and bilateral coxa vara deformity again noted. A brace has been placed, thoracolumbar dextrorotoscoliosis is 62 degrees. Cardiac silhouette size is normal. Persistent chronic subsegmental atelectasis or scarring of the left upper lobe.Nonspecific abdomen the gas pattern. | 62 degree thoracolumbar dextrorotoscoliosis when patient is in brace. |
Generate impression based on findings. | Edema, tenderness, bruising after rolling foot. Fourth or fifth metatarsal fracture? There is a comminuted but predominantly transverse fracture through the base of the fifth metatarsal with extension to the tarsometatarsal joint. There is mild lateral displacement of the main fracture fragment. A tiny ossicle in the soft tissues along the lateral aspect of the base of the proximal phalanx of the fifth toe may reflect old trauma, but I see no donor site to suggest an acute fracture. There is a bipartite medial sesamoid bone which I suspect is a normal variant. | Fracture through the base of the fifth metatarsal as described above. This was discussed over the phone with Dr. Asbury at the time of dictation. |
Generate impression based on findings. | Increased mobility to jaw opening, pain in the TMJ area. Evaluate for proper placement. The mandibular condyles appear appropriately situated within their respective glenoid fossae on the closed mouth views, and translate anteriorly in appropriate fashion on the open mouth views. I see no specific findings to account for the patient's pain. Note is made of dental fillings and implants. | Normal-appearing temporomandibular joints without specific findings to account for the patient's pain. If further imaging evaluation is clinically warranted, temporomandibular joint MRI may be considered. |
Generate impression based on findings. | The cervical internal jugular veins are well opacified and patent from the skull base down to the mediastinum. The subclavian veins are not well opacified on this dedicated CT neck exam but appear opacified well on the concurrent CT chest exam. The left internal jugular vein is somewhat smaller in caliber focally just distal to the skull base and along the upper third, likely within normal limits.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is fluid dependently within the right mastoid air cells. There is diffuse bilateral ethmoid opacification. | Patent cervical internal jugular veins. Subclavian veins not well opacified on this CT neck portion of the exam but better seen on the concurrent CT chest. Please see separately dictated report for further details. |
Generate impression based on findings. | Right-sided radiculopathy Evaluation of the spine is slightly limited by patient motion artifact. For the purposes of this study I will designate 5 lumbar vertebrae, with possible small hypoplastic ribs at L1. There is a slight rightward curvature of the lumbar spine as seen on the frontal view. Moderate degenerative disk disease affects L1/2, L4/5, and L5/S1. Moderate facet joint osteoarthritis affects the lower lumbar spine. There is approximately 4 mm of anterolisthesis of L4 that increases to approximately 6 mm on flexion. There is approximately 6 mm of anterolisthesis of L5 that increases to approximately 7 mm on flexion. Mild osteoarthritis affects the sacroiliac joints. There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries. A metallic density in the pelvis is partially visualized on this study and may represent a bullet. | Degenerative disk disease and other findings as described above. |
Generate impression based on findings. | 69-year-old female with known right breast carcinoma (two sites) presents for ultrasound guided right axillary biopsy. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 1.1 x 2.5 cm within the low right axilla, with increased vascularity. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right axilla was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, five 14-gauge core needle (InRad) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. Three specimens floated. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Clip placement was verified on ultrasound. A post biopsy mammogram was differed, as given the deep axillary position is was very unlikely that it would be seen mammographically. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Happ and Dr. Schacht. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right axillary lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Pain and puncture wound. Suspected foreign body to distal fifth digit There is perhaps mild soft tissue swelling, but I see no foreign body or fracture. | Soft tissue swelling without foreign body evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her sister and maternal great aunts. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Pain and paresthesias. Left cervical radiculopathy. Moderate to severe degenerative disease affects C5/6, with anterior and posterior vertebral body osteophytes at this level. Mild to moderate degenerative disease affects C6/7. The lower cervical spine is slightly kyphotic. There are mild osteoarthritic changes of the facet joints. There is mild narrowing of the C5/6 neuroforamina bilaterally | Degenerative disk disease and neuroforaminal narrowing as above. |
Generate impression based on findings. | Lower back pain with radiation to the left hip status post fall. Evaluate for fracture. Five views of the lumbar spine are provided. There is a compression fracture of L1 with approximately 50% loss of height anteriorly that is of indeterminate age but I suspect chronic in etiology. Moderate to severe degenerative disk disease affects L5/S1. Moderate facet joint osteoarthritis affects the lower lumbar spine. The bones appear demineralized.Two views of the left hip are provided. I see no fracture or malalignment.AP view of the pelvis is provided. I see no fracture. | Compression fracture of L1 of indeterminate age, but I suspect chronic in etiology. Degenerative arthritic changes of the lumbar spine as described above. I see no definite acute fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast excisional biopsy with pathology proven fibroadenoma. Family history breast carcinoma in her mother at age 72. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker has been placed on the scar overlying the central outer right periareolar region. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Mesothelioma restaging after two cycles of chemo. LUNGS AND PLEURA: Bilateral pulmonary nodules and endobronchial lesions, some of which are suspicious for metastases. For reference, a lesion in the lingula measures 9 x 11 mm (6/56).Mild left hemithorax pleural thickening/areas of focally loculated fluid, nonspecific in appearance. High-density material at the left lung base suggests that the patient undergone a prior talc pleurodesis.MEDIASTINUM AND HILA: Aberrant right subclavian artery, normal variant anatomy. Atherosclerotic calcification of the thoracic aorta and its branches including moderate coronary artery calcifications. Calcification along the posterior wall of the left ventricle, correlate for prior MI. No pericardial fluid. Small paraesophageal hernia.CHEST WALL: 6-mm left internal mammary chain lymph node (4/32). Enhancement or calcification in the intercostal space between left ribs 8 and 9 (4/75), indeterminate without comparison to prior studies.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Peripherally calcified, probably thrombosed splenic artery aneurysm measuring 11-mm (4/98). No suspicious findings to suggest intra-abdominal extent of tumor. | Bilateral pulmonary nodules, some of which are suspicious for metastases. Mildly enlarged left internal mammary chain lymph node could be reactive if the patient has had a recent procedure however nodal metastasis cannot be excluded. High-density material associated pleural thickening at in the left lower hemithorax, some of which extends through the chest wall it in a pattern suspicious for a prior pleurodesis and therefore will not be used for reference measurement purposes without comparison to prior examinations or correlation with PET imaging. In either becomes available, an addendum to this report can be provided if formally requested. |
Generate impression based on findings. | There are partially-imaged postoperative findings related to anterior mediastinal tumor resection. There are pathologic pretracheal, right superior mediastinal, bilateral tracheoesophageal groove, and bilateral supraclavicular hypoenhancing lymph nodes. For reference, short axis measurements of the abnormal lymph nodes are as follows: an incompletely imaged 23-mm right pretracheal lymph node, a 12-mm right tracheoesophageal groove lymph node, a 19-mm right superior mediastinal lymph node, a 9-mm left supraclavicular lymph node and a 7-mm right supraclavicular lymph node. There is no significant cervical lymphadenopathy or mass lesion more superiorly in the neck. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is a nondisplaced fracture in the right posterior first rib with marginal sclerosis. There are mild multilevel cervical degenerative changes with disc osteophyte complexes at C3-4 through C5-6 and variable degrees of neural foraminal stenoses. The airways are patent. The imaged intracranial structures are unremarkable. There is an indeterminate 5-mm right upper lobe apical lung nodule. | 1.Pathologic lymphadenopathy in the pretracheal, right superior mediastinal, bilateral tracheoesophageal grooves and bilateral supraclavicular fossae, consistent with lymph node metastases.2.Indeterminate 5-mm right upper lobe apical lung nodule. Please refer to accompanying dedicated CT chest report for further details.3.A right posterior first rib fracture is suspicious for pathologic fracture given its singularity.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Pelvic fracture Again seen is disruption of the left iliopectineal line with a linear lucency traversing the anterior column of the acetabulum indicating a minimally displaced fracture that appears similar to that seen on the prior study. I see no fractures of either obturator ring. I see no fractures of the sacrum. Osteoarthritis of the hips, pubic symphysis, and lower lumbar spine appears similar to that seen on the prior study. | Left acetabular fracture appearing similar to that seen on the prior study. |
Generate impression based on findings. | 64 years old male with a history of metastatic lung cancer. Please restage. RADIOPHARMACEUTICAL: 7.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 79 mg/dL. Today's CT portion grossly demonstrates a large mass in the right lower lung. Additional linear opacities are seen in the left and right lung bases, and are most consistent with atelectasis.Today's PET examination demonstrates increased activity in the mass in the right lower lobe (SUV max = 23.5 on current study and 25.1 on prior study) and is consistent with the patient's diagnosis of non small cell lung carcinoma. A subcarinal lymph node (SUV max = 2.7) has slightly decreased in metabolic activity (SUVmax = 3.2 on prior study). A precarinal lymph node (SUV max = 1.8.) has decreased in metabolic activity (SUV Max on prior study was 2.9). The abnormal FDG uptake in the lung hila is stable. Several new foci of increased activity are seen in the upper abdomen without definite CT correlation, which are probably in the GI tract.No other definite evidence of tumor metastases is identified.Physiological activity is seen in the right, spleen, kidneys, intestines and bladder. | 1.Stable hypermetabolic tumor in the right lower lobe.2.Stable to mildly decreased metabolic activity in the mediastinal and hilar lymph nodes.3.Nonspecific several new foci of increased activity in the upper abdomen, probably in the GI tract. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable moderate chronic small vessel ischemic changes. There has been interval development of an age indeterminate infarct in the left cerebellum. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There are limbic calcifications along the anterior globes. There is extensive intracranial atherosclerotic calcification anteriorly. | 1. No acute intracranial hemorrhage.2. Interval development of left cerebellar age indeterminate small infarct.3. Stable underlying moderate chronic small vessel ischemic changes. |
Generate impression based on findings. | Metastatic lung cancer. Check following chemotherapy and treatment CHEST:LUNGS AND PLEURA: Interval progression and increased size and density of the mixed partially solid groundglass nodular density with calcifications observed in the right middle lobe. The focus has enlarged, currently measuring 1.6 x 1.4 cm (image 37 series 4) for prior measurement of 1.1 x 0 .9 cm.The left lower lobe reference nodule again measures 9 mm in the central solid component and would measured in a similar fashion (image 49 series 4).Diffuse underlying fibrotic changes are similar without new superimposed focal abnormality or nodules. No effusions. Specifically postsurgical changes in the right lower lobe with a partial lobectomy are observed. Overlying rib changes.MEDIASTINUM AND HILA: No lymphadenopathy.Mild cardiomegaly without additional cardiac or pericardial abnormality. Coronary calcifications similarModerate herniaCHEST WALL: Right chest portABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The focal fat is again observed adjacent to the falciform ligament. Cholecystectomy. No suspicious new nodules or masses.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged simple renal cysts greater on the leftPANCREAS: 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: Extensive degenerative changes throughout the thoracic and lumbar spine unchanged. No new suspicious lytic or blastic lesions observed . Mild wedge deformities.OTHER: No significant abnormality noted. | Interval progression and increased solid component involving the reference right upper lobe mixed groundglass and partially solid nodule. Reference measurements are provided and remaining scattered bilateral nodules are otherwise similar. These changes are superimposed upon extensive fibrotic disease. Given this focal subtle and solitary change, concern for a new pulmonary primary malignancy must be considered. |
Generate impression based on findings. | PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. There is an 8 x 9 mm hypoenhancing lesion within the right paramedian thyroid gland extending into the isthmus.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is a partially visualized large predominantly posterior right pleural effusion with adjacent atelectasis. There is a left-sided Port-A-Cath. There slight leftward shift of the visualized upper mediastinum which may relate to the process within the right hemithorax. There is partial visualization of mediastinal lymphadenopathy. There is mild mucosal thickening in the maxillary sinuses, greater on the left side. There are cervical spondylotic changes noted, most conspicuous at C3-C4 where there is a prominent central protrusion with mild to moderate stenosis. There are also shallow disk protrusions at C4-C5, and likely at C5-C6 which appears leftward predominant resulting in moderate left foraminal narrowing at this level. An area of increased uptake on a bone bone scan in the left calvarium is not included within the field of view. | 1. No CT evidence of metastatic disease within the neck.2. Nonspecific right isthmic thyroid lesion. Correlation with thyroid function tests is recommended and thyroid ultrasound may be obtained as clinically indicated.3. Partially visualized large right pleural effusion with atelectasis. Partially visualized mediastinal lymphadenopathy Please see separate report for CT of the chest. |
Generate impression based on findings. | Pain after fall. Rule out fracture. Five views of the lumbar spine are provided. The bones appear demineralized suggesting osteopenia/osteoporosis. There is a slight leftward curvature of the lumbar spine. Severe degenerative disk disease affects L2/3 and L4/5. Moderate degenerative disk disease affects L1/2 and L3/4. Relatively mild degenerative disk disease affects L5/S1. Moderate facet joint osteoarthritis affects the lower lumbar spine. There is a grade 2 anterolisthesis of L4 relative to L5. There is mild loss of height of the left side of the L5 vertebral body that I suspect is chronic in etiology; I see no definite acute fracture. There is atherosclerotic calcification of the abdominal aorta and its branches.Two views of the pelvis are provided. The bones are demineralized adjusting osteopenia/osteoporosis. Components of a bipolar left hip hemiarthroplasty device are situated in near anatomic alignment, although the distal extent of the prosthesis is not included on the field of view of these pelvis radiographs. Mild osteoarthritis affects the right hip. I see no acute fracture. | Demineralized bones, degenerative arthritic changes, and left hip hemiarthroplasty device as described above; I see no acute fracture. |
Generate impression based on findings. | Extended pleurectomy and decortication CHEST:LUNGS AND PLEURA: Interval removal of the left chest tubes with associated marked interval decreasing underlying and currently moderate pneumothorax. Overlying chest wall emphysema extending into the abdomen and neck has also decreased. Persistent and minimally decreasing right to left midline shift associated with a small left pleural effusion.The unchanged small pleural-based subcentimeter nodular thickening at the level of the aortic arch is unchanged. Left diaphragmatic mesh. No suspicious new intrapulmonary abnormalitiesMEDIASTINUM AND HILA: Marked interval and near complete resolution of pneumomediastinum.No lymphadenopathy. No discrete cardiac or pericardial abnormality.Small hiatal hernia.CHEST WALL: Extensive but decreased subcutaneous emphysema. Mild degenerative changes throughout the thoracic spineABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Marked interval decreasing pneumomediastinum and wall emphysema. Left chest tube removed. See detail provided above |
Generate impression based on findings. | NSCLC (squamous cell) 4 month follow-up. CHEST:LUNGS AND PLEURA: Postsurgical volume loss of a right lower lobectomy and right middle lobe wedge resection. Mild bronchiectasis and bronchiolitis in the right middle lobe lateral segment postero-medially, which is now abutting the spine. Very small subpleural opacity which could reflect dependent atelectasis posteriorly on the right (5/52) new from previous but should be monitored on the subsequent examinations. No conclusive signs of localized recurrence or pulmonary metastases. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: No lymphadenopathy. Moderate cardiomegaly. Calcification of the mitral annulus. Severe coronary artery calcification. Aortic valve calcification. No pericardial fluid.CHEST WALL: Unchanged prominent right axillary lymph node containing fatty hilum (3/29).ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cystic lesions containing peripheral calcifications in the posterior segment of the right hepatic lobe, some of which are exophytic. There is a similar appearing lesion which appears separate from the hepatic parenchyma in the right upper quadrant which is unchanged. There appears to be a cleft in the right hepatic lobe.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic desiccation of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific signs of localized recurrence or pulmonary metastases. |
Generate impression based on findings. | Postop prosthetic assessment Again seen is an intramedullary rod and screw device affixing the femur in anatomic alignment. A poorly defined lucent lesion of the femoral neck is again noted, representing metastatic renal cell carcinoma. I see no hardware complication. Foci of heterotopic mineralization along the greater trochanter have undergone some maturation. Moderate osteoarthritis affects the hip. Mild osteoarthritis affects the knee. | Orthopedic fixation of the left femur as described above. |
Generate impression based on findings. | Reason: rule out GI arterial bleed from recent necrosectomy History: blood loss, sanguinous output from drains ABDOMEN:LUNG BASES: Redemonstrated large left pleural effusion with adjacent compressive atelectasis. Redemonstrated scattered areas of atelectasis or consolidation in the right lung. Coronary artery calcifications.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: Percutaneous pigtail drainage catheter and at least 3 gastropancreatic cystic stents are reidentified. Pancreatic ductal stent seen with tip in the below described collection. Air and fluid collection in the lesser sac, and pancreatic body bed. Measures approximately 6.7 x 11 cm (3:64) compared to 7.1 x 11.7 cm (3:66) on prior scan. The fluid tracks throughout the retroperitoneum, and intraperitoneal cavity.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches. Inferior vena cava filter in place. Slitlike appearance of the IVC, likely due to fluid status.BOWEL, MESENTERY: Redemonstrated nasojejunal tube. Large volume ascites. Fat stranding likely secondary to pancreatitis. Compared to the prior exam, there is new significant edematous thickening of the entire colon with pericolonic fat stranding and fluid. At the proximal descending colon/cecum, there is a large extraluminal gas and fluid collection, which extends into the pelvis in addition to free intraperitoneal air. The collection becomes difficult to separate from the large bowel itself, and is multiloculated, with one large component in the right lower quadrant, measuring approximately 11 x 4.3 cm (9:140). Another large portion of the collection is seen in the retrovesicular space (9:157) and extending across the midline at the aortic bifurcation (9:123) The site of perforation is possibly seen on the axial arterial image 117.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large volume ascites. Rectal catheter.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality noted | New intraperitoneal air and large gas and fluid collection, likely secondary to colonic perforation as described above.Grossly unchanged air and fluid collection in the pancreatic bed and lesser sac.Other findings as above.Findings were discussed with IR team at 1:00pm on 3/4/2015. |
Generate impression based on findings. | Postop prosthetic assessment Three views of the right knee show components of a total knee arthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication. Arterial calcifications are noted within the posterior soft tissues.Mild osteoarthritis affects the left knee as seen on the frontal view. | Total knee arthroplasty without evidence of complication. |
Generate impression based on findings. | Head and neck cancer, follow-up CHEST:LUNGS AND PLEURA: Persistent mild apical scarring and postradiation change without additional new pulmonary abnormality. Specifically no new nodules or masses. No effusions. Mild centrilobular emphysema.MEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardial appearance is within limitsSmall hiatal herniaCHEST WALL: Left chest port site demonstrates mild skin thickening, presumably scarringABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted. | No findings to suggest recurrent or metastatic disease, stable exam. |
Generate impression based on findings. | Mechanical loosening of prosthetic joint. AP view of the pelvis reveals components of a right total hip arthroplasty device situated in near-anatomic alignment. Skin staples, a drain, and foci of gas density in the adjacent soft tissues reflect recent surgery. | Right total hip arthroplasty as above. |
Generate impression based on findings. | Non-small cell lung cancer, follow-up. Left hilar tumor CHEST:LUNGS AND PLEURA: A persistent and stable appearing left hilar mixed in opacity correlating with the previously identified mass. Suspected postradiation pneumonitis in this area with decreased focal density in mild flattening adjacent to the fissure (image 49 series 5).The right upper lobe solid Morton triangular nodule appears stable again measuring 2.4 x 1.6 cm (image 22 series 5). The mildly spiculated adjacent small nodule appears similar without new abnormalities. Scattered centrilobular emphysematous changes in all 4 quadrants a scattered scarlike changes greater in the left upper lobe.MEDIASTINUM AND HILA: A stable appearing prevascular lymph node remains 1.7 cm (image 40 series 3). Scattered nodes are all otherwise unchanged without new suspicious abnormalities.Cardiac and pericardium are main significant for severe coronary calcifications.Small hiatal herniaCHEST WALL: Mild scattered degenerative changes without evidence of new suspicious lytic or blastic lesions.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic granulomas and splenules unchangedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Persistent borderline lymphadenopathy and suspected postradiation changes in the region of the mid left lung. No new suspicious abnormalities. Reference measurements provided |
Generate impression based on findings. | 65 years old male. Reason: rectal cancer. Question of inguinal lymph nodes on CT and MRI. Please pay particular attention to this area to determine if biopsy needed. RADIOPHARMACEUTICAL: 10.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 82 mg/dL. Today's CT portion grossly demonstrates a prominence of the lung hila with calcifications. Linear opacities are seen in the lung bases, which are consistent with atelectasis. There is a low-attenuation area in the right lobe liver near the dome. There is thickening of the rectal wall. Multiple enlarged lymph nodes are seen in the inguinal regions bilaterally. The prostate is enlarged. An IVC filter is noted.Today's PET examination demonstrates intense FDG uptake in the thickened rectal wall with SUV Max of 14.7, which is consistent with the patient's diagnosis of rectal cancer. Multiple mild hypermetabolic lymph nodes are seen in the bilateral external and internal iliac regions as well as in the obturator regions. Foci of increased activity are also seen in the pre-sacral space. Multiple foci of increased activity are seen in the bilateral inguinal regions, corresponding to the enlarged lymph nodes seen on the CT. The SUVmax of the dominant lymph node in the right inguinal/upper thigh region is 4.1.There is a focus of increased activity in the dome liver, corresponding to the low-attenuation lesion seen on CT in the dome of right lobe of liver. Additional focus of increased activity is seen in the left lobe of liver/right ventricle without definite CT correlation, which is nonspecific.Physiological activity is seen in the kidneys, intestines, and bladder. There is no definite abnormal FDG uptake in the prominent lung hila. | Hypermetabolic tumor in the rectum consistent with the patient's diagnosis of rectal cancer.Extensive mild to moderate hypermetabolic lymph nodes in the pelvis and inguinal regions, suspicious for nodal metastasis.Focus of increased activity in the dome of the right lobe of liver, which can be due to abscess or tumor.Nonspecific focus of increased activity in the left lobe of liver/right ventricle without definite CT correlation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in her mother at age 63 and maternal aunt. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Three benign morphology intramammary lymph nodes are present within the upper outer right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of cervical carcinoma. Three standard digital views of both breasts were performed with tomosynthesis 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. Scattered benign calcifications are present. Stable bilateral asymmetries are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Left hip pain. Hip fracture? Two views of the left hip are provided. The bones appear demineralized, but I see no fracture. Mild osteoarthritis affects the left hip.Two views of the right hip are provided. The bones appear demineralized, but see no fracture. Mild osteoarthritis affects the right hip.An AP view of the pelvis is provided. The bones appear demineralized, but I see no fracture. Mild osteoarthritis affects both hips. I suspect that there is partial sacralization of L5, with a hypertrophied right transverse process that articulates with the underlying sacrum. There is perhaps mild cortical and trabecular prominence of the left obturator ring relative to the right obturator ring which may represent Paget's disease, but this is equivocal. Arterial calcifications are noted within the pelvis and proximal thighs. Surgical clips are noted within the proximal thighs as well. | Osteoarthritis and other findings as described above; I see no fracture. |
Generate impression based on findings. | Pleural mesothelioma LUNGS AND PLEURA: Right apical surgical starring with a small adjacent pneumatocele unchanged. New groundglass abnormality observed in the right lung, specifically along the right cardiac border and posteriorly. Appearance is nonspecific and lead in the patient history, concerning for possible infection. Please correlate patient presentation.Mild progression in overall right pleural nodularity. Reference measurements are as follows:1. At the level of the brachia cephalic confluence (image 29 series 5), the 3 and 8 o'clock measurements are currently 1.8 and 1 .1 cm, previously 1.6 and 0.9 cm respectively.2. At the level of the carina (image 34 series 5), the 7 and 8 o'clock measurements are currently 1.1 and 0.8 cm, previously 1.0 and 0.6 cm respectively.3. At the level of the atrium (image 53 series 5), the 12 and 9 o'clock measurements are 1.1-cm and 1.2 cm, previously 0.8 and 0.6 cm respectively.Continued scattered shifting tracheal debris.MEDIASTINUM AND HILA: Interval aggressing lymphadenopathy. The reference right paratracheal lymph node has increased, currently measuring 2.5 cm in short axis, previously 1.8 cm (image 14 series 5). The right hilar reference lymph node measures 1.8 cm (image 38 series 5) from a prior measurement of 1.4 cm. Similar enlargement throughout the mediastinal lymph nodes are observed.Persistent pericardial thickening with adjacent indistinguishable small nodules. Suspected grossly unchanged appearance the exam is limited. No additional cardiac or pericardial abnormality other than stable appearing moderate coronary calcificationsCHEST WALL: Left diaphragmatic mash with minimal degenerative changes throughout the thoracic spine. No suspicious new lytic or blastic lesions observedUPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Interposed bowel anterior to the liver. Unchanged nonspecific hepatic hypodensity and simple renal cysts. No additional abnormalities observed in this limited view of the upper abdomen | Interval progressing mesothelioma measurements, see above |
Generate impression based on findings. | Status post left total hip replacement Three views of the left hip reveal components of a total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of hardware complication. Faint heterotopic mineralization is noted between the greater trochanter and ilium.Three views of the pelvis revealed the aforementioned postoperative changes on the left. Moderate osteoarthritis affects the right hip. | Left total hip arthroplasty as above. |
Generate impression based on findings. | Clinical question: Evaluate for cause of a mass versus possible seizure. Signs and symptoms: History of traumatic brain injury with new AMS Nonenhanced head CT:Examination demonstrate a mild healed chronic depressed skull fracture of the right parietal bone. There is a small focus of encephalomalacia of brain parenchyma immediately at this level likely as result of prior trauma. Additionally there is a slightly larger focus of encephalomalacia along the inferior aspect of the right temporal lobe which is also believed to be secondary to prior trauma. There is no detectable acute intracranial process CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex and cortical sulci as well as ventricular system are otherwise unremarkable and midline is maintained.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process CT however E. insensitive for early detection of acute nonhemorrhagic ischemic stroke.2.Chronic healed mildly depressed right parietal skull fracture.3.Small focus of encephalomalacia in the right parietal bone under the chronic skull fracture.4.Additional focus of encephalomalacia along the the inferior aspect of right temporal lobe.5.Unremarkable exam otherwise.6.There are no prior studies for comparison however if such studies are available and provided to the radiology department an addendum to this report will be submitted after comparison. |
Generate impression based on findings. | Postop prosthetic assessment. Evaluate left knee pain after intra-articular injection 6 weeks ago. Three views of the right knee are provided. Components of a total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Small foci of mineralization are seen along/within the extensor mechanism, appearing similar to the prior study.Three views of the left knee are provided. Moderate to severe osteoarthritis affects the knee, particularly the lateral tibiofemoral compartment. There is perhaps a small joint effusion, but overall the findings are similar to those seen on the prior study, and I see no specific radiograph features of septic arthritis. | Right total knee arthroplasty and left knee osteoarthritis as above. |
Generate impression based on findings. | Call back from screening mammogram for an asymmetry in the left breast. ML, MLO and exaggerated CC views and a spot compression view of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is extremely dense, unchanged in pattern and distribution. The asymmetry on the MLO view at posterior aspect is again seen on the repeat MLO view but disperses with spot compression view.Focused ultrasound detected a simple cyst (7 x 3 mm) at 3 o'clock position in the left breast, corresponding to the asymmetry. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. In view of her dense breast tissue, tomosynthesis would be useful. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Multiple clusters of benign fibroadenomatous calcifications are present within the right breast. Additionally, there is a 1.6-cm cluster of fibroadenomatous calcifications within the mid central left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Status post right total hip arthroplasty Two views of the right hip show components of a total hip arthroplasty device situated in near anatomic alignment. Thin lucency along the distal stem of the femoral component is perhaps slightly more prominent on the current study than on the prior study, and while I cannot entirely exclude the possibility of early loosening, I suspect that this may not be of any clinical significance.The AP view the pelvis also shows a left total hip arthroplasty device, although the distal extent of the prosthesis is not included on the field of view of this study. Degenerative arthritic changes affect the visualized lower lumbar spine. | Total hip arthroplasty as above. |
Generate impression based on findings. | Hypoxia. PULMONARY ARTERIES: Excellent contrast infusion quality. No evidence of pulmonary embolus.LUNGS AND PLEURA: Low lung volumes, with elevation of the diaphragm. No pneumothorax. Trace left pleural fluid collection. Moderate, fine pattern of centrilobular emphysema.Multifocal consolidation and atelectasis in the posterior lower lobes and the lingula abutting the fissure. Debris in the left lower lobe bronchus.MEDIASTINUM AND HILA: Upper normal heart size, no pericardial fluid. Mild coronary artery calcifications. Main pulmonary artery appears mildly enlarged measuring 33-mm in transverse dimension. No conclusive signs of right heart strain. Bilateral mild mediastinal lymphadenopathy in all compartments mildly enlarged hilar lymph nodes.CHEST WALL: Thoracic kyphosis and multi-level endplate degenerative changes throughout these thoracic and visualized upper lumbar spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range. Hepatosplenomegaly; the splenic diameter has increased to 13.8-cm (coronal image 30) from a measurement of 12.6-cm on the recent 3/2/2015 examination.. Vascular calcifications. | No evidence of acute pulmonary embolus. Multifocal atelectasis and consolidation in the dependent lung fields, likely related to aspiration given presence of endobronchial debris in the left lower lobe. Mild diffuse mediastinal and hilar lymphadenopathy and hepatosplenomegaly of unclear etiology; note is made of apparent increase in size of the spleen since the 3/2/2015 abdominal CT examination. Trace left pleural effusion is new. Enlargement of the main pulmonary artery suspicious for pulmonary hypertension.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Evaluate for fracture or impingement Four views of the right shoulder reveal a lucency in the proximal diaphysis of the humerus. This most likely represents a prominent deltoid insertion, of no clinical significance. No fractures or dislocations. No significant degenerative changes. | Negative examination of the right shoulder |
Generate impression based on findings. | Status post surgery Again seen are posterior rods with screws entering the L4, L5, and S1 vertebrae. I see no hardware complications. There is a spacer device at L5/S1 associated with increased density presumably representing bone graft material, appearing similar to the prior study. Mature bone graft is seen along the lateral aspects of the lower lumbar spine. Severe degenerative disk disease affects the remaining lumbar levels, with a grade 1 retrolisthesis of L2 relative to L3. Vertebral body heights are preserved. There is a minimal rightward curvature of the lumbar spine, unchanged. | Postoperative and degenerative changes of the lumbar spine as described above, appearing similar to those seen on the prior study. |
Generate impression based on findings. | Evaluate fibular fracture Three views of the right ankle reveal an oblique fracture of the distal fibula in anatomic alignment. The fracture line is indistinct consistent with healing. No change in position from the previous exam | Healing distal fibular fracture |
Generate impression based on findings. | Poorly differentiated adenocarcinoma. Follow-up CHEST:LUNGS AND PLEURA: Postsurgical changes in suture line are observed in the right upper lobe with interval removal of the previously described small nodule peripherally. No discrete superimposed residual abnormality however serial imaging will be helpful to confirm along the suture line.Moderate hyper expansion of the right lung with associated left pneumonectomy and marked mediastinal shift unchanged. No effusions. No suspicious new nodules or massesMEDIASTINUM AND HILA: No lymphadenopathySevere coronary calcifications without additional cardiac or pericardial abnormality.Questionable small hiatal herniaCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status-post cholecystectomy without additional hepatic abnormalitiesSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered small renal cysts unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Postsurgical changes in the apex of the right lung without additional new abnormalities specifically no new signs of metastatic disease |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of calcifications in bilateral breast cysts. Two standard digital views of both breasts were performed with tomosynthesis 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. Scattered benign calcifications are present. Multiple benign morphology masses are present bilaterally, compatible with patient's history of breast cysts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 60 years old; Reason: assess for intrabdominal source of fever History: fever, leukocytosis, abd pain, L flank pain ABDOMEN:LUNG BASES: Small amount of compressive atelectasis involving the right lower lobe, secondary to an osteophyte.LIVER, BILIARY TRACT: Interval placement of a right stent within the common bile duct, and subsequent pneumobilia in intervally decreased dilated intra-hepatic bile ducts. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Small amount of fluid surrounding the pancreatic head and extending along the pararenal space could be related to some component of acute focal pancreatitis or alternatively postsurgical.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left perinephric stranding with slightly decreased enhancement pattern and wedge-shaped areas of subtle hypodensity compatible with pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube in place within the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of free fluid, likely related to above described processes..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Left pyelonephritis and changes suggestive of acute pancreatitis of the pancreatic head, further described above. Findings discussed with Dr. Potts at 1:29pm on 3/4/2015. |
Generate impression based on findings. | Assess internal fixation Three views of the right ankle reveal a side plate fixing the distal fibular fracture. There is a long syndesmotic screw. The previously seen widening of the medial ankle mortise has been reduced. | Internal fixation in anatomic alignment. |
Generate impression based on findings. | 56 years old Male. Reason: change in pleural plaques? History of lung nodules versus rounded atelectasis and cough. RADIOPHARMACEUTICAL: 12.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates numerous pleural plaques in the chest wall and diaphragmatic pleura on both sides. Some of pleural plaques appear slightly enlarged as compared with prior study. For example, right lower lobe posterior and lateral pleural plaques appear thick and more extensive. The diffuse low attenuation is seen in the liver, which is suggestive of fatty infiltration in the liver. Multiple small lymph nodes are seen in the retroperitoneal cavity, which appears stable as compared with prior study.Today's PET examination demonstrates minimally increased metabolic activity in the pleural plaques in both hemithoraces. The SUVmax in the right lower lobe posterior pleural plaque is 1.8.There is no other evidence of FDG avid disease. Physiological activity is seen in the liver, spleen, kidneys, intestines, stomach, uterus and bladder. There is no abnormal FDG uptake in the small lymph nodes in the retroperitoneal cavity. | No definite evidence of FDG avid tumor.Interval slight enlargement of the pleural plaques in both hemithoraces with minimal FDG uptake, which are most likely benign. Suggest follow-up.Please note that the comparison of two studies is limited due to different PET/CT scanners were used for the two PET/CT scans. |
Generate impression based on findings. | Female, 56 years old, status post hepatectomy and cholecystectomy Right upper abdominal drainage catheter. Enteric tube seen with side-port below level of hemidiaphragms. No unexpected radioopaque foreign body, discussed with fellow Dr. Hussain at 1:30 p.m. and surgery attending Dr. Millis at 1:34 p.m. on 3/4/15. | No unexpected radioopaque foreign body. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy. Family history breast carcinoma in her mother, maternal grandmother, in 3 paternal aunts. Two standard digital views of both breasts, and an additional left CC view were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography. An aymmetry is present in the central left breast on CC view only. A cluster of calcifications is present within the mid central left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | 1. Left breast asymmetry. Further evaluation with spot compression views, and possible ultrasound is recommended.2. Cluster of calcifications in the mid central left breast. Further evaluation with spot magnification views is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: ED - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Non-small cell lung cancer, follow-up LUNGS AND PLEURA: Interval removal for treatment of a solitary lungs nodule in the right upper lobe with adjacent mild fluid collection caught in the major fissure and pleural surface. No discrete evidence of postsurgical change or other findings of discrete new focal abnormalities. Multiple scattered micronodules with a small area poorly defined subcentimeter groundglass nodule in the left upper lobe (image 27 series 4) all demonstrate stability (extending back to the outside prior of 6/7/14). No suspicious additional effusions or additional masses or nodules.MEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardium are within limits other than moderate coronary calcifications.CHEST WALL: Moderate thoracic and spinal degenerative changes without suspicious lytic or blastic lesions, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Large hypoattenuating lesion in the dome of the liver, likely a cyst unchanged. Cholelithiasis. Questionable right renal cysts although changes are observed on the last image, consider dedicated imaging | Interval resolution or probable surgical removal of the right upper lobe focal lesion suspicious for primary malignancy. No postprocedural complications or new suspicious abnormalities other than multiple stable scattered pulmonary micronodules and one stable small subcentimeter groundglass nodular density in the left upper lobe, working serial continued imaging |
Generate impression based on findings. | Pain. Fracture follow-up. Again seen is a minimally displaced fracture of the greater tuberosity of the humerus. Portions of the fracture are slightly less distinct on the current study than on the prior study, which may reflect early healing. The lipohemarthrosis seen on the prior study is not visible on the current study. | Greater tuberosity fracture as above. |
Generate impression based on findings. | Neck pain. Evaluate for osteoarthritis. The bones appear demineralized, suggesting osteopenia. Severe degenerative disk disease affects C5/6 and C6/7. Moderate degenerative disk disease affects C3/4. Mild to moderate degenerative disease affects C4/5. The cervical spine is slightly kyphotic, and there are grade 1 anterolistheses of C3 and C4. There is mild to moderate multilevel facet joint osteoarthritis and mild multilevel neuroforaminal narrowing bilaterally. Sternotomy wires are noted. | Degenerative disk disease and other findings as described above. |
Generate impression based on findings. | Follow up right sided lung cancer history thoracic radiation and dyspnea. CHEST:LUNGS AND PLEURA: Lymphangioleiomyomatosis. Fiducial markers lateral to the right hilum with adjacent radiation fibrosis and pleural retraction. Unchanged subpleural nodule in the left lower lobe (5/62), present since 2012, most likely a benign intrapulmonary lymph node.Right lower lobe mass measures 3.3 x 2.5 cm, previously 2.2 x 1.3 cm, difficult to reliably differentiate in its lateral aspect from adjacent radiation reaction.MEDIASTINUM AND HILA: Right hilar lymph node measures 11-mm, previously 12-mm (3/36). The nonindex necrotic lymphadenopathy surrounding the right hilum seen previously has significantly improved (for example measuring 15-mm in short axis previously, now 8mm (3/38)). Right inferior interlobar lymph nodes decreased in size as well. No pericardial fluid. Normal heart size. Severe atherosclerotic calcification of the aorta and its branches. Mildly prominent left hilar and interlobar lymph nodes (3/39) are unchanged in appearance. Non-index subcarinal lymph node appears smaller small lymph nodes elsewhere in the mediastinum are unchanged.CHEST WALL: Displaced partially healed fractures of the right fifth rib and sixth ribs again seen. Adjacent soft tissue thickening slightly more prominent but may be related to radiation there he at this level.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Small left adrenal gland nodule unchanged (3/92).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Extrahepatic biliary ductal dilatation unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Significant interval decrease in nonindex necrotic right hilar and interlobar lymphadenopathy. Mild improvement in nonindex subcarinal lymph node. Reference right lower lobe lesion measures larger. |
Generate impression based on findings. | Reason: 6 month follow up. Lung nodules. LUNGS AND PLEURA: A left lower lobe subpleural nodule measures 5 mm (series 4, image 47), slightly decreased in prominence from 12/2013. Additional scattered benign-appearing micronodules are unchanged. No new suspicious pulmonary nodules or masses.Mild basilar scarring/atelectasis, unchanged. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.Scattered calcified mediastinal and hilar lymph nodes, unchanged. No lymphadenopathy.Mildly enlarged thyroid.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic granulomas. | Left lower lobe 5mm subpleural nodule is slightly decreased from prior exams, and likely benign in etiology. An apparent increase in density on previous exam was likely secondary to focal accumulation of mucus within an adjacent small cyst. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her paternal grandmother, diagnosed in her 60's. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Call back from screening mammogram for an asymmetry in the left breast. ML, MLO and exaggerated CC views and a spot compression view of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is extremely dense, unchanged in pattern and distribution. The asymmetry on the MLO view at posterior aspect is again seen on the repeat MLO view but disperses with spot compression view.Focused ultrasound detected a simple cyst (7 x 3 mm) at 3 o'clock position in the left breast, corresponding to the asymmetry. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. In view of her dense breast tissue, tomosynthesis would be useful. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Relapsed neuroblastoma now status post 10 cycles chemotherapy. Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. There is no abnormal focus of activity to indicate current MIBG avid tumor. Nonspecific activity is seen in the left neck, probably within the left thyroid gland. This region was not imaged SPECT on the previous exam. | No definite evidence of tumor. |
Generate impression based on findings. | Intramedullary rod left femur, evaluate for hardware complications An intramedullary rod and screw device affixes the femur in anatomic alignment. I see no hardware complications. Faint heterotopic mineralization is seen within the soft tissues above the greater trochanter. The previously seen sclerotic focus in the femoral neck is largely obscured by the orthopedic hardware on the current study. Mild osteoarthritis affects the hip. Moderate osteoarthritis affects the knee. Surgical clips are noted within the pelvis. | Orthopedic fixation of the left femur as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in two maternal great aunts. Two standard digital views of both breasts, and an additional right CC view were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is stable focal asymmetry in the left retroareolar region. Small punctate calcification again seen within the upper central left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Head and neck cancer, follow-up CHEST:LUNGS AND PLEURA: Stable adjacent to the major fissure (image 70 series 4) again measuring 2.1 x 1.6 cm. immediately adjacent groundglass changes similar to prior exam. In addition, a new groundglass focal nodule is observed also in the left lower lobe measuring 8 mm (image 70 series 4).Scattered micronodules without additional new abnormality in the left lung, however focal ground glass changes in the right apex are otherwise observed and and demonstrate a lobular pattern. No effusionsMEDIASTINUM AND HILA: No lymphadenopathyCardiac and pericardium are within limitsSmall hiatal hernia.CHEST WALL: Degenerative changes about the thoracic spine without additional superimposed acute abnormalities.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted other than mild fatty replacement.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: Diffuse idiopathic skeletal hyperostosisOTHER: No significant abnormality noted. | 1: Stable left lower lobe nodule adjacent to the major fissure. Small adjacent new groundglass nodular density also in the left lower lobe new since prior study. Serial imaging will be important to differentiate and tract for change.2. Suspect inflammatory change in the right apex. |
Generate impression based on findings. | Pleural mesothelioma ABDOMEN:LUNG BASES: Please see separate chest CT reportLIVER, BILIARY TRACT: Stable subcentimeter low-attenuation focus within segment 3 of the left lobe of the liver. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cystRETROPERITONEUM, LYMPH NODES: Slight interval increase in size of retroperitoneal adenopathy. Reference gastrohepatic ligament node seen on image 26 of series 9 now measures 1.4 x 1 cm; this is in comparison to 1.1 x 1 cm on 12/10/2014. Reference left para-aortic lymph node best seen on image 51 of series 9 now measures 2.6 X 1.8 cm; this is in comparison to 2.3 x 1.6 cm on 12/10/2014.Retrocrural adenopathy has slightly increased in size. A representative retrocrural lymph node best seen on image 38 of series 9 measures 3 x 1.7 cm; this is in comparison to 2.4 x 1.5 cm on 12/10/2014.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right lateral subcutaneous soft tissue nodule best seen on image 53 of series 9 has remained stable measuring 1.3 x 1 cm.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval increase in size of retrocrural and retroperitoneal adenopathy. |
Generate impression based on findings. | Clinical question:. Patient with history of endocarditis, evaluate for brain lesions. Signs and symptoms: Endocarditis Nonenhanced head CT:There is no evidence of an acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes. There is a tiny focus of low-attenuation involving the cortex and subcortical white matter of the left posterior parietal lobe containing a small focus of high density. The finding could represent a focus of ischemic stroke of indeterminate age and high density may represent subtle calcification or hemorrhage. Recommend follow-up with an MRI exam to exclude possibility of an acute or subacute hemorrhagic stroke.Additionally a tiny focus of low-attenuation in the left external capsule or is present and likely representing an age indeterminate lacunar infarct.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.There is very heavy vascular calcification of the vertebral basilar system as well as bilateral internal carotids across the skull base and in their supraclinoid segments. Mild vascular calcification of bilateral anterior and middle cerebral artery distal branches are also present.Calvarium and soft tissues of the scalp are unremarkable.All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized. There is a tiny superficially located cyst like lesion on the left lateral to the left orbital ridge (axial image number two. The finding measures approximately 17 times 13 mm in transaxial dimension. Finding is a nonspecific finding and may represent a superficial cysts. Correlate with direct inspection. | 1.Small focus of parenchymal low density containing a small focus of high density in left posterior parietal lobe. The exact etiology of finding is not clear however considering above provided history, possibility of a chronic stroke with minimal calcification or an acute/subacute stroke with minimal hemorrhage should be considered. Recommend follow-up with an MRI exam for better evaluation.2.Very extensive intracranial vascular calcification is noted.3.Small lacunar infarct of left basal ganglia of indeterminate age. |
Generate impression based on findings. | Isolated ankle swelling. Rule out fracture. There is diffuse soft tissue swelling about the ankle. The bones appear demineralized suggesting osteopenia. I see no acute fracture. I see no joint effusion. Mild osteoarthritis affects the ankle. Moderate osteoarthritis affects the talonavicular joint. There are small posterior and plantar calcaneal spurs. | Soft tissue swelling and degenerative arthritic changes without fracture evident. |
Generate impression based on findings. | Female 62 years old Reason: metastatic renal cell carcinoma History: metastatic renal cell carcinoma Exam is limited secondary to lack of intravenous contrast making evaluation of solid organ and vascular pathology suboptimal. Within these limitations, the following observations can be made:CHEST:LUNGS AND PLEURA: Multiple new nodules bilaterally are suspicious for metastases. Reference large left upper lobe nodule measures 1.0 by 1.1 cm (series 4, image 13).Reference right middle lobe nodule measures 6 mm (series 4, image 38).MEDIASTINUM AND HILA: Scattered mediastinal lymphadenopathy. Reference paratracheal lymph node measures 0.9 x 1.6 cm (series 3, image 23). Cardiomegaly without pericardial effusion. Severe coronary artery calcifications. CHEST WALL: Mildly prominent axillary adenopathy, especially on the right. Vascular dialysis graft is present in the left axilla.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without acute inflammation. No focal hepatic mass within the limits of this noncontrast study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Surgically absent right kidney. No evidence of recurrence in the right renal surgical bed in the limits of this noncontrast study.Multiple low attenuation foci within the left native kidney which are not definitively characterized given the lack of intravenous contrast.RETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcification in the mesenteric vasculature. Mild to moderate atherosclerotic calcifications in the aorta and iliac arteries. Small retroperitoneal lymph nodes. Reference left periaortic lymph node measures 1.0 x 1.2 cm (series 3, image 94).BOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Findings consistent with renal osteodystrophy. No evidence of bone metastasis.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. Transplant kidney is noted in the right iliac fossa.BONES, SOFT TISSUES: Findings consistent with renal osteodystrophy. No evidence of bone metastasis.OTHER: No significant abnormality noted. | 1.Exam is limited secondary to lack of intravenous contrast making evaluation of solid organ pathology suboptimal. Within these limitations, there are multiple bilateral lung nodules suspicious for metastatic disease in a patient with renal cell carcinoma status post right nephrectomy.2.Questionable metastatic involvement of the enlarged mediastinal and retroperitoneal lymph nodes.3.Indeterminate lesions within the left native kidney. |
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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a new focal asymmetry within the upper inner left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present in the right breast. | Focal asymmetry within the upper inner left breast. Further evaluation with spot compression views and possible ultrasound, is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 60 year-old male with history of end-stage renal disease and weak pulses, evaluate vasculature to support kidney transplant. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Mild coronary artery calcifications.LIVER, BILIARY TRACT: Cholelithiasis without surrounding inflammatory changes. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: End-stage, atrophic kidneys. Multiple bilateral renal cysts and additional subcentimeter low attenuation lesions too small to characterize. Bilateral punctate nonobstructive calyceal calculi and/or medullary calcifications. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing umbilical hernia. Severe degenerative disk disease affects the lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative disk disease affects the lumbar spine.OTHER: No significant abnormality noted | 1.No significant atherosclerotic calcifications of the abdominal aorta or its branches.2.Cholelithiasis without surrounding inflammatory changes. 3.End-stage, atrophic kidneys. |
Generate impression based on findings. | Patient with esophageal cancer status post chemotherapy. Evaluate for disease status, compare to previous. CHEST:LUNGS AND PLEURA: Large right pleural effusion, mildly decreased.Bilateral pulmonary nodules are stable. There is a right upper lobe micronodule (series 5, image 15), not definitely visualized on prior study; special attention on follow-up studies.Reference left apical nodule is 7 mm (series 5, image 13), unchanged.Reference right lower lobe nodule is 5 mm, unchanged (series 5, image 54).Medial left lower lobe opacity with mild traction bronchiectasis related to post-treatment change, similar to prior.Trace left pleural effusion, unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Ill-defined mass in the distal esophagus is 14 x 21 mm (series 3, image 67), previously 14 x 19 mm. Circumferential wall thickening of the mid to distal thoracic esophagus with an esophagogastric stent and intraluminal debris, unchanged. Normal heart size. Small pericardial effusion, unchanged.No visible coronary artery calcification.Unchanged hypodense left thyroid nodule.CHEST WALL: Right anterior chest wall mass is 21 mm (series 3, image 58), previously 19 mm.Right chest wall port tip at the cavoatrial junction.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic ligament lymph node is 11 mm (series 3, image 77), unchanged.Reference left peri-aortic lymphadenopathy is 18 mm (series 3, image 97), previously 17 mm and 16 mm (series 3, image 103), previously also 16 mm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Interval placement of jejunostomy tube, incompletely imaged.Apparent short segment circumferential thickening of the transverse colon may be artifactual due to collapse, however a mild colitis is not excluded.BONES, SOFT TISSUES: Nonspecific small L1 lucency, unchanged.Ill-defined mottled sclerosis in left lateral L4 vertebral body, suspicious for a metastasis, unchanged.OTHER: No significant abnormality noted. | Stable reference lesions. New right upper lobe micronodule, special attention on follow-up studies. |
Generate impression based on findings. | Left posterior iliac crest bone marrow site with persistent pain. Evaluate for fracture or sacroiliac joint involvement. I see no fracture, and the sacroiliac joints appear normal. I see no specific findings to account for the patient's left posterior iliac crest pain. Mild to moderate osteoarthritis affects both hip joints, with prominence of the femoral head neck junction bilaterally suggesting a CAM deformity. | Osteoarthritis of the hips, but no findings to suggest an etiology for the patient's left posterior iliac crest pain. |
Generate impression based on findings. | Pain. Fracture follow-up. There is prominence of the coronoid process of the ulna indicating a healing fracture. The fracture margins appear slightly less distinct on the current study than on the prior study and there is adjacent periosteal new bone formation, suggesting some interval healing. Swelling of the soft tissues along the dorsal aspect of the ulna appears similar to the prior study. | Healing coronoid process fracture as above. |
Generate impression based on findings. | Prostate cancer. The T9 vertebral body lesion which was present previously corresponds with an irregularity at the left endplate on prior CT of the chest abdomen and pelvis and appears more degenerative in etiology. This can be secondary to the scoliosis in this region. Increased activity adjacent to the L2 and L4 vertebral bodies correlates with endplate changes at the L2-3 and L4-5 regions on the recent previous CT indicating likely degenerative changes. No evidence of osseous metastases. | No evidence of bone metastases. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her mother, maternal grandmother, and maternal cousin. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A focal asymmetry is present within the upper outer right breast, anterior depth. A stable benign morphology intramammary lymph node is noted within the upper outer right breast, posterior to the aforementioned asymmetry. No suspicious microcalcifications or areas of architectural distortion are present. | Focal asymmetry within the upper outer right breast. Additional imaging including spot compression views, with possible ultrasound, is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Non-small cell lung cancer CHEST:LUNGS AND PLEURA: Moderate interval decreasing size of the right upper lobe nodular mass abutting the minor fissure (image 35 series 5). Current measurements are 2.1 x 1.4 cm, previously 2.9 x 2.7 cm. Adjacent interstitial and air space abnormalities have also diminished. No associated effusion or new suspicious nodules in either lung. Scattered mild centrilobular emphysematous changesMEDIASTINUM AND HILA: No lymphadenopathy, specifically the subcarinal focus is not currently measurable are identified.Moderate hernia with decreased esophageal wall thickening and enhancement, and decreasing suspicion for esophagitis.The cardiac and pericardium are within limitsCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.G-tubeBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decreasing size since suspicion involving the right upper lobe spiculated lesion. Reference measurements provided. No new suspicious lesions |
Generate impression based on findings. | Reason: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. CHEST:LUNGS AND PLEURA: Stable radiation reaction in the anterior right thorax, with stable somewhat nodular apical scarring.A small left apical nodule (series 5, image 14) is unchanged from 04/2013, likely benign.Previously described clustered ground glass and nodular densities in the bilateral lower lobes are not seen on this exam, likely postinflammatory in etiology.No new suspicious pulmonary nodules or masses.Mild basilar scarring/atelectasis. No new 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: Status post right mastectomy and right axillary lymph node dissection.Sclerotic lesions in T3, T5, T6, and T11 are unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic hypodensities are unchanged, likely benign cysts. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable sclerotic lesions involving multiple lumbar vertebral bodies.OTHER: No significant abnormality noted. | 1. Stable exam with no new sites of disease.2. Resolution of previously described ground glass and nodular densities in the bilateral lower lobes, compatible with an inflammatory etiology. |
Generate impression based on findings. | Metastatic breast cancer with suspicious lesion on previous scan at L4. Abnormally increased activity is noted in the T7, T12, and L4 vertebral bodies as well as the right parietal convexity and right ischium compatible with metastases. | Likely metastatic lesions involving the T7, T12, and L4 vertebral bodies as well as the left frontoparietal convexity and right ischium. |
Generate impression based on findings. | 51-year-old female with rectal cancer status post low anterior resection and diverting loop ileostomy (2/2/15) for evaluation of anastomosis. A lateral scout image of the pelvis showed suture lines reflecting an anastomosis. Contrast was manually injected via a 18 Fr Foley catheter into the neorectum and flowed freely from the neorectum to the distal transverse colon. No extravasation of contrast was noted to suggest a leak at the end-to-end anastomosis. No abnormal fistulous connections were evident. Air was noted in the vagina and is nonspecific. TOTAL FLUOROSCOPY TIME: 1:28 minutes | Low anterior resection anastomosis without evidence of leak or fistula. |
Generate impression based on findings. | Male 18 years old Reason: post GDE procedure History: respiratory failureVIEW: Abdomen AP (one view) 3/4/15 1343 hrs. Central length deep he at the right atrium. Gastrostomy tube and left acetabular osteotomy nails again noted. Interval removal of metallic foreign body. Generalized, nonspecific bowel distention with no evidence of obstruction or free air. Persistent mild fecal loading. | Increasing in generalized, nonspecific bowel distention. |
Generate impression based on findings. | Status post curettage/prophylactic stabilization of the right proximal tibia. Evaluate for hardware failure. Again seen is a plate and screw device affixing cement within the proximal tibia, presumably representing curettage and packing of a myelomatous lesion. I see no hardware complications. Small metallic coils are seen anterior to the proximal fibula. Osteoarthritis affects the knee. Note is made of an os trigonum posterior to the talus. | Orthopedic fixation of the proximal tibia as described above |
Generate impression based on findings. | 3 year old male with history of right brachial plexus injury, concern for dysplasia. Compare development of the right upper extremity to the normal left upper extremity. Right shoulder: Normal alignment of the humerus with the humeral head situated within the glenoid cavity. Normal variant fragmentation of the humeral epiphysis. No evidence of fracture or dislocation.Left shoulder: Normal alignment of the humerus with the humeral head situated within the glenoid cavity. Normal variant fragmentation of the humeral epiphysis. No evidence of fracture or dislocation.Dependent atelectasis is noted in the lungs. | Normal examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast cyst aspiration. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 65 years old Reason: achalasia? correct placement of lap band? motility disorder? mass? History: dysphagia, h/o lap band Before administering contrast, preliminary view of the lap and in inspiration and expiration showed no evidence of air-fluid level in the gastric pouch and no mobility. The angle of Phi is abnormal, 93 degrees.The study was initiated with a test bolus of contrast in the upright AP projection. A lap band is identified in an abnormal horizontal position. Passage of contrast through the esophagus progressed without significant delay with immediate opacification of the gastric pouch. The approximate trans-sectional dimensions of the functional gastric pouch are approximately 2.1-cm cephalocaudad by about 3.2-cm AP.The remainder of the stomach is normal. Visualized duodenum and jejunum are grossly unremarkable.For evaluation of dysphasia AP and lateral movie loops (AP series #9, lateral series #7) were obtained at 30 pulses/sec showing normal swallowing and no evidence of cricopharyngeal bar or web or diverticulum. The lateral projection there is subjectively decreased caliber of the proximal cervical esophagus at the level of C4-C5. This might explain the patient's dysphasia to solids. It might be related to prior neck surgery.Esophageal peristalsis showed mild occasional proximal escape. No tertiary waves. No evidence of mass, thoracic esophageal stricture, web or hernia.FLUORO TIME: 4 min 14 sec. | Suggestion of mild decreased caliber in the cervical esophagus in the AP dimension with no other abnormality to explain dysphasia.Abnormal horizontal lie of the lap band which is sometimes associated with slippage. However there was no air fluid level within the pouch and there is prompt emptying of the pouch. This is therefore of questionable significance. Correlate clinically as to need for lap and adjustment.Findings discussed with Dr. Newton. |
Generate impression based on findings. | Lung cancer, follow-up LUNGS AND PLEURA: No significant abnormality noted. Specifically no suspicious nodules,effusions or masses. Mild emphysemaMEDIASTINUM AND HILA: No lymphadenopathy.Postoperative changes the right lower neck, please correlate with dedicated neck CTThe cardiac and pericardium are well within limitsCHEST WALL: Left chest port removed with mild soft tissues changes.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominalpathology. No significant abnormality noted. | No evidence of metastatic disease |
Generate impression based on findings. | Pain to third and fourth toes after kicking furniture. Fracture? There is an oblique fracture through the head and neck of the proximal phalanx of the fourth toe with fracture fragments in near-anatomic alignment. The bones of the third toe appear intact. | Fourth toe fracture as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, with additional bilateral MLO views, were performed with tomosynthesis 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. | 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. | 67 years, Female. Reason: assess Dobbhoff placement History: s/p Dobbhoff placement Left lower lobe opacity. Dobbhoff tube projects over the gastric body. Central venous catheter tip is in the right atrium. Surgical clips near midline abdomen. Nonobstructive bowel gas pattern. | Dobbhoff tube projects over the gastric body. |
Generate impression based on findings. | 12-year-old male status post tib/fib surgery 3 weeks agoVIEWS: Left tibia and fibula, AP and lateral (two views) , left knee, AP, oblique, and lateral (3 views) 3/4/15 12:52 Tibia and fibula: Staples affix the proximal lateral aspect of the tibia and fibula without evidence of hardware complication. No fracture is evident.Knee: Moderate joint effusion without fracture or dislocation. Proximal tibia and fibula staples are again noted. | Moderate knee joint effusion. Proximal lateral tibia and fibula staples without evidence of hardware complication. |
Generate impression based on findings. | Pain in the hand. Follow-up exam. Again seen is an oblique fracture through the proximal diaphysis of the proximal phalanx of the fifth finger with minimal dorsal angulation and displacement of the distal fracture fragment. There appears to be a small amount of callus along the fracture, suggesting an attempt at healing. | Fifth finger fracture as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in a maternal aunt, as well of ovarian cancer in a paternal aunt in 3 paternal cousins. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 79-year-old female history of metastatic lung cancer. ABDOMEN:LUNG BASES: Moderate right pleural effusion. Multiple subcentimeter pulmonary nodules in the lung bases are suspicious for pulmonary metastases. Please see report of CT chest same date for further details. Focal left basal atelectasis.LIVER, BILIARY TRACT: Multiple low-attenuation lesions are again identified throughout the hepatic parenchyma many of which are too small to characterize but are suspicious for metastatic disease. Previously described low attenuation lesion in the region of the right hepatic vein (series 8, image 27) measures 0.7 x 0.5 cm, measured 0.7 x 0.5 cm previously. A second reference lesion inferiorly in the right hepatic lobe measures 1.1 x 1.3 (series 8, image 54), previously 1.2 x 1.3 cm. There appears to be at least one new lesion in the hepatic dome (series 8, image 28). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Thickening of the lateral limb of the left adrenal gland is not significantly changed compared to prior study.KIDNEYS, URETERS: Multiple bilateral low-attenuation renal lesions many of which are too small to characterize. Previously described right kidney upper pole lesion suspicious for metastasis (series 8, image 46) measures 0.8 x 0.8 cm, unchanged. Additional hypoattenuating lesions have the appearance of renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Numerous sclerotic foci are present throughout the osseous skeleton, similar to prior. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The uterus is atrophic or absent. Hypoattenuating lesion in the right adnexa is unchanged in size. This lesion is nonspecific but favor benign etiology.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Numerous sclerotic foci are present throughout the osseous skeleton, similar to prior. OTHER: No significant abnormality noted | 1.Hypoattenuating liver and renal lesions suspicious for metastases. There is at least one new hepatic lesion with additional previously described reference regions unchanged in size.2.Diffuse osseous metastatic disease with sclerosis which may represent treatment/healing response, similar to prior. 3.Multiple pulmonary nodules suspicious for metastatic disease. Please see report of CT Chest same date for further details. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign bilateral excisional biopsies for cysts. Patient reports history of breast carcinoma in her mother. Two standard digital views of both breasts, with additional bilateral MLO views, were performed with tomosynthesis 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. Linear markers have been placed on scars overlying the upper outer aspects of both breasts. Scattered benign calcifications are present. Stable bilateral asymmetries are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: lung transplant list annual testing History: sob LUNGS AND PLEURA: Severe apical predominant centrilobular emphysema, similar to the prior exam. Mild bronchiectasis and mild bronchial wall thickening.Scattered benign-appearing micronodules, some calcified, unchanged. No new suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcification. Aberrant right subclavian artery, a normal variant.Scattered small mediastinal and hilar lymph nodes, some calcified, unchanged.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic and splenic granulomas. | Severe apical predominant centrilobular emphysema, unchanged. No other acute abnormality. |
Generate impression based on findings. | 44 year old female with sickle cell disease and avascular necrosis of the humeral head status post total shoulder arthroplasty in 1997. Please evaluate prosthesis. There has been interval revision of the patient's left hemiarthroplasty device into a total left shoulder arthroplasty device since the prior CT. However, there is now anterior dislocation of the humeral component of the total arthroplasty device with respect to the glenoid component. There is also new fragmentation involving the humeral head and proximal neck adjacent to the humeral component of the arthroplasty device. The distal humerus is intact. The acromioclavicular joint is within normal limits. The visualized lower cervical and upper thoracic spine are unremarkable. There are punctate calcifications with central fat density in the anterior subcutaneous soft tissues of the shoulder at the inferior margin of the deltoid muscle, compatible with fat necrosis. | Anterior dislocation of left total shoulder arthroplasty. New bony fragmentation around the humeral component of the device . |
Generate impression based on findings. | Female 72 years old Reason: Large B Cell NHL History: s/p 3 cycles of chemotherapy CHEST:LUNGS AND PLEURA: Nonspecific left upper lobe pulmonary nodule is unchanged in size and measures 5 mm (series 4, image 40). No pleural effusions. No suspicious nodules or masses. MEDIASTINUM AND HILA: Scattered mediastinal lymph nodes are not pathologically enlarged by size criteria. The heart size is normal without pericardial effusion. Interval placement of right chest wall port with catheter tip at the cavoatrial junction.CHEST WALL: Marked interval improvement in the numerous reference and non-reference bilateral axillary and subpectoral lymph nodes. For reference, a right axillary lymph node has markedly decreased in size and measures 0.4 x 1.0 cm (series 3, image 38), previously 1.6 x 2.4 cm. Reference left supraclavicular node has decreased in size and measures 0.9 x 1.0 cm (series 3, image 6), previously 1.5 x 1.8 cm. Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions are stable and too small to characterize.SPLEEN: The spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left hydronephrosis, unchanged. There are multiple bilateral renal sinus cysts. No definite lymphomatous involvement of the kidneys is identified.RETROPERITONEUM, LYMPH NODES: There has been improvement in the previously seen retrocrural, porta hepatis and aortocaval nodes. A reference right caval node has decreased in size and measures 0.6 x 0.8 cm (series 3, image 122), previously 1.4 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Enlarged left external iliac chain node has significantly decreased in size and measures 0.7 x 1 .2 cm (series 3, image 168), previously 2.2 x 3.2 cm. Enlarged right inguinal lymph node has also improved. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Marked interval improvement in the size of the supraclavicular, axillary, retroperitoneal, and pelvic lymph nodes consistent with treatment response. |
Generate impression based on findings. | 5-year-old male with history of constipationVIEW: Abdomen AP (one view) 3/4/15 12:17 Interval decrease in colonic stool burden. Nonobstructive bowel gas pattern. | Decreased colonic stool burden without evidence of obstruction. |
Generate impression based on findings. | Male 70 years old Reason: r/o abd path History: 7-8 day abd pain, 5-6/10 pain. No nausea, vomiting, no hematuria. Occasional constipation in the past. No hx of rash ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypodense lesion in the right lobe of the liver measuring 1.6 x 1.1 cm (series 4, image 40). Favor benign etiology such as a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence for acute inflammatory or infectious process. |
Generate impression based on findings. | 9-year-old male, twisted right ankleVIEWS: Right foot, AP, oblique, lateral (3 views) 3/4/15 Alignment is anatomic. No discrete fracture is visualized. Faint sclerosis is present within the cuboid. | No discrete fracture or malalignment. Faint sclerosis within the proximal cuboid corresponding to stress reaction seen on prior MRI. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Questionable history of breast carcinoma in her brother at age 18. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Bilateral asymmetries are present and need to be confirmed to be stable. No suspicious microcalcifications or areas of architectural distortion are present. | Bilateral asymmetries for which confirmation of stability is needed. Correlation with prior mammograms is advised. If outside mammograms cannot be obtained, further evaluation with additional imaging including spot compression views and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female; 48 years old. Reason: Bilateral hip pain Single AP view of the pelvis demonstrates no acute fracture or dislocation. Alignment is anatomic. Mild degenerative changes are noted about both hips. Dedicated views of both hips show no additional abnormalities. | Mild osteoarthritis without evidence of fracture. |
Generate impression based on findings. | Six years status post lung resection for lung cancer. LUNGS AND PLEURA: Stable postsurgical findings of left lower lobectomy.A focal area of bronchiectasis with surrounding ground glass opacity in the right upper lobe is unchanged from 2008 and likely benign (series 4, image 23).Stable scattered micronodules, most likely postinflammatory.No suspicious nodules.Mild apical scarring and small bullae.MEDIASTINUM AND HILA: Small and mildly enlarged mediastinal lymph nodes are slightly increased in size from prior. AP window node is 11 mm (series 3, image 34), previously 9 mm.Mild cardiomegaly without a pericardial effusion.Severe coronary artery calcification.CHEST WALL: Mild to moderate degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Calcified atherosclerotic disease of the abdominal aorta and splenic artery. | Mildly enlarged mediastinal lymph nodes, slightly increased from prior, which may be reactive; continued follow-up recommended. No evidence of recurrent or metastatic disease in the lungs. |
Generate impression based on findings. | Reason: 67F with RUL nodule s/p RULobectomy 12/29/2014 without nodule noted in specimen. CHEST:LUNGS AND PLEURA: Interval postoperative changes of a right upper lobectomy, with minimal residual foci of subcutaneous gas and a new small to moderate pleural effusion. Soft tissue opacity along the suture line likely representing post surgical contusion and atelectasis. Focal scarring and bronchiectasis. Postsurgical focal loculated air collection in the fissure.The previously described right upper lobe part solid nodule, compatible with known adenocarcinoma, is not seen on this exam status post lobectomy.A left lower lobe groundglass nodule measures 7 mm (series 7, image 181), increased in prominence, and only very faintly visible on prior exams in retrospect.Additional scattered micronodules and calcified granulomas are unchanged.No new focal air space consolidation.MEDIASTINUM AND HILA: The heart is normal in size, with small pericardial fluid, unchanged. Severe coronary artery calcification.Mildly prominent mediastinal lymph nodes, increased from the prior exam. A precarinal lymph node measures 9 mm (series 5, image 41).CHEST WALL: Mildly prominent axillary lymph nodes are unchanged.Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered hepatic granulomas. Cholelithiasis.SPLEEN: Punctate granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities, unchanged, likely benign cysts. Nonobstructing right lower pole calcification.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent celiac axis and periportal lymph nodes, unchanged.Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Postoperative changes of a right upper lobectomy with a moderate right pleural effusion, small loculated pneumothorax and subcutaneous emphysema. 2. The previously described right upper lobe nodule, compatible with known adenocarcinoma, is not seen on this exam following right upper lobectomy, though, given its part solid morphology, it could be obscured by postoperative contusion and atelectasis.3. A 7mm left lower lobe groundglass nodule remains indeterminate for infection, AAH or adenocarcinoma in situ. Recommend continued followup imaging. |
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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. Stable asymmetry is present within the right retroareolar region, and is marked by a mole marker on mammogram dated January 6, 2012. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
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