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Generate impression based on findings. | Female; 82 years old. Reason: Evaluate right hip s/p revision THA with concern for loosening History: Pain. Right Hip: Hardware components of a right total hip arthroplasty device are in near-anatomic alignment. There is no evidence of hardware complication or loosening. Acetabular protrusio is again noted.Pelvis: Bilateral total hip arthroplasty devices are again seen in near anatomic alignment. There is no evidence of hardware complication or loosening. Bilateral acetabular protrusio is unchanged. Degenerative changes affect the lower lumbar spine. | Bilateral total hip arthroplasty devices without evidence of complication. |
Generate impression based on findings. | 19 year-old male with history of MPNST, one year off therapy. Surveillance. LUNGS AND PLEURA: Tree in bud opacities in the posterior segment of the right upper lobe are noted. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No mediastinal or hilar adenopathy.CHEST WALL: Left chest port catheter tip is at the cavoatrial junction. No axillary lymphadenopathy.UPPER ABDOMEN: Partially visualized gastrostomy tube. No evidence of pathology in the upper abdomen. | 1. No evidence of metastatic disease in the chest. 2. Findings are suspicious for infection in the posterior segment of the right upper lobe. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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 composed of scattered fibroglandular density. 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. | 21-year-old male with osteosarcoma, off therapy LUNGS AND PLEURA: Interval resolution of previously noted micronodules. No new nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: No axillary or supraclavicular lymphadenopathy.UPPER ABDOMEN: The visualized structures of the upper abdomen are normal. | No evidence of metastatic disease. |
Generate impression based on findings. | Cerebral palsy, contracture.VIEWS: Thoracic and lumbar spine AP. Pelvis AP. 3/4/15 (2 view/s) Minimal thoracolumbar dextrocurvature. No segmentation or fusion defects. Cardiac silhouette size is normal. Left lower lobe opacity, likely atelectasis. No effusions or pneumothorax.Gastrostomy tube noted. Generalized, nonspecific bowel distention. No obstruction or free air.Interval bilateral VDRO procedure performed. Both femoral head are well directed into the acetabulum. No evidence of hardware complication. | No evidence of scoliosis.Post surgical changes of both femurs as described. |
Generate impression based on findings. | Male 2 months old Reason: fracture History: tenderness on examVIEWS: Left elbow AP and lateral left arm AP in internal and external rotation 3/4/15 (4 views) There is a left elbow joint effusion. A curvilinear density just adjacent to the inferior margin of the distal metaphyses of the left humerus in lateral view, which correlates with a linear density adjacent to the medial aspect of the distal metaphyses of the same bone on AP view is concerning for bucket handle fracture of the left humerus. | Question of a bucket-handle fracture of the left humerus.Left elbow joint effusion.Findings were communicated to and acknowledged by Dr. LIZENBERGS, LARISA on 3/4/15 at 2:40 p.m. hours |
Generate impression based on findings. | Pain and numbness right arm. Right cervical radiculopathy. Severe degenerative disk disease affects C4/5 and C5/6, that appears to have progressed when compared with the prior study. Moderate degenerative disk disease at C3/4 likewise appears to have progressed compared with the prior study. There are grade 1 retrolistheses of C4 and C5. There is narrowing of the C3/4, C4/5, and C5/6 neuroforamina on the left, and narrowing of the C4/5 and C5/6 neuroforamina on the right. | Degenerative disk disease and neuroforaminal narrowing as described above. |
Generate impression based on findings. | Male; 60 years old. Reason: Follow up status post ORIF of calcaneal fracture. Orthopedic plate and screw device affixes a comminuted intra-articular fracture of the calcaneus in near anatomic alignment. No evidence of hardware complication or loosening. The fracture lines appear more indistinct, consistent with interval healing. Mild osteoarthritis affects the first MTP joint. No new fracture or dislocation identified in the foot. | Healing calcaneal fracture as described above. |
Generate impression based on findings. | Male 4 days old Reason: where is pcvc tip? History: new PCVC placement, respiratory distress.VIEW: Chest AP (one view) 3/4/15 at 1425 hrs. UVC terminates at the right atrium. NG tube proximal side port is above the GE junction. Interval placement of left upper extremity PICC, tip at the at the left internal jugular vein. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Misplaced central line and NG tube as described. |
Generate impression based on findings. | 64 years, Female. Reason: NGT repositioned. Assess location. History: as above Enteric feeding tube tip projects over the pyloric area. Partially visualized bilateral nephroureterostomy stent again noted, unchanged. Mild interval decrease in diffuse small bowel dilatation compatible small bowel obstruction versus ileus. Pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the pyloric area. Interval decrease in diffuse small bowel dilatation compatible small bowel obstruction versus ileus. |
Generate impression based on findings. | 18 year-old male, evaluate for abscess or consolidation LUNGS AND PLEURA: Consolidation and atelectasis of the right lung sparing the apex. Moderate pleural effusion layering within fissure. Debris is noted within the right airways. Small left pleural effusion and scattered patchy pulmonary opacities.MEDIASTINUM AND HILA: Tracheostomy tube tip below the thoracic inlet.CHEST WALL: Stranding and postinflammatory changes along the right chest wall corresponding to the site of prior chest tube insertion.UPPER ABDOMEN: The visualized structures of the upper abdomen appear normal. | Right lung consolidation and atelectasis as well as patchy left pulmonary opacities consistent with pneumonia. Small to moderate pleural effusions. No evidence of abscess. |
Generate impression based on findings. | Pain. Bunion. Again seen is a severe pes planovalgus deformity as well as a hallux valgus deformity appearing similar to prior study. Bandlike sclerosis traversing the anterior aspect of the calcaneus presumably represents a healed osteotomy. Osteoarthritic changes are noted at the talonavicular and calcaneocuboid articulations. | Hallux valgus and pes planovalgus deformities as well as other findings described above. |
Generate impression based on findings. | 44 year old woman with history of cyclical breast pain and palpable mass in the right axilla. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral benign-morphlogy calcifications are noted. No dominant mass, suspicious microcalcifications, or areas of architectural distortion in either breast. Accessory breast tissue is noted in the axillae bilaterally.Benign appearing lymph nodes are projected over the right axilla.SONOGRAPHIC | 1. No mammographic evidence of malignancy. 2. Stable intradermal lesions in the superior right axilla, probably inclusion cysts.3. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Lung adenocarcinoma. LUNGS AND PLEURA: Left upper lobe mass abutting the major fissure is 22 x 29 mm (series 7, image 27), previously 22 x 28 mm.Numerous bilateral micronodules consistent with metastases are similar to prior.Right middle lobe subsegmental atelectasis, unchanged.Large right pleural effusion, increased from prior.MEDIASTINUM AND HILA: Small mediastinal and hilar lymph nodes, not significantly changed.Reference AP window lymph node is 7 mm (series 5, image 34), previously 8 mm.Lower right paratracheal node is 4 mm (series 5, image 35), unchanged.Small nonspecific thyroid nodules, unchanged.Patulous thoracic esophagus with intraluminal oral contrast.Small pericardial effusion, unchanged.CHEST WALL: Extensive thoracolumbar sclerotic and left clavicle metastases, similar to prior.UPPER ABDOMEN: Refer to separately dictated CT abdomen/pelvis report. | Increased size of large right pleural effusion. The primary left upper lobe mass and metastatic lesions are stable. No new sites of disease. |
Generate impression based on findings. | Male; 57 years old. Presents with left knee and right shoulder pain. Knee: No acute fracture or dislocation. Mild degenerative changes are noted. Bony outgrowth projecting from the superior aspect of the medial femoral condyle is likely secondary to remote MCL injury. Shoulder: No acute fracture or dislocation. Moderate osteoarthritis affects the acromioclavicular joint. Note is made of a high riding humeral head. | 1.High riding humeral head, which may represent underlying atrophy or tearing of rotator cuff muscles. MRI is recommended for further evaluation. 2.No acute abnormality identified on knee radiographs. |
Generate impression based on findings. | Female 37 years old Reason: Evaluate for left ankle fracture History: pain, edema lateral left ankle after tripping in a pothole yesterday. We have 3 views of the left ankle. There is mild soft tissue swelling along the lateral aspect of the ankle but we see no underlying fracture or malalignment. | Soft tissue swelling without underlying fracture. |
Generate impression based on findings. | Large cell neuroendocrine carcinoma. Status post resection CHEST:LUNGS AND PLEURA: Postsurgical changes including volume loss on the right with suture material adjacent to the medial margin and mediastinal contour. Overall appearance again suggests more subacute postsurgical fluid and hematoma adjacent and questionably involving the anterior lower mediastinal tissues, however serial imaging will be needed to confirm.Multiple scattered bilateral micronodules including a solitary nodular density in the right lower costophrenic angle (image 62 series 4) measuring 1.8 x 1.3 cm. Basilar atelectasis with more minimal changes observed on the left.MEDIASTINUM AND HILA: Scattered lymphadenopathy. For reference a 2.4 right paratracheal lesion is observed (image 28 series 3)No discrete additional cardiac or pericardial abnormalitySmall hiatal herniaCHEST WALL: Midline sternotomy with very minimal degenerative changes scattered through out the thoracic spine. No suspicious lytic or blastic lesions observedABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous scattered hepatic cysts without suspicious lesionsSPLEEN: 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. | Lymphadenopathy with post surgical changes within the right hemithorax with a questionable intrapulmonary nodular densities in the right lung base. Without prior images for comparison, determining the significance is limited. |
Generate impression based on findings. | Acute leukemia. CHEST:LUNGS AND PLEURA: Motion artifact degrades image quality. Peripheral subsegmental area of focal consolidation in the postero-basal right lower lobe. Smaller, approximately 1 cm peripheral airspace opacity slightly higher in the right lower lobe (4/42).No pleural fluid or pneumothorax. Mosaic attenuation of the lung parenchyma with extensive subsegmental atelectasis. Patchy multifocal less than 1 cm in size groundglass opacities in the lung periphery bilaterally.MEDIASTINUM AND HILA: Mild lymphadenopathy in the right paratracheal chain, para-aortic space, possibly in the left paratracheal space and in the subcarinal region. For reference, a subcarinal lymph node on the right measures 17-mm in short axis (3/38). The distal esophageal segment appears thickened, incompletely assessed by this technique. Posterior mediastinal lymphadenopathy is seen at this level. No visible hilar lymphadenopathy. Upper normal heart size with trace pericardial fluid, probably physiologic in volume. No visible coronary artery calcifications. A right jugular catheter terminates at the SVC level.CHEST WALL: Shotty supraclavicular, axillary and subpectoral lymphadenopathy bilaterally, right greater than left.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: HepatomegalySPLEEN: Splenomegaly.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys appear enlarged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild diffuse lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Diffuse mesenteric lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Mild diffuse lymphadenopathy throughout visualized chest and upper abdomen.2. Organomegaly involving the liver spleen and kidneys.3. Right lower lobe multifocal consolidation and small groundglass opacities may be infectious or due to leukemic cell infiltration of the parenchyma.4. Distal esophageal wall thickening incompletely assessed, of unclear etiology. |
Generate impression based on findings. | 68 years, Male. Reason: OGT placement verification History: ogt placement verification Nasogastric tube tip projects over the gastric body. Massive distention of colon measuring up to 9 cm. No pneumatosis. Note that the pelvis and portions of abdomen are excluded from the field-of-view. | Nasogastric tube tip projects over the gastric body. Worsening large bowel ileus versus distal obstruction. |
Generate impression based on findings. | 64-year-old female status post lumbar fusion. Posterior stabilization rods with screws entering the L4 and L5 pedicles/vertebral bodies are again noted. Disk spacer device and bone graft material is present between L4 and L5. Mild degenerative changes and disk space narrowing affect the remaining lumbar spine, most prominent at L5/S1. Grade 1 anterolisthesis of L4 on L5 is unchanged. No acute fractures. Vertebral body heights are preserved. Slight leftward curvature of the lumbar spine is seen on the frontal view. | Postoperative changes status post lower lumbar fusion as described above. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (12/22/14) and ultrasound images of left axilla (1/19/15) performed at Advocate Illinois Masonic. DIGITAL MAMMOGRAPHIC IMAGES (12/22/14):The breast parenchyma is composed of scattered fibroglandular elements. A benign appearing intramammary lymph node is present in the right upper outer quadrant.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. There is a significantly enlarged lymph node in the left axilla.ULTRASOUND IMAGES OF LEFT AXILLA (1/19/15):A large hypoechoic mass is visualized in the left axilla. This mass likely corresponds to the large axillary lymph node seen on the mammogram. There are a few smaller, but abnormal morphology (absent hilum) lymph nodes in left axilla. There are images with a needle placed in the mass, likely from the needle biopsy of the large lymph node.Outside pathology report states "Atypical lymphoid proliferation, most suggestive of reactive lymphoid hyperplasia." | Multiple enlarged left axillary lymph nodes. Per outside pathology report, the biopsy result was benign. Pathology slides should be reviewed at University of Chicago.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 71 years, Female, Reason: 71F with metastatic colon cancer History: surveillance. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion.No suspicious nodules or masses.MEDIASTINUM AND HILA: Prominent paratracheal node measures 1.6 x 1.0 Cm (3/24), previously 1.5 x 0.8 cm. Right chest port tip terminates at the cavoatrial junction.CHEST WALL: Right chest port.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating segment 8 lesion is unchanged measuring 8 mm (3/65), previously 7 mm. Segment 5 lesion is also unchanged. Subcentimeter hyperattenuating lesion in right hepatic lobe stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic node measures 1.2 x 0.9 cm (3/77), previously 1.4 x 1.3 cm.BOWEL, MESENTERY: Status post partial right hemicolectomy. Reference mesenteric nodule measures 0.8 x 0.5 cm (3/117), previously 0.9 x 0.6 cm.Additional enlarged mesenteric node previously referenced is unchanged (3/99).BONES, SOFT TISSUES: See below. Mild degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue along the surgical scar in the right rectus muscle is unchanged measuring 3.2 x 2.5 cm (3/152), previously 3.5 x 2.3 cm. An implant more inferiorly within the subcutaneous tissues measures 3.3 x 2 .3 cm (3/160), previously 3.1 x 2.4 cm.Additional nodules within the anterior subcutaneous tissues are likely related to injections.OTHER: No significant abnormality noted. | Grossly stable exam. |
Generate impression based on findings. | Soft tissue contrast is suboptimal despite contrast administration, limiting evaluation. Mild rightward lumbar curvature. Vertebral body heights are well-maintained without evidence of an acute fracture or traumatic subluxation. Osseous structures are diffusely sclerotic likely related to renal osteodystrophy. There are relatively defined although irregular endplates at L4-L5, especially on the right side.Previously noted questioned small fluid collection within the medial right psoas muscle does not demonstrate a definite corresponding CT abnormality. More laterally along the right psoas muscle, there is linear low density which corresponds to the symmetric T2 hyperintense fat plane noted on the MRI examination Loss of fat plane is again noted adjacent to the right psoas muscle consistent with inflammatory changes. Multiple scattered renal calcifications are noted and may represent nonobstructing nephrolithiasis versus vascular calcifications. The kidneys appear atrophic. Multiple hypoattenuating foci in the kidneys bilaterally, presumably cysts. There is aortoiliac atherosclerotic calcifications.T12/L1: Facet arthropathy without significant central spinal canal stenosis or neural foraminal narrowing.L1/2: No significant central spinal canal stenosis or neural foraminal narrowing.L2/3: No significant central spinal canal stenosis or neural foraminal narrowing.L3/4: Moderate disk height loss with mild to moderate disk bulge, left greater than right, as well as facet arthropathy resulting in mild central spinal canal stenosis and mild left neural foraminal narrowing.L4/5: Moderate to severe disk height loss, mild to moderate disk bulge, facet arthropathy results in mild central spinal canal stenosis, moderate bilateral neural foraminal narrowing.L5/S1: There are endplate degenerative changes with severe disk height loss and mild diffuse disk bulge which results in mild bilateral foraminal narrowing. The auto-fusion across the disk space at L5/S1. No significant central spinal canal stenosis. | 1.No specific CT findings to suggest a focal fluid collection or abscess. Previously identified tiny questioned right psoas fluid collection does not demonstrate corresponding CT abnormality, although soft tissue contrast is limited despite intravenous contrast administration.2.Significant disk height loss at L4/5 and L5/S1 and associated osseous changes corresponding to the abnormalities seen on the MRI examination. Some additional findings on CT support a degenerative etiology, especially given autofusion at L5/S1 across the disk space and the relatively defined although irregular endplates; however, infectious/inflammatory diskitis/osteomyelitis cannot be excluded. Follow-up MRI examination with diffusion-weighted images (b = 500) which can be utilized to evaluate for a "claw sign" to potentially differentiate diskitis/osteomyelitis from Modic type changes may be helpful if clinically indicated. |
Generate impression based on findings. | Left upper lobe squamous cell carcinoma LUNGS AND PLEURA: Postsurgical changes and volume loss involving the left partial lobectomy. No suspicious new nodules or masses. No effusions. Mild mediastinal shift and architectural distortion.MEDIASTINUM AND HILA: Enlarged left thyroid lobe with a posterior and inferior nodule again measuring approximately 3.2 x 2.0 cm.No additional lymphadenopathyThe cardiac and pericardium other than moderate to marked coronary calcifications remain unchanged.CHEST WALL: Specifically the previously described soft tissue opacity involving the left sixth rib interspace has continued to decrease and again likely represents postsurgical access with minimal residual scarring.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Again adrenal glands are incompletely visualized | Interval resolution of the previously described left upper lobe mass, presumably postsurgical. No evidence of residual and or recurrent disease. |
Generate impression based on findings. | Male; 51 years old. Reason: EtOH abuse presenting with fever and back pain after falling at home. No acute fracture or malalignment. Vertebral body heights are preserved. No suspicious osseous lesions are identified. The bilateral sacroiliac joints are unremarkable. Small anterior osteophytes are noted at the L2/L3 disk space. | No fracture or other acute findings to account for the patient's pain. |
Generate impression based on findings. | Breast cancer LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions. Small focal calcified pleural plaque along the posterior right lung base.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcifications.No mediastinal or hilar lymphadenopathy.CHEST WALL: Markedly enlarged left axillary and subpectoral lymph nodes. A reference node measures 32 mm (series 3, image 36). No breast mass identified by CT imaging.No focal osseous lesions identified.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Diffuse hypoattenuation of the hepatic parenchyma is compatible with hepatic steatosis. | Marked left axillary and subpectoral lymphadenopathy compatible with known history of breast cancer. |
Generate impression based on findings. | Male 48 years old Reason: shoulder pain History: as above. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. The glenohumeral joint alignment is within normal limits. | Mild osteoarthritis. |
Generate impression based on findings. | 12-year-old male, evaluate for fracture/hip subluxationVIEW: Pelvis AP, Right and Left Femur Lateral view (3 view) 3/4/2015 Bilateral coxa valga are again noted. The femoral heads are well directed into normal acetabula. No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | 78 years, Female. Reason: abdominal pain, eval for obstructive gas pattern, stool burden History: abdominal discomfort Residual enteric contrast within diverticula in the descending colon. Nonobstructive bowel gas pattern. Below average stool burden. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | There is scattered ethmoid sinus opacification. The other paranasal sinuses are clear. The nasal cavity is clear. The nasal septum is deviated to the left with an associated spur. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There are multiple dental caries, some of which are associated with mild periodontal lucencies. | 1. Nonspecific scattered ethmoid sinus opacification. 2. Multiple dental caries. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 65 years, Male. Reason: eval for ileus History: ams Enteric feeding tube tip projects over the pyloric area. Surgical clips noted in the right quadrant. There is a paucity of bowel gas. Lower portion of the pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the pyloric area. |
Generate impression based on findings. | The previously noted mottled sclerosis along the posterior left mandible is slightly less conspicuous, with further analysis confluent ossific density along the margins of the bone consistent with evolving periosteal reaction. The normal fat within the left mandibular foramen remains effaced. No soft tissue mass is identified.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. There is a small air level within the upper thoracic esophagus. The upper trachea and esophagus are otherwise 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 continues to be an overall increased number of scattered cervical lymph nodes, although none appear pathologically enlarged. Partially calcified right supraclavicular lymph nodes are again noted. There is also an opacification of a tiny left submandibular lymph node.OTHER: The right internal jugular vein is not visualized along its distal half, although this is a chronic finding. This is extensive opacification within the paranasal sinuses, worsened since prior exam, while the mastoids/middle ears remain clear. There are minimal nonspecific scattered ground glass opacities in right lung apex. | 1. Further expected evolution of periosteal reaction along the posterior left mandible, consistent with healing. Slight decreased conspicuity of mottled sclerosis of the left posterior mandible.2. Interval calcification of the left small submandibular lymph node, likely representing posttreatment changes. Stable calcified right supraclavicular lymph nodes.3. Persistent but worsened pan sinus opacification. Please correlate clinically.4. Chronic mid to distal right internal jugular vein occlusion. |
Generate impression based on findings. | 65 years, Male. Reason: r/o toxic megacolon History: abd distension Enteric feeding tube tip projects over the fourth portion of the duodenum. Support devices are unchanged. Again seen are multiple surgical clips and probable bullet fragment projecting over the pelvis. Nonobstructive bowel gas pattern. Lower portion of the pelvis is excluded from the field-of-view. | Nonobstructive bowel gas pattern with normal caliber transverse colon. |
Generate impression based on findings. | 49 years old male. Reason: Evaluating for metastatic disease History: new diagnosis of lung cancer. RADIOPHARMACEUTICAL: 14.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates mucosal thickening in the right maxillary sinus. There is a mass in the right upper lobe. Consolidation with volume loss is seen in the right upper lobe, which consistent with the atelectasis. Enlarged lymph nodes are seen in the mediastinum at mediastinal paratracheal regions and AP window. The right hilum is enlarged. There is a small right pleural effusion. A questionable low attenuation is seen in the right lobe of liver.Today's PET examination demonstrates intense FDG uptake in the right upper lobe mass with SUV Max of 14.1, which consistent with the patient's diagnosis of lung cancer. Intense FDG uptake is seen in the extensive lymphadenopathy in the mediastinum at paratracheal regions, precarinal region, subcarinal region, and the left AP window. Several foci of increased activity are seen in the right hilum. Multiple hypermetabolic lymph nodes are also seen in the right supraclavicular region. Multiple foci of increased activity are seen in the liver. There is increased activity in the bilateral adrenal glands. Increased of activity is seen in the T5 and L2 vertebral bodies. A focus of increased activity is seen in the right proximal femur. A focus of increased is seen in the left psoas muscle. Above findings are compatible with tumor activity.There is a focus increased activity in the left lobe of thyroid, which can be due to the thyroid adenoma, carcinoma or metastasis.Increased activity is seen in the right maxillary sinus, which is most likely due to sinusitis. Diffuse FDG uptake is seen in the consolidation of the right upper lobe, which is consistent with the obstructive pneumonia/atelectasis.The evaluation of the brain is limited due to incomplete coverage. Within limitation, there is a focus of increased activity in the right temporal pole with SUVmax of 13.5, suspicious for brain metastasis. | 1.Hypermetabolic tumor in the right upper lobe with nodal metastasis in the mediastinum including AP window, right lung hilum and right supraclavicular region.2.Multiple hepatic metastases and osseous metastasis in the spine and proximal femur.3.Bilateral adrenal nodules in with increased metabolic activity, suspicious for metastasis.4.Probable metastasis in the left psoas muscle. 5.Hypermetabolic focus in the right temporal pole, correlating with a lesion seen on contrast enhanced MRI images. |
Generate impression based on findings. | T3N0 laryngeal squamous cell carcinoma completed 7/7 TFHX completed 6/21/2013. Excellent recovery, but now concern for recurrence with symptoms of right neck / throat pain and swelling that is getting worse. However, strobe testing in February 2015 revealed no evidence of recurrent malignancy of the right vocal cord. There are stable post-treatment findings in the neck without definite evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. Indeed, there is unchanged deformity of the right vocal cord. The laryngeal framework appears to be intact. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis. The imaged intracranial structures are unremarkable. There is right apical pulmonary scarring and bilateral pulmonary emphysema. | Stable post-treatment findings in the neck without discernible evidence of measurable mass lesions or significant cervical lymphadenopathy. However, if recurrent tumor remains a concern, MRI or PET may be useful for further evaluation. |
Generate impression based on findings. | Evaluate for chronic PE. The comparison chest radiograph performed on 3/4/2015 demonstrates a focal opacity in the right lung base. No pleural effusion. The ventilation images show decreased ventilation bilaterally within the lung bases. There are multiple matched ventilation perfusion defects throughout the lungs bilaterally in a non-segmental distribution. No discrete mismatched perfusion defects are noted. | Low probability scanned for a pulmonary embolus. |
Generate impression based on findings. | 58 years, Female. Reason: assess for obstipation History: 58 y.o. woman with celiac disease and constipation. History scoliosis surgery. Gas bloating, abd pain Above average stool burden is noted in the ascending and transverse colon without evidence of bowel obstruction. Posterior fusion hardware, S-shaped scoliosis and degenerative changes are noted in the thoracolumbar spine. | Nonobstructive bowel gas pattern with above average stool burden. |
Generate impression based on findings. | Male, 52 years old.Elevated BMI. Examination is limited by patient body habitus and motion artifact. No unexpected radiopaque foreign objects. Enteric feeding tube tip projects over the pyloric area. Surgical clips project over the right upper quadrant and right lower quadrant. Foley catheter is in place. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign objects.Findings discussed with Dr. Roggin over the telephone at 3:00 p.m. on 3/4/2015 by Dr. McCann. |
Generate impression based on findings. | Female 68 years old Reason: s/p fall. Pain posterior lateral malleolus. Evaluate for fracture. History: Right ankle pain. There is soft tissue swelling along the lateral aspect of the ankle, but we see no underlying fracture or malalignment. Note is made of a small plantar calcaneal spur. | Soft tissue swelling without fracture. |
Generate impression based on findings. | Female 75 years old Reason: MCL re- eval History: mantle cel lymphoma CHEST:LUNGS AND PLEURA: New right upper lobe air space opacity which is likely inflammatory/infectious in etiology. No suspicious nodules or masses. No pleural effusion. MEDIASTINUM AND HILA: Improvement in the mild mediastinal and hilar lymphadenopathy. Reference pretracheal lymph node (series 3, image 33) measures 1.2 x 0.5 cm, previously 1.4 x 0.9 cm. Reference right hilar lymph node (series 3, image 49) measures 1.2 x 0.7 cm, previously 1.3 x 0.9 cm. No new foci of lymph node enlargement is seen.Normal heart size without pericardial effusion. Mild coronary artery calcifications. CHEST WALL: No significant axillary lymphadenopathy. No change in the previously seen left lower pole thyroid nodule.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes which are not enlarged by CT criteria. As calcifications of the aorta and its branches.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: No iliac or internal pelvic lymphadenopathy is seen. Reference left inguinal lymph node (series 3, image 170) measures 1.0 x 1.4 cm, previously 1.3 x 1 .7 cm.BOWEL, MESENTERY: Scattered, diffuse colonic diverticula without acute inflammation. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval improvement in the mildly prominent lymph nodes in the chest, abdomen, and pelvis. No new foci of lymph node enlargement. |
Generate impression based on findings. | 52-year-old male with history of colon cancer, evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules are present. No suspicious nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Small hiatal hernia. No hilar or mediastinal lymphadenopathy. CHEST WALL: Right-sided chest port with catheter tip at the SVC atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis and contracted gallbladder without adjacent inflammatory changes. No focal hepatic lesions are identified.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A nephroureteral stent is present on the right with the proximal tip in the right renal pelvis and the distal tip within the bladder. There is moderate-severe hydronephrosis on the right, increased from prior. There is trace hydroureteronephrosis on the left. No obstructing stones or lesions are identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of partial colectomy with left lower quadrant colostomy. Normal caliber bowel without evidence of obstruction. BONES, SOFT TISSUES: A small umbilical hernia is present which contains part of a small bowel loop without evidence of obstruction.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes of partial colectomy with left lower quadrant colostomy. Normal caliber bowel without evidence of obstruction. BONES, SOFT TISSUES: Degenerative disk disease most prominent at L5-S1 without suspicious osseous lesions.OTHER: A thin-walled presacral fluid collection is again present similar to prior and is thought to represent a Hartmann's pouch. | 1.No specific evidence of metastatic disease.2.Moderate-severe hydronephrosis on the right, increased from prior.3.Cholelithiasis |
Generate impression based on findings. | 34 years, Female. Reason: stool burden History: abdominal pain Nonobstructive bowel gas pattern with moderate stool burden in the colon. | Nonobstructive bowel gas pattern with moderate stool burden in the colon. |
Generate impression based on findings. | Thoracic spine: There is no evidence of fracture. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There is incompletely imaged pulmonary consolidation and mediastinal lymphadenopathy. Lumbar spine: There is no evidence of fracture. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. There is incompletely imaged retroperitoneal lymphadenopathy. | 1. No evidence of spine fracture or significant spinal canal stenosis.2. Pulmonary airspace opacities and lymphadenopathy. Please refer to the separate chest CT report for additional details.3. Partially-imaged retroperitoneal and mediastinal lymphadenopathy. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Female 54 years old Reason: ankle fx History: as above. We have 3 views of the left ankle which again show a plate and screws device affixing a fracture of the distal fibula in near anatomic alignment. We see no hardware complications. The fracture line is indistinct, suggesting healing and appearing similar to the prior study. Plate and screws also affix a fracture of the distal tibia in near anatomic alignment. There is a minimal step-off of the articular surface of the tibial plafond. Otherwise, the fracture is indistinct suggesting healing. We see no hardware complications. | Orthopedic fixation of healing tibial and fibular fractures. |
Generate impression based on findings. | 39-year-old female patient with infertility. Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without mucosal irregularity or filling defects in the uterine cavity. Both tubes were freely opacified with free spillage on both sides into the pelvis, indicating tubal patency. Anteverted uterus noted.TOTAL FLUOROSCOPY TIME: 1:09 minutes. | Normal uterine cavity and patent fallopian tubes. |
Generate impression based on findings. | Small cell lung cancer with liver metastasis now with weakness nausea and vomiting ABDOMEN:LUNG BASES: Please see separate chest CT reportLIVER, BILIARY TRACT: Interval increase in size of bilateral hepatic metastases. Reference segment 4 lesion best seen on image 82 of series 3 now measures 5.1 x 4 cm; this is in comparison to 4.8 x 2.2 cm on 1/20/2015.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval increase in size of reference portacaval lymph node best seen on image 99 of series 3 now measuring 2.9 x 1.7 cm; this is in comparison to 2.3 x 1.5 cm on 1/20/2015.BOWEL, MESENTERY: Mild ascites unchanged.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: Mild ascites unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in size of bilobar hepatic metastases and interval increase in size of reference portacaval metastatic lymph node. |
Generate impression based on findings. | 33-year-old female patient with infertility. Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a retroflexed uterine cavity without mucosal irregularity or filling defects in the uterine cavity. Only the left tube was freely opacified with free spillage into the pelvis, indicating tubal patency. There is filling of a thin, nondilated right tube, however there was no spillage. TOTAL FLUOROSCOPY TIME: 1:13 minutes. | Normal uterine cavity and patent left fallopian tube. There was no free spillage from the thin, nondilated right fallopian tube. |
Generate impression based on findings. | Postoperative changes are seen from previous right floor of mouth resection and right neck dissection. There is further decreased extent and confluence of enhancement along the right neck dissection bed, with areas of minimal 4-5 mm nodular enhancement is seen on 6/46 as well as other areas of scattered lacelike enhancement predominantly deep to the right sternocleidomastoid muscle. More cranially, there is a bilobed appearing area of ring enhancement along the inferior aspect of the parotid gland which also appears unchanged. Surgical clips are also seen along the left neck. 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 submandibular glands are not visualized and may be surgically absent. The postcontrast appearance of the remaining salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: The right internal jugular vein is again not visualized and presumably has been ligated. There is minimal reversal of the normal cervical lordosis. | Expected evolution of post treatment changes without evidence of discrete mass or cervical lymphadenopathy. |
Generate impression based on findings. | 69 years, Female. Reason: 2 months of diarrhea, weight loss History: see above Gaseous distention of the stomach. Nonobstructive bowel gas pattern. Cholecystectomy clips in the right upper quadrant. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. Increased radiotracer uptake is again seen in the superior thoracic spine and within the soft tissues of the breasts appearing similar to the prior exam. The increased activity within the right anterior eighth rib is nonspecific and could represent fracture. No new foci of abnormal radiotracer uptake are identified. | Stable exam with no new osseous metastases. |
Generate impression based on findings. | 41 years, Female. Reason: evaluate for constipation, ? obstruction History: LLQ abdominal pain Right mediastinal silhouette is normal. Small bilateral pleural effusions. No pneumothorax. No focal pulmonary opacities.No pneumoperitoneum. Nonobstructive bowel gas pattern. Below-average stool burden. | Nonobstructive bowel gas pattern. Below-average stool burden. |
Generate impression based on findings. | Right apical mass; assess for malignancy ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cystRETROPERITONEUM, LYMPH NODES: Heavily calcified foci within the pre-caval space; favor chronic inflammatory process/calcified lymph nodes.Abdominal aortic ectasia.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterusBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No acute, inflammatory, or neoplastic/malignant process within the abdomen or pelvis. |
Generate impression based on findings. | 16-year-old male with painVIEWS: Panorex view of the mandible (one view) 3/4/15 15:12 There is an oblique fracture of the posterior body of the left mandible extending to the unerupted molar. The paranasal sinuses are normal. | Left posterior mandibular body fracture extending to the unerupted molar. |
Generate impression based on findings. | Male 70 years old Reason: CT per living kidney donor protocol History: kidney donor Lack of oral contrast makes evaluation of bowel pathology suboptimal. Within these limitations, the following observations can be made.ABDOMEN: LUNG BASES: No significant abnormality noted LIVER, BILIARY TRACT: Subcentimeter hypodense segment two lesion in the left lobe of liver. Favor benign etiology such as a cyst. Cholelithiasis without evidence of acute inflammation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two orthotopic kidneys are visualized. Subcentimeter nonobstructing stones in the right kidney. Three separate right renal arteries are visualized. One distinct left renal artery is seen. Conventional venous anatomy bilaterally.No renal masses bilaterally. No hydronephrosis bilaterally. Renal sinus cysts bilaterally.Left kidney length: 11.8 cmLeft kidney width: 6.3 cmRight kidney length: 10.9 cmRight kidney width: 6.5 cmRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the abdominal aorta and its branches. No significant atherosclerotic calcifications in the renal arteries bilaterally.BOWEL, MESENTERY: No significant abnormality noted.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: Colonic diverticulosis without acute inflammation.BONES, SOFT TISSUES: Suture material is present in the right lower quadrant.OTHER: No significant abnormality noted | 1.Three separate right renal arteries are visualized. Conventional vasculature of the left kidney is present.2.Subcentimeter, nonobstructing stones in the right kidney. |
Generate impression based on findings. | 62-year-old male status post gastrostomy tube balloon integrity distruption for evaluation of G-tube placement Anteroposterior and lateral scout images demonstrated a nonobstructive bowel gas pattern with a gastrostomy tube tip projecting over the proximal gastric body. Injection of contrast demonstrates brisk opacification of the gastric body and proximal duodenum without extravasation to suggest leak or misplacement. TOTAL FLUOROSCOPY TIME: 1:02 minutes | Gastrostomy tube without evidence of leak of misplacement. |
Generate impression based on findings. | 45 year old woman with history of right breast masses seen on prior mammogram. Three standard views of the right breast with CC and ML spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The previously described masses in the lower inner right breast are stable in size and morphology. Scattered benign morphology calcifications are noted. No suspicious microcalcifications or areas of architectural distortion are seen in the right breast. | Stable, benign masses in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 72-year-old male with pelvic mass seen on ultrasound. 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: Basilar groundglass opacities and interstitial thickening compatible with pulmonary edema appearing similar to 2011 exam. Trace left pleural effusion. LVAD device. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine most severe at L3-L4.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatomegaly. BLADDER: No significant abnormality notedLYMPH NODES:No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: There is a thin walled, round collection within the left inguinal canal. The internal attenuation of the collection measures approximately 20 Hounsfield units compatible with complex fluid. No significant adjacent inflammatory changes. No bowel is contained within the bilateral inguinal canals. Degenerative changes of the thoracolumbar spine most severe at L3-L4.OTHER: No significant abnormality noted | 1.Fluid collection within the left inguinal canal which may represent a hematoma but is best considered indeterminate. 2.Prostatomegaly. 3.Cardiomegaly. Basilar pulmonary edema and small left pleural effusion, similar to 2011 exam. |
Generate impression based on findings. | Small cell lung cancer with liver metastases. Now with weakness, nausea/vomiting. Evaluate for worsening metastases. LUNGS AND PLEURA: Increased size of right perihilar heterogeneously enhancing tumor that occludes the upper lobe bronchus. It cannot be measured due to adjacent post-obstructive atelectasis. Moderate to large left pleural effusion and partially loculated small right pleural effusion, similar to prior. Loculated pleural air and fluid in the right major fissure and in the periphery of the right middle lobe; correlate for history of thoracentesis/procedure, if no such history of intervention, bronchopleural fistula should be considered. Interlobular thickening at the right base may represent lymphangitic spread of tumor or edema, similar to prior.Small amount of debris in the trachea.MEDIASTINUM AND HILA: Tumor encasement and narrowing of the SVC, similar to prior.Reference prevascular lymph node is 12 mm (series 3, image 29), previously 14 mm.Reference subcarinal lymph node is 13 mm (series 3, image 42), previously 16 mm.Normal heart size. Moderate pericardial effusion has resolved with residual trace fluid.No visible coronary artery calcification.Reference right supraclavicular lymph node is 15 mm, unchanged (series 3, image 12).Diffuse mild esophageal wall thickening suggestive of esophagitis, unchanged.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Refer to separately dictated same day CT abdomen/pelvis report. | 1. Increased size of right upper lobe/perihilar tumor.2. Slight decreased size of reference mediastinal lymph nodes.3. New foci of pleural air in the right major fissure and along the right middle lobe; correlate for history of thoracentesis. If there is no such history of recent intervention, a bronchopleural fistula should be considered. Bilateral pleural effusions, not significantly changed.4. No new sites of disease. |
Generate impression based on findings. | History of chronic ear infection. Left: There is a globular soft tissue attenuation lesion that measures up to 6 mm in diameter along the inferior aspect of the retracted tympanic membrane with associated mild scalloping of the external auditory canal wall. There is also patchy opacification of the right mesotympanum and epitympanum. The ossicular chain and scutum appear to be grossly intact intact. There is also partial opacification of the mastoid air cells with mild diffuse sclerosis of the septations. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. | A globular soft tissue attenuation lesion that measures up to 6 mm in diameter along the inferior aspect of the retracted left tympanic membrane with associated mild scalloping of the external auditory canal wall may represent a cholesteatoma. Otherwise, partial left tympanomastoid opacification may represent sequela of chronic otomastoiditis. |
Generate impression based on findings. | Female 9 years old Reason: eval for fracture History: R arm painVIEWS: Right forearm AP and lateral right elbow AP lateral and oblique on 3/4/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Dyspnea. Evaluate for pneumonia, atypical infection as etiology of COPD exacerbation. LUNGS AND PLEURA: Interval resolution of previously seen ground glass opacities and small right pleural effusion.Mucus plugging in right lower lobe segmental bronchi with postobstructive subsegmental atelectasis (series 6, image 68).Calcified micronodules consistent with healed granulomatous disease. Stable noncalcified micronodules, most likely also post-inflammatory. No evidence of pneumonia.MEDIASTINUM AND HILA: Interval resolution of mediastinal and right hilar lymphadenopathy, which was likely reactive.Stable moderate cardiomegaly with single pacemaker lead terminating in the right ventricle. Epicardial pacer wires.Severe native coronary artery calcification. Post surgical findings of CABG.CHEST WALL: Mild degenerative changes of the thoracic spine.Median sternotomy with nonunion of the lower half of the sternum and separation of bone fragments by up to 3 cm, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholecystectomy clips. Small amount of abdominal ascites.Severe calcified atherosclerotic disease of the abdominal aorta and splenic artery.Calcified hepatic granulomas. | 1. Interval resolution of previously seen groundglass opacities and small right pleural effusion. Mediastinal/hilar lymphadenopathy has also resolved.2. Focal mucus plugging of right lower lobe segmental bronchi with post-obstructive subsegmental atelectasis. No evidence of pneumonia.3. Small amount of abdominal ascites. |
Generate impression based on findings. | 67 years, Male. Reason: increased drainage from NG, eval for evidence of ileus vs obstruction History: high NG output NG tube is coiled with tip projecting over the gastric fundus. Gas distended bowel in the left hemiabdomen with a relative paucity in the right. Note that the lower abdomen and pelvis is excluded from the field-of-view. Small bilateral pleural effusions. | NG tube is coiled with tip projecting over the gastric fundus. |
Generate impression based on findings. | Female 93 years old Reason: assess for fracture History: left hip pain s/p fall. We have 3 views of the left femur. Again seen are hardware or components of a left bipolar hemiarthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication. Ossification along the greater trochanter is favored to represent heterotopic bone related to the patient's surgery rather than a fracture. The bones appear demineralized. There is osteoarthritis and chondrocalcinosis of the knee. There are arterial calcifications in the soft tissues. | Left hip hemiarthroplasty with ossification along the greater trochanter that is favored represent heterotopic bone related to the patient's prior surgery. However, if there is strong clinical concern for a fracture, CT may be considered. |
Generate impression based on findings. | Altered mental status, cough. Right apical mass concerning for malignancy. LUNGS AND PLEURA: Right apical scarring with coarse calcification and associated volume loss and traction bronchiectasis, likely the sequela of remote granulomatous infection such as TB.Mild left apical scarring.Calcified nodules consistent with prior infection.Left upper lobe 4 mm subpleural nodule (series 8, image 53).Severe upper lobe paraseptal emphysema.No evidence of active infection.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes consistent with healed granulomatous disease.Normal heart size without a pericardial effusion. Mild coronary artery calcification and thoracic aortic calcification.CHEST WALL: Demineralized bones. Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Right apical scarring with coarse calcification and volume loss/traction bronchiectasis, likely the sequelae of remote infection such as TB. No lung mass is identified.2. Left upper lobe 4 mm nodule, likely benign. In a high risk patient, this would be followed-up in 1 year to confirm stability.3. Severe upper lobe paraseptal emphysema. |
Generate impression based on findings. | Female 45 years old Reason: R shoulder pain History: as above. We have 4 views of the right shoulder. Minimal enthesopathic changes are seen along the greater tuberosity at the expected site of the rotator cuff insertion and are of questionable clinical significance. The shoulder otherwise appears normal for age. The glenohumeral joint alignment is within normal limits. | Minimal enthesopathic changes along the greater tuberosity, but otherwise normal-appearing shoulder. |
Generate impression based on findings. | Female 62 years old Reason: follow up History: follow up. We have 4 views of the left foot which again show two orthopedic screws affixing the first tarsometatarsal joint in near-anatomic alignment. There is also postoperative flattening of the medial aspect of the first metatarsal head. There is soft tissue swelling along the first metatarsal. A small bony fragment is noted along the lateral aspect of the base of the first proximal phalanx and could represent a small fracture fragment which appeared to be present on the prior study. | Postoperative changes of bunion correction surgery as described above with possible small fracture fragment along the lateral aspect of the base of the first proximal phalanx. |
Generate impression based on findings. | Female 55 years old Reason: CERVICALGIA History: CERVICALGIA. Evaluation of the cervicothoracic junction on the lateral view is slightly limited due to overlying anatomy. Evaluation of the cervical spine on the AP view is limited due to overlying braids. There is severe degenerative disk disease at C6/C7 and there is moderate degenerative disk disease at C5/C6 and C7/T1 with anterior and posterior vertebral body osteophytes at these levels. There are also anterior osteophytes at C4/C5. The alignment is within normal limits. | Degenerative disk disease of the cervical spine. |
Generate impression based on findings. | Female 48 years old Reason: follow up History: follow up. We have two views of the right tibia/fibula and 3 views of the right ankle, which show a plate and screw device affixing a comminuted fracture of the distal tibial diaphysis in near-anatomic alignment. We see no radiographic evidence of hardware complication. There is an oblique fracture of the proximal fibular diaphysis with mild anterior displacement of the distal fracture fragment. Tubular lucencies in the proximal tibia and calcaneus reflect prior external fixation. Ankle joint alignment is within normal limits. | Orthopedic fixation of a distal tibial fracture and other findings as above. |
Generate impression based on findings. | Female, 72 years old, with large B-cell non-Hodgkin's lymphoma. An enhancing nodule within the right parotid gland has decreased in size, now measuring 8 x 7 mm (image 90 series 4), previously 17 x 17 mm.A nodule in the right submandibular space measures 11 x 6 mm (image 99 series 4), previously 19 x 9 mm. A nodule in the left submandibular space measures up to 6 mm in diameter (image 90 series 4), previously 8 mm.An aggregate of small nodules along the left lower jugular chain measures 16 x 10 mm (image 163 series 4), previously 20 x 19 mm. Previously referenced lesions in the bilateral axillae are only partially visualized but do appear smaller. A left supraclavicular nodule currently measures up to 6 mm in diameter (image 146 series 4), previously 9 mm. | Response to therapy with decrease in size of numerous nodules and lymph nodes in the neck. |
Generate impression based on findings. | Status post cystectomy with ileal conduit with pelvic fluid collection status post percutaneous drainage. ABDOMEN:LUNG BASES: Small bilateral pleural effusionsLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval placement of gastrostomy tube with distal end of the tube within stomach. Interval resolution of small bowel obstruction; mild ileus pattern persists.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Unremarkable ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval removal of percutaneous drainage catheter and surgical drain within the pelvis. Persistent loculated pelvic collection best seen on image 146 of series 3 measuring 8 x 5 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval removal of percutaneous drainage catheter and surgical drain from the pelvis with persistent loculated pelvic collection as described.Interval resolution of small bowel obstruction; small bowel ileus persists. |
Generate impression based on findings. | 17-year-old male with injury to right thumb, pain on movement.VIEWS: Right hand PA, right thumb PA and lateral (3 views) 3/4/2015 No soft tissue swelling or joint effusion. Normal alignment. No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Clinical hyperparathyroidism. Elevated Calcium 10.8 with PTH of 102. A large lesion is noted along the posterior aspect of the left thyroid gland which appears separate from the thyroid gland. On delayed washout this lesion persists and is suspicious for a parathyroid adenoma.The right thyroid lobe appears to measure 6 cm and the left lobe 6 cm in length. | Findings compatible with a left-sided parathyroid adenoma. |
Generate impression based on findings. | 62 year-old female with history of lung abscess and colitis, follow-up. 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: CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema with lower lobe mild bronchiectasis and bronchial wall thickening. Previously described areas of consolidation with internal low attenuation within the lingula and posterior left lower lobe continue to decrease in size and are without evidence of abscess currently. Diffuse centrilobular and tree-in-bud opacities are again present in the lower lungs. There are new superimposed scattered bilateral nodular and subpleural opacities. No pleural effusionsMEDIASTINUM AND HILA: Mild mediastinal and left hilar lymphadenopathy appears similar to the prior study and likely reactive. Mild coronary artery calcifications. Debris is present in the trachea.CHEST WALL: Stable degenerative arthritic changes of the thoracolumbar spine with multilevel mild superior endplate compression deformities.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously seen renal cyst not well visualized.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Normal caliber bowel without obstruction. Previously seen colonic and rectal wall thickening has resolved within the limitations of a noncontrast examination.BONES, SOFT TISSUES: Anasarca has resolved. Demineralized bones. Mild degenerative changes of the thoracolumbar spine including mild compression deformity of T12, similar to prior. 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: Normal caliber bowel without obstruction. Previously seen colonic and rectal wall thickening has resolved within the limitations of a noncontrast examination.BONES, SOFT TISSUES: Anasarca has resolved. Demineralized bones. Mild degenerative changes of the thoracolumbar spine including mild compression deformity of T12, similar to prior. Geographic fluid-density lesion in the sacrum, unchanged, most likely a Tarlov cyst. Right hip prosthesis.OTHER: No significant abnormality noted. | 1.Findings again suggestive of aspiration bronchiolitis/infection. Previously described areas of subpleural consolidation with necrotic centers have decreased in size without evidence of abscess currently. There are, however, several new nodular and subpleural opacities. Atypical infection remains in the differential. Given history of head and neck malignancy, recommend continued follow-up to ensure resolution and to exclude metastatic disease.2.Resolved pancolitis and proctitis. |
Generate impression based on findings. | Male; 52 years old. Reason: Evaluate for osteomyelitis History: Swelling, pain, blistering, discoloration. Three views of the left foot show no acute fracture or dislocation. No specific radiographic evidence of osteomyelitis. Punctate radiodensity between the fourth and fifth toes seen on AP and oblique views is suspicious for a foreign body. | Punctate radiopaque foreign body between the fourth and fifth toes. No specific radiographic evidence of osteomyelitis. |
Generate impression based on findings. | Evaluate hepatic vasculature, status post autotransplant for cholangiocarcinoma resection Suboptimal exam due to patient's body habitus and technique.LIVER/VASCULAR: Visualized left liver measures approximately 16.7 cm. Right liver area not well assessed. Patent left portal vein with normal directional flow, velocity at upper limits of normal, ranging from 33 to 41 cm/sec. Patent left hepatic artery, resistive index ranges from 0.69 to 0.71 and velocity ranges from 49 to 123 cm/sec. Left hepatic vein patent with normal directional flow. IVC not well seen and thus difficult to evaluate. Visualized splenic artery and vein patent. | Visualized hepatic vasculature patent as above. |
Generate impression based on findings. | History of chronic ear infection. Left: There is a globular soft tissue attenuation lesion that measures up to 6 mm in diameter along the inferior aspect of the retracted tympanic membrane with associated mild scalloping of the external auditory canal wall. There is also patchy opacification of the right mesotympanum and epitympanum. The ossicular chain and scutum appear to be grossly intact. There is also partial opacification of the mastoid air cells with mild diffuse sclerosis of the septations. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. | A globular soft tissue attenuation lesion that measures up to 6 mm in diameter along the inferior aspect of the retracted left tympanic membrane with associated mild scalloping of the external auditory canal wall may represent a cholesteatoma. Otherwise, partial left tympanomastoid opacification may represent sequela of chronic otomastoiditis. |
Generate impression based on findings. | Two month old male with history of humerus fracture. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is opacification of the maxillary and ethmoid sinuses. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Female; 47 years old. Reason: r/o fx History: pain and swelling after ankle rolled. Three views of the left foot demonstrate a nondisplaced extra-articular fracture at the base of the fifth metatarsal.Three views of the left ankle demonstrate lateral soft tissue swelling and the previously described fracture at the base of the fifth metatarsal. No additional fractures are identified in the ankle. No joint effusion is present. Plantar heel spur is noted. | Nondisplaced fracture at the base of the fifth metatarsal. |
Generate impression based on findings. | Status post insertion of LP shunt for pseudotumor cerebri, POD#2, now with speech changes. There are postoperative findings related to craniofacial reconstructive surgery with dysmorphic features. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration, with mild prominence of the lateral ventricles. There is no midline shift or herniation. There is minimal scattered opacification of the paranasal sinuses. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. Otherwise stable postoperative findings related to craniofacial reconstructive surgery. |
Generate impression based on findings. | Female; 39 years old. Reason: Right ankle pain, evaluate for fracture. Mild soft tissue swelling is noted about the lateral ankle. However, no acute fracture or dislocation is seen. The ankle mortise is congruent. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | Female; 54 years old. Reason: Left wrist pain Three views of the left wrist demonstrate no acute fracture or dislocation. Alignment is anatomic. No significant degenerative changes are noted. | Normal examination. |
Generate impression based on findings. | Female 47 years old with chronic back pain status post breast cancer. Physiologic activity is present throughout the skeleton, with no suspicious foci of increased activity to suggest metastases. | No evidence of bone metastases. |
Generate impression based on findings. | Posterior mediastinal mass and perigastric mass or suspicious for paraganglioma or possible Gist. RADIOPHARMACEUTICAL: 15.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion grossly demonstrates a mass in the left posterior mediastinum and an additional exophytic mass along the fundus of the stomach.Today's PET examination demonstrates mildly increased activity within the left level 2 and left level 5 as well as right level 2 lymph nodes within the neck. The SUVmax for the left level 2 lymph node is 3.3, which is nonspecific. The SUVmax for the left posterior mediastinal mass is 2.2. The SUVmax of the left upper quadrant mass it is also 2.2. | Left posterior mediastinal and left upper quadrant masses with minimal FDG activity. Direct sampling or contrasted MRI exam may provide further information. |
Generate impression based on findings. | Postoperative changes from previous suboccipital craniotomy are again noted, with associated susceptibility artifact. The resection cavity within the right inferior cerebellar vermis is stable, with minimal persistent marginal FLAIR hyperintensity which may in part be artifactual in etiology. There is also persistent linear enhancement along its medial aspect, which likely relates to granulation tissue. There is no evidence of recurrent mass.The ventricles and sulci are within normal limits other than ex vacuo dilatation of the fourth ventricle. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Continued stable postoperative changes within the posterior fossa without evidence of recurrent mass. |
Generate impression based on findings. | Male 85 years old Reason: eval for fracture, dislocation History: knee pain, fall. Four views of the right knee show no acute fracture or dislocation. There is, perhaps, a small joint effusion. Mild osteoarthritis with tricompartmental osteophytes affects the knee joint. | Osteoarthritis with no fracture evident. |
Generate impression based on findings. | Male 21 years old Reason: suspected fb, glass History: puncture wounds. There is no acute fracture or dislocation. Alignment is within normal limits. No radiopaque foreign body is evident. | No underlying fracture or dislocation. No radiopaque foreign body is evident. |
Generate impression based on findings. | There is mild nonspecific prominence of the lateral ventricles. The ventricles and sulci are otherwise within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is mild to moderate crowding at the foramen magnum likely secondary to mild platybasia. The cerebellar tonsils are rounded in configuration and do not extend below the level the foramen magnum. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the maxillary sinuses with small air-fluid levels. There is scattered right greater than left ethmoid air cell opacification and mucosal thickening. There is also opacification partially of the right frontal sinus. There is left sphenoid mucosal thickening. There are enlarged bilateral nodes of Rouviere up to 14 mm on the right and 16 mm on the left. There is also prominence of Waldeyer's ring. These are nonspecific findings and may be reactive. | 1. Unremarkable contrast enhanced MRI of brain except for mild-moderate crowding at the foramen magnum likely relating to mild platybasia. No MR imaging findings to support a Chiari 1 malformation at this time. Please correlate clinically.2. Scattered prominent sinus inflammatory changes including small air-fluid levels in the maxillary sinuses, for which clinical correlation is recommended for possible acute sinusitis.3. Significantly enlarged nodes of Rouviere bilaterally which are nonspecific but likely reactive in a patient this age, with also concomitant Waldeyer ring enlargement. |
Generate impression based on findings. | Male 27 years old mandible fracture History: Again seen are maxillary-mandibular fixation wires that have been broken bilaterally. A sideplate device with multiple screws fixes a nondisplaced fracture of the mandibular symphysis, the underlying fracture line is not evident suggestive of interval healing. There has been interval removal of a left inferior molar and a right superior molar . | Healed mandibular fracture as described above. |
Generate impression based on findings. | 20 year-old male with testicular mass with plans for orchiectomy, staging exam. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bilateral left greater than right prominent para-aortic lymph nodes are present. An example left para-aortic lymph node (series 3, image 60) measures 1.0 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy by size criteria. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Prominent para-aortic lymph nodes suspicious for metastatic disease. |
Generate impression based on findings. | Acute tachycardia and shortness of breath. The comparison chest radiograph performed on 3/4/2015 demonstrates a left lung base consolidation consistent with pneumonia. No definite pleural effusion.The ventilation images show decreased ventilation in the left lung base which corresponds to the patient's left lung base pneumonia. The remaining lung shows normal ventilation.The perfusion images show two large segmental defects in the left lung, including the posterior segment and apical segments. In addition, there is a moderate defect in the right middle lobe. Taken together, these findings are compatible with a high probability scan for pulmonary emboli. | High probability scan for pulmonary emboli. Findings were text paged to the primary service represented by Jessica Waite Marin, P.A. (pager # 6839) at the time of this dictation. |
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 mild age-indeterminate small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial hemorrhage. Mild age-indeterminate small vessel ischemic changes. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended. |
Generate impression based on findings. | Images are degraded by patient motion and other artifact. Sagittal T1 postcontrast images are somewhat limited due to bandlike susceptibility artifact obscuring the upper cervical spinal canal and spanning across the C3-C4 level. Postoperative changes are seen from interval C2 through T2 laminoplasty. There is redemonstration of abnormal T1 hypointense and patchy T2/STIR hyperintense signal throughout the C5 through T1 vertebrae, with corresponding enhancement.There is redemonstration of a lobulated enhancing mass which appears to be extradural in location, spanning the visualized mid C2 level down to at the T1-T2 level, on the left side. The abnormal soft tissue extends through the left-sided foramina at these levels, which are again chronically widened. There is extensive paraspinal soft tissue involvement by the mass. The mass is T1 isointense and T2 hyperintense to cord.There are areas of surgical debulking with small irregular defects along the medial aspect of the epidural component of the mass centered at the C4-C5 level but extending up to the C2-C3 and down to C5-C6 levels. There are also new areas of hypoenhancement within the left foraminal/far lateral component of the mass at C5-C6, as well as increased heterogeneity in the component of the mass just posterior to the slightly anteriorly displaced left cervical vessels at this level, with insinuation into the adjacent paraspinal musculature. Within the areas of probable subtotal resection, there is heterogeneous T2 signal likely relating to blood products. There is abnormal signal and enhancement along the left longus coli muscle, with loss of intervening fat planes. There is improved visualization of the thecal sac at essentially all visualized levels, although there remains displacement of the thecal sac the right within the bony spinal canal and deformity of the contour. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. The spinal cord is of normal signal. There is no pathological intrathecal enhancement.There remains prominent T2 hyperintense signal within the pre-vertebral space which is incompletely visualized due to saturation bands, and may represent fluid and/or edema as well as some areas of tumor. Bilateral mastoid air cell fluid is noted. | 1. Interval debulking of extensive left paraspinal lobulated enhancing mass with transforaminal extension from C2 through T2 levels into left lateral epidural space. Given extensive involvement, differential diagnosis includes primarily sarcoma, nerve sheath tumor, less likely lymphoma. Abnormal signal and enhancement also noted in the C5 through T1 vertebrae, also likely representing malignant involvement.2. Interval multilevel laminoplasty is from C2 through T2 with slightly improved visualization of the thecal sac although with continued rightward displacement and deformity. No definite cord signal abnormality. |
Generate impression based on findings. | 85-year-old man with history of HTN, dementia, and hypothyroidism, who presented to ED (3/2/15) with fever, chest pain found to be in A-fib with RVRCPT: 75571 Calcium Score:LM: 0LAD: 57.4LCx: 0RCA: 11.3Total: 69, This represents the 34th percentile for this patients age and gender.Coronary anatomy: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove.LCx: The left circumflex coronary artery courses normally in the left AV groove.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva.Left Ventricle: Assessment limited due to absence of contrast. LV size appears to be normal.Right Ventricle: Assessment limited due to absence of contrast. RV size appears to be at least mildly enlarged.Left Atrium: Assessment limited due to absence of contrast. The left atrium appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. Right atrium, vena cavae, and coronary sinus: Assessment limited due to absence of contrast. The right atrium appears to be at least mildly enlarged. SVC, IVC, and coronary sinus appear to drain normally into right atrium.Valves: There is no calcification on the aortic valve. There is no calcification on the mitral valve.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of aneurysm. The aortic arch is not seen. The main pulmonary artery is mildly dilated.Pericardium: The pericardium is normal in thickness. Small pericardial effusion. | 1.Total Calcium score was 69; 34th percentile for age and gender.2. Mild dilation of the Right ventricle, right atrium, and main pulmonary artery.3. Small pericardial effusion.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | 34 year old with history of hypertension and borderline cholesterol presenting to with atypical chest pain. CPT Code: 75574 Coronary arteries: No coronary calcification is noted. LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is co-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches and the posterolateral branch. There are no significant stenoses in the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva and has a variant anatomy. It is a co-dominant coronary artery supplying a posterior descending artery. The proximal and mid RCA is without significant stenosis. At the level of the mid RCA, a large acute marginal gives rise 3 large branches which supply the usual territory of the posterior descending artery. No distal RCA is present. Left Ventricle: The left ventricular size is normal. There is normal wall thickness. No left ventricular thrombus.Right Ventricle: Normal RV size.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. There are no significant coronary artery stenoses present. 2. Variant right coronary artery anatomy. 3. No coronary artery calcification.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 53 year old with history of hypertension and tobacco use presenting to emergency department with new onset chest pain. CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main. Minimal atherosclerosis is noted.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery. There is minimal atherosclerosis in the proximal vessel.Left Ventricle: Normal LV size with mild left ventricular hypertrophy.Right Ventricle: Normal RV size. Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. There are no significant coronary artery stenoses present. 2. Minimal coronary atherosclerosis. 3. Mild left ventricular hypertrophy.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | prostate cancer work up, lower extremity weakness No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. Phthisis bulbi on the right eyeball. | No evidence of acute ischemic or hemorrhagic lesion.Right eyeball, phthisis bulbi.If clinically indicated, brain MRI with and without contrast can be considered for metastasis work up. |
Generate impression based on findings. | Clinical question: Rule out subarachnoid hemorrhage in patient with history of ruptured aneurysm. Signs and symptoms: CVA headache. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of an acute nonhemorrhagic ischemic stroke.Large cluster of high density in the medial aspect of left temporal lobe consistent with embolic material results in streak artifact. There is a large area of parenchymal low attenuation surrounding this region which compared to prior MRI exam demonstrates subtle interval increase in extent. Recommend follow-up with an MRI examination.The ventricular system remains within normal size and with maintained midline. The CSF cisterns and cortical sulci remain widely patent and unremarkable.Calvarium, paranasal sinuses, mastoid air cells and orbits are unremarkable. | 1.No acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic strokes.2.High density it regularly shaped material along the medial aspect of the left temporal lobe consistent with embolic agents.3.Low attenuation of the surrounding parenchyma surrounding the embolic agents may be slightly more conspicuous compared to prior MRI exam. 4.Recommend follow-up with an MRI examination. |
Generate impression based on findings. | supratherapeutic INR No evidence of acute ischemic or hemorrhagic lesion.Multifocal patchy low attenuations on especially periventricular white matter and centrum semiovale indicate non specific age indeterminate ischemic lesions.However, if clinically indicated, brain MRI can be considered for more precise evaluation for acute ischemic lesions.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Non specific small vessel disease.Brain MRI can be considered if clinically indicated |
Generate impression based on findings. | Bilateral hand weakness starting during chemotheraphy, colon cancer patient No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.If clinically indicated, brain MRI with and without contrast can be considered for metastasis work up. |
Generate impression based on findings. | Clinical question: Acute minimally hemorrhagic ischemic stroke on MRI. Signs and symptoms: Word finding difficulties. Nonenhanced head CT:No evidence of change in size or density of a small left frontal MCA territory subacute ischemic stroke.No evidence of any new finding since prior study. Stable normal size of ventricular system and complete maintained midline. Findings suggestive of age indeterminate a small was ischemic strokes remain grossly similar to prior exam. | 1.Stable small nonhemorrhagic left frontal MCA territory is in the stroke.2.No detectable acute or new findings since prior study. |
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