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Generate impression based on findings. | right distal ICA aneurysm rupture which was coiled, IVH and ICH with bifrontal EVD tube insertion, follow up Re-demonstration of SAH, IVH, ICH and ventriculomegaly, no change of hemorrhage extent as well as the degree of ventricular dilatation.Specifically, bilateral frontal lobe ICH (right on the EVD track and left frontal lobe) do not show any interval change indicating stable status.No evidence of new ischemic or hemorrhagic lesion on this scan.Metallic artifacts on the distal right ICA representing coils and stent appear to be stable.The paranasal sinuses and mastoid air cells are clear. | Stable bifrontal ICH since prior exam.No significant interval change of the extent of SAH, IVH and ICH as well as ventriculomegaly since prior exam. |
Generate impression based on findings. | Clinical question: Evaluate for bleed. Signs and symptoms: Comatos Nonenhanced head CT:Examination demonstrate near complete effacement of gray -- white matter differentiation. Considering provided clinical information this finding is highly suspected for diffuse cerebral edema. In addition there is a focal region of parenchymal low attenuation involving the cortex and subcortical white matter of left frontal lobe suspicious for a focus of acute to early subacute ischemic stroke.There is paucity of cortical sulci which may be as a result of increased intracranial pressure. Ventricular system remain within normal size and with maintained midline. The CSF cisterns remain patent.Follow-up with an MRI exam if patient's condition permits is recommended. There are no prior exams for comparison.Calvarium, soft tissues of the scalp, orbits, mastoid air cells are unremarkable.Extensive right maxillary and to a lesser degree other paranasal sinus disease is noted. This appearance however could be at least partially secondary to intubation. | 1.Effacement of gray -- white matter differentiation suspicious for cerebral edema considering provided clinical data.2.Small focus of low-attenuation involving the left frontal cortex and subcortical white matter suspicious for a small focus of acute to early subacute ischemic stroke.3.Normal size of ventricular system and with maintained midline. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial lesion. Right temporal edema on outside hospital. Signs and symptoms: Decreased mentation. Nonenhanced head CT:Examination demonstrates a large focus of low involving the anterior and mid temporal operculum of right frontal lobe. There is resultant mass effect and partial effacement of right sylvian fissure. Finding is suspicious for a subacute right MCA territory ischemic stroke. Recommend follow-up with MRI exam. The ventricular system remain within normal size and with maintained midline. Examination in addition demonstrate mild findings of age indeterminate small vessel ischemic strokes.Focus of attenuation in the right cerebellum is highly suggestive of a small chronic ischemic stroke.Moderate bilateral reticular and internal carotid artery vascular calcifications are present.Unremarkable calvarium, orbits and paranasal sinuses. | 1.Late acute to early subacute right MCA frontal and temporal lobe nonhemorrhagic ischemic stroke with regional mass-effect. Follow-up with MRI examination is recommended.2.Mild age indeterminate small vessel ischemic strokes.3.Small right cerebellar chronic ischemic stroke.4.Normal size of ventricular system and with maintained midline. |
Generate impression based on findings. | 16-year-old male, punched someone, positive pain. Evaluate for fracture.VIEWS: Left hand PA, oblique, lateral (3 views) 3/4/2015 Transverse fracture along the proximal diaphysis of the first metacarpal bone which slight medial angulation. There is associated periosteal reaction and callus formation consistent with healing. There is associated mild soft tissue swelling. No additional fractures or dislocations are present. | Healing transverse fracture of the proximal diaphysis of the first metacarpal bone with slight medial angulation. |
Generate impression based on findings. | follow up tumor resection. There is evidence of left fronto temporal craniotomy as well as air densities, fluid collections and blood products on the left sylvian fissure. The blood product appears to be layered with operation site fluid with evidence of adjacent brain parenchymal swelling, edema or deformity indicating non parenchymal blood products.Stable ventricle size without evidence of midline shift.Right cerebellar hemispheric tissue defects indicating prior postoperative change.The paranasal sinuses and mastoid air cells are clear. | Postop status of the left sylvian fissure area, no unusual finding. |
Generate impression based on findings. | 9 year old female with desaturation, decreased breath sounds on the left. Evaluate for pneumonia.VIEW: Chest AP (one view) 3/4/2015 17:59 Right central venous catheter tip in the right atrium. Four sternotomy wires appear intact.Cardiothymic silhouette is normal. Low lung volumes. No focal pulmonary opacities. No pleural effusion or pneumothorax.Geographic density is noted in the right upper quadrant and was seen on prior radiographs. | No evidence of pneumonia. |
Generate impression based on findings. | 14-year-old female with pain. Evaluate for constipation.VIEW: Abdomen AP (one view) 3/4/2015 Average stool burden. Nonobstructive bowel gas pattern. | Average stool burden. |
Generate impression based on findings. | 53 years, Female, Reason: SBO History: diffuse abdominal pain. ABDOMEN:LUNG BASES: Basilar dependent atelectasis.LIVER, BILIARY TRACT: Scattered granulomas. Hepatic hypodensity formation are too small to characterize.SPLEEN: Splenic granulomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Periportal node measuring 1.4 x 1.8 cm (3/59) is nonspecific.BOWEL, MESENTERY: Postoperative changes of sleeve gastrectomy with small hiatal hernia. Ventral diastasis containing multiple bowel loops.Minimally dilated proximal jejunal loops up to 3.1 cm, however no transition point is identified and contrast is seen within the ileum and colon. This likely reflects normal peristalsisBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of small bowel obstruction.2.Small hiatal hernia. |
Generate impression based on findings. | 10-week-old male with left arm fracture. Evaluate for fracture, nonaccidental trauma.EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, right ribs AP, left ribs AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (20 views) 3/4/2015 The calvarium is normal in appearance with no evidence of fracture or dislocation.Cardiothymic silhouette is normal. No focal opacity. No pleural effusion or pneumothorax.There are multiple healing fracture present along the left posterior 9th, 10th and 11th ribs as well as along the right posterior 9th and 10th ribs.Nonobstructive bowel gas pattern.The cervical, thoracic and lumbar spine are in normal alignment. The vertebral body height and disk spaces are maintained. No prevertebral soft tissue swelling. Question of a bucket handle fracture of the distal right humerus. There is periosteal reaction along the left tibia. | Multiple healing fractures along the left posterior 9th, 10th, and 11th ribs as well as right posterior 9th and 10th ribs. Question of a bucket handle fracture of the distal right humerus. Periosteal reaction along the left tibia. Correlation with clinical history is recommended, as constellation of findings can be seen in nonaccidental trauma. |
Generate impression based on findings. | 86-year-old female with history of abdominal aortic aneurysm dissection with abrupt onset of stabbing back pain. CHEST:LUNGS AND PLEURA: Severe emphysema. Right upper lobe masslike opacity (series 14, image 24) measures 2.2 x 3.6 cm, unchanged from 2/28/2015 and remains suspicious for neoplasm. Right middle lobe peripheral nodule (series 14, image 54) measures 0.9 x 1.1 cm, unchanged from 2/28/2015.MEDIASTINUM AND HILA: No evidence of thoracic abdominal aortic aneurysm. Prominent pulmonary arteries. Cardiomegaly. Pacemaker device. Diffuse atherosclerotic changes involving the thoracic aorta and coronary arteries.CHEST WALL: Postoperative changes from left apical plombage. Multiloculated and partially calcified fat containing collections in the left posterior lateral and posterior chest wall are unchanged.ABDOMEN:LIVER, BILIARY TRACT: New mild nonspecific periportal edema and trace perihepatic fluid. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral hypodense lesions likely representing benign and complex cysts. The left kidney again shows decreased enhancement.RETROPERITONEUM, LYMPH NODES: Aneurysmal dilatation of the upper abdominal aorta measures 4.1 centimeter in largest AP dimension, not significantly changed. There are severe atherosclerotic changes involving the aorta and its major branches. Severe stenosis is present at the origin of the celiac trunk and SMA. IMA is not visualized. Left renal artery is not visualized. Severe stenosis at the origin of the right renal artery. Focal dissection involving the distal abdomen aorta for a short segment, similar to prior.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Diverticulosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Diverticulosis. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid present in the pelvis. | 1.Upper abdominal aortic aneurysm similar to prior. No acute dissection.2.Severe diffuse atherosclerotic disease including significant stenosis at the origin of the celiac trunk, right renal artery, and SMA, similar to prior. Left renal artery not visualized, similar to prior. Focal dissection of the distal abdominal aorta for a short segment, similar to prior. 3.Right upper lobe mass suspicious for a primary lung cancer.4.Small amount of nonspecific pelvic free fluid. 5.New mild nonspecific periportal edema and trace perihepatic fluid. |
Generate impression based on findings. | 77 years, Female. Reason: confirm NG tube placement History: SBO Enteric feeding tube with tip at the gastric fundus and sidehole immediately proximal to the gastroesophageal junction. Persistent dilated small bowel in midabdomen compatible with small bowel obstruction. Right lung opacities appear unchanged compared to prior examination. | Enteric feeding tube with tip at the gastric fundus and sidehole immediately proximal to the gastroesophageal junction. Findings compatible with persistent small bowel obstruction. Please see subsequent CT abdomen and pelvis for further details. |
Generate impression based on findings. | Female 60 years old Reason: 60 F with GI bleeding with 4 gram Hgb drop, negative EGD/colonoscopy, assess small bowel for mass or lesion causing bleeding History: GI bleeding. History of renal cell cancer. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic steatosis. No focal hepatic mass or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable nodular bilateral adrenal glands, favoring benign etiology like adenoma.KIDNEYS, URETERS: Again seen are multiple bilateral hypodense lesions, some of which are too small to accurately characterize. The larger lesions are unchanged from prior study without enhancement, favoring benign cysts. Atrophic kidneys suggestive of medical renal disease.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branchesBOWEL, MESENTERY: No evidence of small bowel mass. No evidence to suggest gastrointestinal hemorrhage. No bowel wall thickening or dilatation. No evidence of obstruction or intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small calcified uterine fibroids, unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of gastrointestinal hemorrhage. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of a small bowel mass or gastrointestinal hemorrhage. 2.Bilateral renal hypodense lesions most likely represent simple cysts, many of which are too small to characterize. |
Generate impression based on findings. | Male 12 years old Reason: ? fx, dislocation History: painVIEWS: Right hand AP, lateral and oblique 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. | 78 years, Male. Reason: assess GJ tube site History: intolerance to feeds Gastrojejunostomy tube balloon projects over the gastric body with jejunostomy tubing coiled in the stomach. Gaseous distended large and small bowel suggestive of ileus. | Gastrojejunostomy tube balloon projects over the gastric body with jejunostomy tubing coiled in the stomach. Ileus type bowel gas pattern. |
Generate impression based on findings. | 61-year-old male with abdominal pain and peritonitis, assess for incarcerated hernia. ABDOMEN:LUNG BASES: Mild basilar atelectasis. Small hiatal hernia.LIVER, BILIARY TRACT: Subcentimeter nonspecific hepatic hypodensities likely benign and unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Trace hydronephrosis on the right, improved from prior. Mild right hydroureter persists with right ureteral stricture at the ureterovesical anastomosis. Mildly prominent extrarenal pelvis on the left appearing similar to prior. Right kidney enhancement delayed compared to left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Fat containing ventral hernia with inflammatory and postsurgical changes in the adjacent fat. The hernia sac measures approximately 8.5 cm in the cranio-caudal dimension (sagittal series, image 65).OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Foley catheter with tip in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above. BONES, SOFT TISSUES: Fat containing ventral hernia with inflammatory and postsurgical changes in the adjacent fat. The hernia sac measures approximately 8.5 cm in the cranio-caudal dimension (sagittal series, image 65).OTHER: No significant abnormality noted | 1.Trace right hydronephrosis, improved from prior. Persistent diminished right nephrogram and mildly dilated right ureter similar to prior. 2.Fat containing ventral hernia with inflammatory and postsurgical changes in the adjacent fat. Hernia does not contain bowel. 3.No bowel obstruction. |
Generate impression based on findings. | Female 15 years old Reason: eval for appy vs colitis History: abd pain, 3wks ABDOMEN:LUNG BASES: No evidence of focal opacities, effusions or pneumothorax. No pericardial effusion.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. Specifically no evidence of colitis or appendicitis as clinically questioning |
Generate impression based on findings. | Reason: r/o PE History: SOB and chest pain, hx of PE, missed multiple doses of lovenox PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Mild centrilobular emphysema.No suspicious pulmonary nodules or masses. Moderate dependent atelectasis. Mild basilar scarring/atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification. No mediastinal or hilar lymphadenopathy.Small hiatal hernia.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter left hepatic lobe hypodensity, unchanged, likely a benign cyst. | No evidence of pulmonary embolism or other acute abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 64 years, Female. Reason: s/p NGT adjustment History: s/p NGT adjustment Enteric feeding tube tip projects over the pyloric area. Dilated loops of small bowel are not significantly changed compared to prior examination and are compatible with small bowel obstruction. Bilateral nephroureterostomy stent again noted. Skin staples and surgical clips project over the pelvis. | Enteric feeding tube tip projects over the pyloric area. Persistent small bowel obstruction. |
Generate impression based on findings. | Clinical question: Evaluate pneumocephalus is status, check for acute changes, status post tumor resection. Signs and symptoms: Drowsy. Nonenhanced head CT:There is normal evidence of an acute new finding since prior study.Large right anterior frontal surgical cavity containing small amount of air and acute blood product demonstrate no definitive change since prior exam.Pneumocephalus primarily centered in the right frontal demonstrate no evidence of interval change and in particular no evidence of interval increase in volume is again noted. Postoperative changes results in subtle mass effect on the right frontal lobe and right frontal horn of lateral ventricle similar to prior exam. There is no convincing evidence of any interval change in the size of mildly larger left lateral ventricle compared to the right. | 1.No evidence of any acute or new finding since prior exam. 2.Stable extensive postoperative changes of right frontal tumor resection and including a stable pneumocephalus.3.Stable size of ventricular system and with maintained midline. |
Generate impression based on findings. | Female 15 years old Reason: r/o constipation, stool burden History: abdominal pain epigastr and LLQVIEWS: Abdomen AP supine and upright 3/4/15 (two views) Normal abdominal gas pattern. No evidence of free air or obstruction. | Normal examination. |
Generate impression based on findings. | 77-year-old female with known small bowel obstruction, evaluate for lymphadenopathy, PTLD, or adhesive disease. Study somewhat limited by reduced intravenous contrast dose. CHEST:LUNGS AND PLEURA: Right basilar atelectasis/consolidation suspicious for infection. Small right pleural effusion.MEDIASTINUM AND HILA: Moderate coronary calcifications. No hilar or mediastinal adenopathy.CHEST WALL: Left-sided PICC with tip in the SVC.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: Endstage native kidneys. Right renal cystic lesion.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy by size criteria. Moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Enteric tube with tip in the gastric body. The small bowel is dilated up to 4.2 cm with a transition point in the right lower quadrant (series 3, image 126) with collapse of the distal ileum and colon compatible with high-grade incomplete small bowel obstruction. No associated intraperitoneal free air or pneumatosis. No evidence of intussusception.BONES, SOFT TISSUES: Mild anasarca laterally.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foci of gas are present in the bladder. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Transplant kidney in the right iliac fossa without evidence of complication. Small amount of nonspecific free fluid in the pelvis. | 1.High-grade incomplete small bowel obstruction with transition point in the right lower quadrant thought to be related to adhesive disease. No specific evidence of PTLD such as lymphadenopathy or intussusception.2.Right basilar atelectasis/consolidation suspicious for infection. Small right pleural effusion.3.End stage native kidneys. Transplant kidney in the right iliac fossa without evidence of complication.4.Nonspecific foci of gas in the bladder which may be related to recent instrumentation. |
Generate impression based on findings. | 75 years, Male, Reason: evaluate for primary malignancy, question of intracranial lesion, h/o AICD, cholecystectomy, L CVA CHEST:LUNGS AND PLEURA: Right lower lobe consolidation and small left lower lobe consolidation. Scattered calcified and noncalcified micronodules are nonspecific. No suspicious mass.MEDIASTINUM AND HILA: AICD. Atherosclerotic calcifications of the aorta and its branches. Small mediastinal nodes. Mild cardiomegaly. Tracheostomy tube tip terminates 4.5 cm above the carina.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic granuloma. Status post cholecystectomy.SPLEEN: Splenic granuloma.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large right renal sinus cyst with additional exophytic simple cyst. Subcentimeter left upper pole hypodensity is too small to characterize.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Enteric tube tip in the pylorus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter within the bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large amount of stool the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No CT evidence of neoplasm in the visualized chest, abdomen or pelvis.2.Bibasilar consolidations, right greater than left, possibly from aspiration. |
Generate impression based on findings. | Female 5 years old Reason: eval lung fields History: first time seizure concern for aspirationVIEW: Chest AP (one view) 3/5/15 0 17 hours ET tube terminates below the thoracic inlet. Cardiac silhouette size is normal. Left retrocardiac streaky opacities, likely subsegmental atelectasis. No effusions or pneumothorax | Subsegmental atelectasis of the left lower lobe. |
Generate impression based on findings. | 61-year-old female with anemia, evaluate for retroperitoneal bleed. 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: Moderate hiatal hernia.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral end stage native kidneys with hilar calcifications. Transplant kidney in the right iliac fossa. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall. Degenerative changes affect the thoracolumbar spine. OTHER: Small amount of scattered abdominopelvic ascites is present.PELVIS: Evaluation of the pelvis is limited by extensive metallic streak artifact from bilateral hip prostheses.UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral hip prostheses. Degenerative changes affect the thoracolumbar spine. OTHER: A new large, multiloculated collection is present in the pelvis and is most consistent with a hematoma. Due to lack of intravenous contrast and extensive metallic streak artifact, it is difficult to differentiate the collection from the adjacent uterus and bladder. A portion of the collection (series 3, image 118) measures 9.0 x 8.1 cm. An additional component (sagittal series, image 53) measures 6.2 x 4.8 cm. Additional small amount of scattered abdominopelvic ascites is present. | 1.New large pelvic multiloculated collection compatible with hematoma. Lack of intravenous contrast and extensive metallic streak artifact limits evaluation.2.Right femoral catheter with tip in the intrahepatic IVC.3.End stage native kidneys. Right iliac fossa renal transplant. Findings discussed by the resident with nurse practitioner Nickols at 7:55 p.m. on 3/4/2013. |
Generate impression based on findings. | 53 years, Female. Reason: SBO History: abd distension and diffuse abd pain Suture material projects over the left upper quadrant and surgical clips project over the left hemiabdomen. Prominent loops of jejunum noted in the left hemiabdomen, however, there is air noted in the large bowel. | Prominent loops of jejunum and postsurgical changes in the abdomen may represent early/partial obstruction versus localized ileus. Please see subsequent CT abdomen and pelvis for further details. |
Generate impression based on findings. | Female 64 years old Reason: recent R stent change 1.5wks prior History: diffuse abd pain Limited exam secondary to lack of intravenous and oral contrast. Lack of intravenous contrast makes evaluation of vascular and solid organ pathology suboptimal. 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 hypodensity in the posterior right hepatic lobe is unchanged and too small to characterize. Cholelithiasis without evidence of acute cholecystitis..SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic hypodensity is unchanged and measures 8 mm (series 3, image 32). ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nephroureteral stent catheter is in place with tip in a distended bladder. No significant hydronephrosis. Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Juxtarenal aortic aneurysm is redemonstrated and appears grossly unchanged in size given the limitations of this noncontrast study, measuring 4.8 x 4.1 cm (series 3, image 35), previously 4.9 x 4.0 cm immediately below the right renal artery. Status post aortobifemoral bypass with a right femoral-popliteal graft. BOWEL, MESENTERY: No small bowel dilatation. No evidence of bowel obstruction or intraperitoneal free air. No evidence of loculated fluid collection. Ventriculoperitoneal shunt tip terminates in the right upper quadrant without adjacent fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific, small amount of free fluid in the pelvis also seen on prior scan.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Both common iliac arteries are aneurysmal but grossly unchanged compared to prior exam. Both common femoral arteries are aneurysmal but grossly unchanged compared to prior with the right measuring approximately 1.8 cm in diameter (series 3, image 109) and the left measuring approximately 1.8 cm in diameter (series 3, image 104). | 1.Limited exam secondary to lack of intravenous contrast making evaluation of vascular and solid organ pathology suboptimal. Within these limitations, no evidence of bowel obstruction or intraperitoneal free air. No loculated fluid collections are visualized.2.Right nephroureteral stent is in the expected location without significant hydronephrosis.3.Persistent aneurysmal dilatation of the abdominal aorta and its branches is grossly unchanged. |
Generate impression based on findings. | 28-year-old female with recent cesarean section (post op day 5) now with fever despite antibiotics. Evaluation of the lung bases and upper abdomen limited by motion.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Layering material in the gallbladder compatible with cholelithiasis. No adjacent inflammatory changes. No focal hepatic lesions. Small hiatal hernia.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. BONES, SOFT TISSUES: Fat-containing umbilical hernia. Postsurgical changes to the lower anterior abdominal wall from recent cesarean section including subcutaneous foci of air.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Enlarged, postpartum uterus. There are foci of gas within the anterior wall of the lower uterine segment in the expected distribution of the cesarean section incision. Additional foci of gas are present within the uterine cavity. The bilateral gonadal veins are visualized without gross evidence of thrombus. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Fat-containing umbilical hernia. Postsurgical changes to the lower anterior abdominal wall from recent cesarean section including subcutaneous foci of air.OTHER: No loculated fluid collections are present. | 1.Postsurgical changes of recent cesarean section.2.Foci gas within the anterior uterine wall in the expected distribution of the cesarian section incision. Given that the procedure was only 5 days ago, this is nonspecific but raises the question of dehiscence. Recommend baseline ultrasound exam.3.Foci of gas within the uterine cavity are nonspecific but may be related to endometritis. 4.No loculated fluid collections to suggest abscess.5.Cholelithiasis. Findings discussed with SCHUFREIDER, ANN at 09:35 a.m. on 3/5/2015. |
Generate impression based on findings. | 59 years, Male. Reason: ileus perforation History: obese male admitted for management of Acute on chronic chf exacerbation w/ 7 days of constipation Nonobstructive bowel gas pattern. Average stool burden in the colon. AICD leads are partially visualized. Streaky opacities in the right lung base may are present atelectasis versus scarring. A calcification is noted in the right upper quadrant, correlating to a previously seen intraperitoneal calcification seen on prior CT abdomen and pelvis. | Nonobstructive bowel gas pattern with average stool burden. If there is continued clinical concern for pneumoperitoneum an upright chest radiograph should be obtained. |
Generate impression based on findings. | 7-year-old male with intermittent hip painVIEWS: Chest AP/lateral (two views), right hip, AP and frog leg (2 views) 3/4/15 16:08 Chest: The cardiothymic silhouette is normal. Bronchial wall thickening without focal pulmonary opacity or pleural effusionRight hip: The femoral head is well directed with respect to the normally formed acetabula. | Bronchiolitis or reactive airway disease. No hip subluxation. |
Generate impression based on findings. | COPD, worsening of SOB/DOE. Possible right-sided larynx mass. LUNGS AND PLEURA: Mild centrilobular emphysema.Mild diffuse bronchial wall thickening. Interval resolution of mild lower lobe bronchiectasis and scattered mucus impaction.8 x 12 mm solid nodule in the right middle lobe (series 12, image 56), previously 8 x 14 mm.Calcified nodules consistent with prior infection.No new nodules.MEDIASTINUM AND HILA: Cardiomegaly with left atrial and left ventricular enlargement. Mitral annulus and aortic valve calcification.Left chest wall pacemaker with lead in the right ventricle.Severe coronary artery calcification. Moderate thoracic aorta atherosclerotic calcification.No pericardial effusion.CHEST WALL: Moderate degenerative views of the thoracic spine, unchanged. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Atrophic left kidney. Mild atrophy of the right kidney with multifocal scarring.Calcified atherosclerotic disease of the abdominal aorta. | Unchanged right middle lobe nodule, likely benign given its stability from 3/2014; one additional follow-up in 1 year is recommended to confirm its benignity. |
Generate impression based on findings. | 10-year-old female with lateral tendernessVIEW: Right ankle, AP, oblique, lateral (3 views) 3/4/15 17:04 Alignment is anatomic. Mild lateral soft tissue swelling. No joint effusion. No fracture is evident. | Normal examination. |
Generate impression based on findings. | Female 52 years old Reason: recent hernia repair 2/19 now with drainage and subjective fevers History: abd pain, wound dehiscence ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Loops of small bowel and transverse colon are matted at the anterior abdominal wall with overlying induration and foci of gas and fluid along the midline incision. There is intraperitoneal fluid adjacent to the small bowel and transverse colon best seen on coronal images (series 80260, image 90).There is no evidence of extraluminal contrast, however, given the proximity of the inflammatory changes to the small bowel and colon, a fistula cannot be excluded.BONES, SOFT TISSUES: Soft tissue induration and foci of air tract laterally towards the skin. (series 3, image 125). OTHER: Small amount of pericardial fluid. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Wound dehiscence is apparent inferiorly. OTHER: No significant abnormality noted | 1.Extensive anterior abdominal soft tissue induration, gas, and fluid along the midline incision with dehiscence inferiorly consistent with incisional soft tissue infection. 2.Intraperitoneal fluid accumulation adjacent to the transverse colon and small bowel. 3.No evidence of extraluminal contrast, however, given the proximity of the inflammatory changes to the small bowel and colon, a fistula cannot be excluded. Please correlate clinically with extrinsic wound output. |
Generate impression based on findings. | Fall, alcohol use No intracranial hemorrhage is identified. There is ovoid hypoattenuation involving the right putamen favored to represent a dilated perivascular space. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.Dedicated images of the orbits demonstrate no evidence of orbital fracture. Globe and extraocular muscles appear unremarkable. Lens appear in place. No retrobulbar hematoma. Visualized portions of the paranasal sinuses, zygomatic arches, and pterygoid plates are intact. | 1. No evidence of intracranial hemorrhage or skull fracture.2. No orbital fracture. |
Generate impression based on findings. | Female 42 years old Reason: eval obstruction History: dysphagia. There is no prevertebral soft tissue swelling. The airway is widely patent. Mild arthritic changes affect the cervical spine with disk space narrowing at the C4/C5 and C5/C6 and small posterior vertebral body osteophytes seen at C5/C6. | Patent airway; no radiographic evidence of obstruction. |
Generate impression based on findings. | 15-year-old male, injury during basketballVIEWS: Right hand PA, lateral, and oblique (3 views), right wrist PA, lateral, and oblique (3 views), right forearm AP and lateral (2 views) 3/5/15 7:41 Hand and wrist: Alignment is anatomic. No acute fracture or wrist joint effusion.Forearm: Alignment is anatomic. No joint effusion or fracture. The forearm is intact. | No fracture or malalignment. |
Generate impression based on findings. | 15 year-old female with history of anuria, left CVA tenderness. Rule out urinary obstruction. Rule out unilateral right vein thrombosis. Spectral and Doppler evaluation of the inflow and outflow renal vasculature was performedBLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 8.6 cm Left: 8.1 cm Mean for age: 10.2 cm Range for age: 9.0 - 11.5 cmADDITIONAL OBSERVATIONS: NoneDOPPLER | No evidence of hydronephrosis. No evidence of renal artery or vein occlusion. The kidneys are small in size for age.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Male 53 years old Reason: fx? History: pain. There is no acute fracture or dislocation. Mild degenerative arthritic changes affect the wrist. | No fracture or dislocation. |
Generate impression based on findings. | Male 11 years old Reason: evaluate for consolidation/collapse History: respiratory distressVIEW: Chest AP (one view) 3/5/15 at 525 hours. VP shunt catheter is noted. A gastrostomy tube is present. Cardiac silhouette size is normal. Left diaphragmatic elevation, E. more likely due to on expiratory film. Streaky subsegmental atelectasis of the left lower lobe | Subsegmental atelectasis of the left lower lobe.Interval gastrostomy tube placement |
Generate impression based on findings. | 5-month-old male with emesis, evaluate abdominal gas patternVIEW: Abdomen AP (one view) 3/4/15 17:37 NG tube tip and side-port in the stomach. Gaseous distention of the bowel without bowel wall pneumatosis, portal venous gas or free intraperitoneal air. No evidence of obstruction. | Mild diffuse gaseous distention of the bowel without evidence of obstruction. |
Generate impression based on findings. | Male 18 years old Reason: fx? History: crush injury. There is a nondisplaced comminuted fracture of the second proximal phalanx, with minimal surrounding soft tissue swelling. | Fracture of the second proximal phalanx as described above. |
Generate impression based on findings. | Female 63 years old Reason: fx? History: pain to lateral malleolus and mid shin. There is no acute fracture or dislocation. Degenerative arthritic changes affect the knee. Vascular calcifications are noted in the distal soft tissues. | No acute fracture or dislocation seen. Degenerative arthritic changes of the knee. |
Generate impression based on findings. | Female 28 years old Reason: fracture abnormality History: lateral hip pain. Two views of the left hip show no acute fracture or dislocation. Alignment of the acetabular joints within normal limits.Single AP chest pelvis and shows no acute fracture or dislocation. | Unremarkable left hip joint without fracture or dislocation. |
Generate impression based on findings. | Female 53 years old Reason: r/o fx History: pain. There is no joint effusion. There is no acute fracture or dislocation evident. | No acute fracture or dislocation is evident. |
Generate impression based on findings. | Female 65 years old Reason: RLE wound History: fever, ecchymosis. Three views of the right foot show diffuse soft tissue swelling. The bones appear diffusely demineralized. Large soft tissue defects are seen along the medial aspect of the ankle. Two plates and screws device affixes the distal tibia medially in near anatomic alignment, compatible with patient's prior resection and bone graft. No acute fracture or dislocation is seen. While there is no definite cortical erosion to suggest osteomyelitis, this cannot be entirely excluded given patient's large soft tissue defect.Two views of the right tibia and fibula show aforementioned plate and screws device in the distal tibia. A large and deep soft tissue defect is seen extending from the medial ankle to the mid tibial diaphysis. Bones appear demineralized with a permeative pattern that may be secondary to osteoporosis. While there is no definite cortical erosion, given the extent and depth of the soft tissue defects, osteomyelitis cannot be excluded. Arterial calcifications and vascular surgical clips are noted in the surrounding soft tissues. | Deep extensive soft tissue defect compatible with patient's nonhealing ulcer, and osteomyelitis cannot be excluded. If additional imaging is clinically warranted, an MRI is recommended. |
Generate impression based on findings. | Male 21 years old Reason: r/o fx History: pain s/p punching wall. There is no acute fracture or dislocation. The right hand appears normal. | Normal-appearing right hand without fracture or dislocation. |
Generate impression based on findings. | Male 1 day old Reason: new admission History: INITIAL XR - increasing respiratory distress; increasing O2 requirementVIEW: Abdomen chest AP (two views) 3/5/15 ET tube terminates below the thoracic inlet. NG tube tip is at the stomach. Esophageal temperature probe terminates at GE junction. UVC is coiled towards itself in the umbilical vein, though one is at T12 and tip is at L3. UAC terminates at T5.The aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette size is normal. Question of small left-sided medial pneumothorax. No focal opacities or effusions.Disorganized, likely age related and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Misplaced esophageal temperature probe and UVC.Question of small left-sided medial pneumothorax. |
Generate impression based on findings. | Five day old male, evaluate for interval changeVIEW: Chest AP (one view) 3/5/15 4:29 ETT just above carina. Enteric tube tip and side-port in the stomach. UVC tip in the right atrium. Right chest tube tip directed superiorly and across the midline. The cardiothymic silhouette is normal.Small residual right pneumothorax. Hazy bilateral pulmonary opacities are not significantly changed. Small round and oblong lucencies in right lower lung may represent PIE. | Small residual pneumothorax. Unchanged pulmonary opacities. |
Generate impression based on findings. | Reason: tachycardia, SOB, hx of multiple DVTs, new R heart failure on TTE, eval for PE History: tachycardia, SOB, R heart failure on TTE PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: New right pleural effusion, with associated near complete atelectasis of the right upper and lower lobes. Residual aeration of the middle lobe.New small left pleural effusion. New scattered ground glass and consolidation throughout the left upper and lower lobes. The previously described left lower lobe nodule measures 25 x 17 mm (series 9, image 55), mildly increased from 10/2013 and markedly increased from 03/2010. The size change is most apparent on coronal images (series 80532, image 45).MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.Surgical changes in the breasts with increasing soft tissue in the left breast and chest wall, without focal mass.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. New large right and small left pleural effusions, with significant atelectasis of the right lung. Scattered ground glass and consolidation throughout the left upper and lower lobes is nonspecific but compatible with edema.3. Left lower lobe nodule is mildly increased from 10/2013 and markedly increased from 03/2010. This remains highly suspicious for malignancy, including primary lung neoplasm.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Five day old male, assess pneumothoraxVIEW: Chest AP (one view) 3/4/15 20:25 Interval placement of right chest tube with tip directed apically. ETT is above the carina. Enteric tube side port is at the EG junction. UVC tip in the right atrium. The cardiothymic silhouette is normal.Hazy bilateral pulmonary opacities are unchanged. Small round lucencies in the right lower lung may represent PIE. Small residual right pneumothorax. | Chest tube placement with small residual pneumothorax. |
Generate impression based on findings. | Male 78 years old Reason: obstruction? History: dilated small bowel loops, gas in large intestine with stool ABDOMEN:LUNG BASES: Interval worsening of diffuse bronchial wall thickening and multifocal areas of ground glass opacity with superimposed consolidation in the left lower lobe. Consistent with progressing aspiration and superimposed focal infection. No suspicious pulmonary nodules or masses. No significant pleural effusions.Left infrahilar lymph node with central low density is again seen and measures up to 18 mm (series 4, and image 7), previously 16 mm. No additional significant lymphadenopathy. LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral atrophic kidneys with large bilateral renal cysts, left greater than right.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and it a s branches. No the exam BOWEL, MESENTERY: Gastrojejunostomy tube tip is no longer in the jejunum and the tube is now coiled in the gastric fundus with tip in the stomach. Fluid-filled loops of small bowel without evidence of obstruction. Mild ileus may be present.BONES, SOFT TISSUES: Small fat-containing umbilical hernia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Fat-containing right inguinal hernia. Impression fractures of T10 and L2 vertebral bodies are again seen and unchanged. Degenerative changes of the remainder of the visualized spine are seen.OTHER: No significant abnormality noted | 1.Interval worsening of diffuse aspiration pneumonitis and superimposed focal infection. 2.Gastrojejunostomy tube tip is no longer in the jejunum. The tube is now coiled in the gastric fundus with tip in the stomach. 3.Fluid-filled loops of small bowel without evidence of obstruction. Mild ileus may be present. |
Generate impression based on findings. | One day old male, evaluate intubationVIEW: Chest AP (one view) 3/4/15 19:12 ETT is above the thoracic inlet. NG tube tip in the gastric antrum. UAC tip at T6. UVC likely in the ductus venosus or hepatic vein.Cardiothymic silhouette is normal. No focal pulmonary opacities or pleural effusions. No pneumothorax. | ETT tip above the thoracic inlet. |
Generate impression based on findings. | Male 1 day old Reason: where is UVC. New line placement History: replace UVC lines , encephalopathy.VIEW: Chest and abdomen AP (two views) 3/5/15 at 459 hours ET tube and NG tube are unchanged. Esophageal temperature probe tip is at the mid esophagus. UVC terminates at the SVC. UAC tip is at T8.Cardiac silhouette size is normal. Persistent small left-sided medial pneumothorax with no effusions or focal opacities.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas.. | Misplaced UVC.Interval repositioning of esophageal temperature probe and UVC as described.Persistent small left-sided medial pneumothorax. |
Generate impression based on findings. | Possible seizure, evaluate for hemorrhage Examination is motion degraded. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. Motion degradation limits evaluation for small fractures however no obvious skull fracture is demonstrated. There is partial opacification of the bilateral middle ear cavities and partially pneumatized mastoid air cells. | Examination is motion degraded. There is no evidence of intracranial hemorrhage or intracranial mass effect. If there is continued suspicion for a structural etiology for seizure, MRI may be helpful. |
Generate impression based on findings. | 5-year-old male with cough and fever, history of neuroblastomaVIEW: Chest AP (one view) 3/4/15 19:19 Left central venous catheter tip at the cavoatrial junction. Right upper quadrant surgical clips are again noted. The cardiothymic silhouette is normal. No focal opacities or pleural effusions. | No pneumonia. |
Generate impression based on findings. | Male 18 years old Reason: evaluate for pneumoperitoneum History: abdominal distension.VIEW: Abdomen AP (one view) 3/5/15 at 517 hours. Left lung base atelectasis and central line again noted. Gastrostomy tube and left acetabular osteotomy K wires are present.Interval decreasing in the number of distended bowel loops with no evidence of obstruction or free air. | Interval decreasing number of distended bowel loops. |
Generate impression based on findings. | Male 70 years old Reason: EUS/ERCP showed mass at ampulla of pancreas: pancreas protocol CT required History: Painless jaundice ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Definitive mass in the common bile duct is not visualized. There is no arterial enhancement. There is a nonspecific, circumferential hypodensity in the periampullary distal common bile duct (series 8, image 54), which may represent the mass seen on ERCP.Subcentimeter hypodense lesions are present in the liver which are too small to characterize (series 10, image 25, 28, 36, and 44). These lesions are not definitively seen on the MRCP study.Expected postprocedural pneumobilia. Interval placement of common bile duct stent is in place with distal tip in the duodenum. IVC, portal vein, and SMV are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in the left kidney which is likely a renal cyst.RETROPERITONEUM, LYMPH NODES: Nonspecific regional lymphadenopathy is noted including prominent gastrohepatic, periportal, pericaval, peripancreatic, and retroperitoneal lymph nodes. Reference peripancreatic lymph node measures 0.8 x 1.1 cm (series 10, image 42). An additional reference left periaortic lymph node measures 0.8 x 1.2 cm (series 10, image 61).Mild atherosclerotic calcifications of the abdominal aorta. There is suggestion of the left gastric artery originating from the aorta.BOWEL, MESENTERY: No evidence of bowel thickening or dilatation.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1.Enhancing periampullary mass is not definitively visualized. There is a nonspecific, circumferential hypodensity in the periampullary common bile duct which may represent the ampullary mass seen on ERCP.2.Nonspecific hypodense lesions within the liver are too small to characterize. Continued to follow with subsequent surveillance imaging.3.Nonspecific regional lymphadenopathy. |
Generate impression based on findings. | Female 76 years old Reason: 76 yo female with anterior knee pain. Eval for OA. Please shoot weight bearing films. History: left ant knee There is moderate to severe medial compartment joint space loss with near bone-on-bone apposition. There are tricompartmental osteophytes, worst in the medial compartment.There is a trace joint effusion. No acute fracture or malalignment. | Moderate to severe left knee medial compartment osteoarthritis. |
Generate impression based on findings. | Female 49 years old Reason: Evaluate for compression fracture History: as above Thoracic spine: Thoracic vertebral bodies normal in height and alignment. There is mild to space narrowing in the midthoracic spine. No acute fracture or malalignment.Heart size is enlarged. There is a left pulmonary opacity and pleural effusion.Right central venous catheter terminates at the level of the hepatic veins.Lumbar spine: Lumbar vertebral bodies normal in height. There is mild facet hypertrophic changes involving the mid to upper lumbar spine. No compression fractures are evident.The small bowel is dilated suggestive of an ileus or obstruction. A catheter projects over the right upper abdomen. | No radiographic evidence of compression fracture. |
Generate impression based on findings. | Female 42 years old Reason: right index finger pain at Prox phalanx History: as above There is mild interphalangeal joint space narrowing. No acute fracture or malalignment. Mild osteoarthritic changes affects the metacarpophalangeal jointNo radiopaque foreign body. | Osteoarthritis without acute fracture or malalignment. |
Generate impression based on findings. | Male 58 years old; Reason: Eval interval change, peri-pancreatic fluid collection, r/o pelvic hemorrhage or abscess History: Pancreatitis with infected per-pancreatic cyst s/p cystgastrostomy, US with ?pelvic fluid collection/hemorrhage? Suboptimal study due to beam hardening from patient's arms and lack of intravenous contrast, along with motion.ABDOMEN: LUNG BASES: Redemonstrated bilateral pleural effusions with adjacent compressive atelectasis.Mild cardiomegaly. Calcified coronary arteries.LIVER, BILIARY TRACT: New small amount of predominantly left sided pneumobilia is nonspecific, and could be post procedural or related to cholangitis. Correlate clinically.SPLEEN: No significant abnormality noted.PANCREAS: Status post cyst gastrostomy with two new drainage catheters located in the stomach and cystic collection, respectively. Oral contrast, presumably secondary to gastrostomy, is seen within the collection which is somewhat bilobed, with larger components along the greater curvature and in the subdiaphragmatic peri-splenic region. The collection along the greater curvature measures 3.1 x 6.4 cm (coronal image 49) compared to about 9.4 x 3.6 cm on prior scan (coronal image 53). The crescentic presplenic/subdiaphragmatic collection appears increased in size compared to prior exam, previously measuring 1.2 cm in maximal thickness. Surrounding the spleen (coronal image 33), now measuring up to 2.4 cm circumferentially around the spleen (coronal image 34). The ends of the drainage catheters are seen within this portion of the collection. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nasojejunal tube in appropriate position - some discontinuity in the tube is felt to be secondary to motion. No definite obstruction. Ascites, with several fluid pockets appearing loculated throughout the abdomen and pelvis, the largest described below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: A Foley catheter within decompressed urinary bladder. Air within the urinary bladder is likely iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered pockets of loculated fluid, one large pocket in the left lower quadrant, measuring 7.8 x 4.8 cm (3:58) compared to 7.9 x 3.2 cm (3:98). Ascites in the pelvis may also be loculated, and measure up to 16.4 x 9.2 cm (sagittal image 53). No obstruction. Oral contrast goes to the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Given limitations of a noncontrast exam:1.Bilobed peripancreatic cyst, as described above, now traversed with new drainage catheters between the stomach and cyst. While the greater curvature component of the cyst has decreased in size, the parasplenic/subdiaphragmatic portion has increased, further detailed above.2.Compared to prior scan, there appears to be more loculation of the ascites seen throughout the abdomen and pelvis, with the largest pockets described above.3.New pneumobilia could be postprocedural or related to cholangitis, correlate with clinical history.4.Redemonstrated bilateral pleural effusions. |
Generate impression based on findings. | Reason: eval for pe History: h/o pe, discontinued anticoagulation, hemoptysis PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Scattered benign-appearing micronodules. No suspicious pulmonary nodules or masses. Midline mild basilar subsegmental atelectasis. Small scar-like opacities in the lower lobes (series 12, image 87) may be related to prior pulmonary embolus or infection. Mild dependent atelectasis.No pleural effusions.Mild bronchial wall thickening.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. Bronchial wall thickening may relate to bronchitis or asthma.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 91 years old Reason: fracture History: L elbow fracture. There is a moderately sized joint effusion. There is no definite fracture line evident, however, an occult radial fracture cannot be entirely excluded. Enthesopathic changes are seen along the olecranon process. | Joint effusion without definite fracture line. Occult proximal radial fracture cannot be excluded and follow-up in 7 to 10 days is recommended. |
Generate impression based on findings. | 31 years, Female. Reason: 31F w/ metastatic colon cancer History: Abdominal pain IUD projects over the mid pelvis. Nonobstructive bowel gas pattern. Lung bases are clear. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 65 years, Male. Reason: DHT coughed up by pt, new DHT replaced History: DHT coughed up by pt, new DHT replaced Dobbhoff tube tip projects over the gastric body. Retrocardiac opacity. Essentially gasless abdomen. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the gastric body. |
Generate impression based on findings. | Female 47 years old Reason: eval hardware, fracture, malalignment History: R shoulder pain, limited ROM, hx of arthoplasty. Four views of the shoulder show hardware components of a right shoulder hemiarthroplasty device situated in near anatomic alignment with no radiographic evidence of hardware complication. There is no acute fracture or dislocation. | Right shoulder hemiarthroplasty without radiographic evidence of hardware complication. |
Generate impression based on findings. | 60 years, Male. Reason: presents from OSH with persistent SBO s/p colonic tube placement History: vomiting Cardiomediastinal silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. NG tube tip projects over the gastric body. No pneumoperitoneum. Gas is distention of small bowel measuring up to 3.9 cm in diameter. Persistent dilation of a featureless appearing ascending colon. Multiple air-fluid levels are also noted. Colonic tube projects over the mid descending colon. Surgical clips scattered throughout the abdomen. Ring shaped opacity similar to a Sitz marker is noted projecting over the L3 vertebral body. | 1.Findings compatible with small bowel obstruction. 2.Colonic tube tip projects over the mid descending colon.3.Featureless appearing ascending colon suggestive of colitis. Clinical correlation is recommended. |
Generate impression based on findings. | 67 year old female with history of mitral valve repair in 1996, chronic atrial fibrillation who is being evaluated for repeat mitral and tricuspid repair. CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with a normal brachiocephalic branching pattern is normal . Additionally, and accessory artery (likely the vertebral artery) arises between the left carotid and left subclavian artery. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has moderate amount of tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is moderate calcification of the aortic root. There is mild calcification of the aortic arch. There is mild calcification of the descending aorta. No aortic coarctation is noted. There is mild atherosclerosis the proximal brachiocephalic vessels. Sinus of Valsalva: 35 x 28 mmSinotubular Junction: 27 x 25 mmAscending Aorta (4cm from annulus): 29 mmMid Aortic Arch: 25 x 26 mmDescending Aorta: 26 x 24 mmAortic Valve: There is moderate calcification of the aortic valve, predominantly involving the right coronary cusp.Mitral Valve: Mitral valve annuloplasty ring is noted. Mild mitral valve calcification.Left Ventricle: The left ventricle is small in size. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. There is no significant sigmoid septum noted. Right Ventricle: Normal right ventricular size.Atria: Gigantic biatrial dilation. There is a mild filling defect in the left atrial appendage which could represent either a left atrial appendage thrombus or poor flow. Normal pulmonary vein anatomy. The superior and inferior vena cavae and coronary sinus are dilated. Pulmonary Artery: Normal in size. The right and left pulmonary arteries are dilated 27 mm and 25 mm, respectively. Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerin was not administered, this exam was not performed to optimally visualize the coronary arteries. Coronary Bypass Grafts:None present. | 1. Moderate tortuosity and mild to moderate calcification of the thoracic aorta2. Gigantic biatrial dilation.3. There is a mild filling defect in the left atrial appendage which could represent either a left atrial appendage thrombus or poor flow. 4. Moderate aortic valve calcification.5. Mitral anuloplasty ring noted.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. The abdomen/ Pelvis CTA reported separately.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Altered mental status, not following commands Compared to 2/26/2015, there is trace interval increase in size of the lateral ventricles compared to prior. Otherwise ventricular system is unchanged. Right parietal approach ventriculostomy catheter is unchanged in position. Dysmorphic appearance of the brain parenchyma is unchanged with tip near the interhemispheric fissure. There appears to be dysgenesis of the corpus callosum. The frontal horns are oriented in a parallel fashion. The bodies and occipital horns of the bilateral lateral ventricles are dilated and seems to communicate with a large CSF filled space. The cerebellum is somewhat towering and wraps around the brainstem. There is beaking of the tectum. There is atrophy of the bilateral parietal and occipital lobes. The calvarium is also dysmorphic and is elongated and narrowed in transverse dimension on coronal view. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. Compared to 2/26/2015, there is minimal increase in size of the lateral ventricles and are similar to 11/20/2014. Dysmorphic ventricular system is otherwise unchanged.2. No intracranial hemorrhage or mass effect.3. Again seen is dysmorphic appearance of the brain parenchyma which can be better assessed with MRI if clinically indicated. There are features of Chiari 2 malformation with dysgenesis of the corpus callosum. |
Generate impression based on findings. | Metastatic lung cancer. Complaining of increased coughing and shortness of breath. Evaluate disease status. CHEST:LUNGS AND PLEURA: Postsurgical findings of left lower lobectomy.Small partially loculated left pleural effusion. Multiple areas of pleural thickening, for example at the superior aspect of the left upper lobe, suspicious for pleural metastases (series 3, image 24).Two adjacent subpleural nodules in the left upper lobe, the larger of which is 10 mm (series 4, image 43), suspicious for metastases.Multiple right paramediastinal micronodules and reticular opacities, likely related to post radiation change.Peripheral scattered micronodules in the right lung are indeterminate, special attention on follow-up scans.MEDIASTINUM AND HILA: Necrotic mediastinal lymphadenopathy in the AP window and right paratracheal region. 11 mm right paratracheal lymph node (series 3, image 28).Normal heart size with a trace pericardial effusion. No visible coronary artery calcification.Left upper extremity PICC tip is at the origin of the coronary sinus (series 3, image 60).CHEST WALL: T6 sclerotic metastases involving the vertebral body and posterior elements.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Minimal abdominal aorta atherosclerotic calcification.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Findings suspicious for left pleural metastases with a likely malignant small left pleural effusion. Two left upper lobe nodules suspicious for metastases and right lung micronodules that are indeterminate. 2. Necrotic mediastinal lymphadenopathy.3. T6 vertebral metastasis. 4. Left PICC tip is at the origin of the coronary sinus. |
Generate impression based on findings. | Female 54 years old Reason: s/p IM nail History: s/p IM nail Status post IM nail placement affixing a comminuted mid to distal tibial fracture.Hardware components are intact with proximal and distal interlocking screws. There is some callus formation. Fracture involving the fibula also shows signs of healing without change in alignment. Small osteochondroma involving the medial tibial metaphysis is unchanged. | Healing tibial fracture status post ORIF. |
Generate impression based on findings. | 49 years, Female. Reason: epigastric pain History: epigastric pain Pigtail catheter projects over the right upper quadrant. Central venous catheter tip is in the right atrium. Left basilar atelectasis and pleural effusion. Moderate stool burden mainly within the ascending and transverse. Nonobstructive bowel gas pattern. Mild leftward curvature of the thoracolumbar spine. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Reason: Pt with mass in R suprascapular region- evaluate for etiology History: R suprascapular mass LUNGS AND PLEURA: Postsurgical changes of a right lower and left upper lobectomy, and radiation fibrosis in the right paramediastinal region, unchanged.Moderate apical predominant centrilobular and paraseptal emphysema.No new suspicious pulmonary nodules or masses.Basilar scarring/subsegmental atelectasis, unchanged. No new focal air space consolidation. No pleural effusions.Small right tracheal diverticulum (series 5, image 24)MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.No mass lesion or other abnormality identified in the suprascapular region.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Right renal hypodensity partially visualized, unchanged, likely a benign cyst. | 1. No mass lesion or other abnormality identified in the suprascapular region in the field of view of this exam. CT soft tissue neck may be useful for more complete evaluation.2. No other acute abnormality or significant interval change. |
Generate impression based on findings. | 75 years, Male. Reason: eval NG tube placement from OSH History: eval NG tube placement Residual contrast from prior study in the collecting systems. NG tube projects over the gastric antrum. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube projects over the gastric antrum. |
Generate impression based on findings. | Reason: 64 yo with NSCLC please re-stage History: see above CHEST:LUNGS AND PLEURA: The right lower lobe mass, compatible with a known history of non-small cell lung cancer, measures 5.4 x 5 .0 cm (series 4, image 69), mildly increased from the prior exam dated 09/2014, contiguous with the pleura.Anterior right nodular pleural plaques (series 4, image 50) are unchanged, not hypermetabolic on PET imaging, and presumably benign. Left basilar subsegmental atelectasis is decreased from the prior exam. No new suspicious pulmonary nodules or masses.No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is enlarged, with a small pericardial effusion. No visible coronary artery calcification. The main pulmonary artery is enlarged, raising the question of pulmonary hypertension.Scattered small mediastinal and hilar lymph nodes are decreased in size from the prior exam. For reference, and AP window node measures 5 mm (series 604, image 42), previously approximately 8 mm.CHEST WALL: Right chest port, tip in the right atrium.Mild degenerative disease of the thoracic spine. No extension of the large lung mass into the chest wall. A small right anterolateral lipoma is unchanged.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | 1. The right lower lobe mass, compatible with known history of non-small cell lung cancer, is mildly increased from 09/2014. The mass is contiguous with the pleura, without evidence of chest wall invasion.2. Mediastinal lymph nodes are mildly decreased in size from the prior exam.3. No new sites of disease identified. |
Generate impression based on findings. | AAA screening, ex smoker, diabetic ABDOMINAL AORTA: Nonaneurysmal abdominal aorta and visualized common iliac arteries, scattered atherosclerotic calcifications. Measurements as follows:Proximal aorta measures 2.3 x 2.3 cm.Midportion of aorta measures 2 x 1.9 cm.Distal aorta measures 1.8 x 1.8 cm.Right common iliac artery measures approximately 1.3 x 1 cm.Left common iliac artery measures approximately 1.6 x 1.1 cm. | No evidence of aortoiliac aneurysm as above. |
Generate impression based on findings. | Gastrostomy tube and multiple surgical sutures again noted. Generalized, nonspecific bowel distention. No evidence of obstruction or free air. No bowel wall thickening, pneumatosis intestinalis or ascites. | Nonspecific bowel distention as described. |
Generate impression based on findings. | Female 16 years old Reason: Evaluate heart size with effusion as well as pulmonary vascular markings, and for possible thoracic mass. History: Pericardial effusionVIEWS: Chest PA/lateral (two views) 3/5/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Left retrocardiac opacity, likely atelectasis and possible either left costophrenic angle pleural thickening versus loculated effusion.. | Left costophrenic angle pleural thickening/effusion none of segmental atelectasis of the left lower lobe. |
Generate impression based on findings. | Female 53 years old Reason: s/p r. foot surgery. Assess healing History: foot pain Status post removal of orthopedic hardware involving the medial cuneiform, and base of the first metatarsal.Pin type device involving the proximal phalanx of the first digit is unchanged. There are postsurgical changes in the first metatarsal head. There is mild hallux valgus. Mild to moderate osteoarthritis affects the midfoot. Mild soft tissue swelling along the dorsum of the foot persists. | Status post hardware removal as detailed above. |
Generate impression based on findings. | 67-year-old female patient with diverticulum seen on EGD. Evaluate for fistula. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. There are postsurgical changes along the left mediastinum, compatible with known left lung resection. Linear lucency along the left heart border was evaluated fluoroscopically and was confirmed to be external to the patient.Initial single contrast evaluation of the esophagus with barium demonstrated a long segment linear intramural fistula along the right side of the distal third of the esophagus (series 15, cine series 2) with associated small blind ending sinus tract distally (series 18). There are what appear to be intramural pseudodiverticula in the midesophagus. Further evaluation was performed with water-soluble dilute Omnipaque 350. Finally, multiple water flushes were swallowed with a small residual amount of contrast in the blind ending sinus tract (series 18).TOTAL FLUOROSCOPY TIME: 5:18 minutes. | 1.Long segment intramural fistula with associated sinus tract. 2.Intramural pseudodiverticula. |
Generate impression based on findings. | Female 75 years old Reason: s/p femoral neck pinning History: s/p femoral neck pinning Orthopedic screws affix the right femoral neck fracture in near anatomic alignment. No hardware complication is evident. Single view of the pelvis shows aforementioned right hip surgical change. Osteoarthritis affects the lower lumbar spine | Status post fixation of the right femoral neck fracture without change in alignment. |
Generate impression based on findings. | Evaluate for mass/tumor of the larynx in the setting of worsening right sided throat pain x 2 months, dysphagia, referred ear pain (right), and tender cervical adenopathy. Neck: There is asymmetric enlargement of the right thyroid lobe with suggestion of an ill-defined nodule, although beam hardening artifact limits the assessment. There is bilateral cervical lymphadenopathy. For example, a right level 2A lymph node measures 17 x 21 mm and a left level 2B lymph node measures 16 x 18 mm. The aerodigestive track, including the larynx appears to be grossly unremarkable. The major salivary glands are unremarkable. There is atherosclerotic plaque at the carotid bifurcation regions. There is multilevel degenerative spondylosis. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial mass or abnormal enhancement. There is patchy nonspecific cerebral white matter hypoattenuation, which may represent small vessel ischemic disease. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. Asymmetric enlargement of the right thyroid lobe with suggestion of an ill-defined nodule, although beam hardening artifact limits the assessment. A thyroid ultrasound may be useful for further evaluation.2. Nonspecific bilateral cervical lymphadenopathy.3. The aerodigestive track, including the larynx appears to be grossly unremarkable. However, CT is less sensitive for detecting mucosal lesions that laryngoscopy of PET.4. No evidence of acute intracranial tumors. |
Generate impression based on findings. | Male 46 years old; Reason: pre-op for left THA Mako Stryker robotic system. History: pain Severe osteoarthritis affects the left hip, with subchondral sclerosis and cyst formation. No fracture is present. Mild osteoarthritis affects the right hip. | Osteoarthritis |
Generate impression based on findings. | Respiratory failure. 2-year-old former 24 week gestational age patient.VIEW: Chest AP (one view) 03/05/15, 0541 Endotracheal tube tip is below thoracic inlet. Left upper extremity PICC tip is at junction of superior vena cava and right atrium. A gastrostomy tube is present. Surgical clips are noted around the GE junction.Cardiothymic silhouette is normal. Airspace disease is identified in the right upper and left lower lobes. Hazy opacities are present bilaterally. No pneumothorax or pneumomediastinum is visualized. | Focal opacities on a background of chronic opacities. |
Generate impression based on findings. | Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST:LUNGS AND PLEURA: Focal streaky opacity in the right middle lobe compatible with scarring, which likely accounts for abnormal opacity seen on the lateral chest radiograph. Calcified and noncalcified small nodules also in the right middle lobe compatible with previous infection.MEDIASTINUM AND HILA: Calcified hilar lymph nodes compatible with previous infection.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. | No significant extra cardiovascular abnormalities in the visualized portion of the thorax. |
Generate impression based on findings. | Male 52 years old Reason: assess prothesis History: S/P total elbow arthroplasty. Hardware components of a left total elbow arthroplasty device are situated in near anatomic alignment. There is a lucency about the ulnar aspect of the prosthesis which is compatible with bone resorption, but appears stable when compared to the prior study. There has been a resection of the radial head. The humerus and radial stems are unchanged. | Total elbow arthroplasty as described above. |
Generate impression based on findings. | 5-day-old former 32 week gestational age patient with adjustment of PICC.VIEW: Chest AP (one view) 03/05/15, 0435 Left upper extremity PICC tip is in left internal jugular vein. Feeding tube tip is in the stomach. Umbilical venous line tip is at junction of the inferior vena cava and right atrium.Cardiothymic silhouette is normal. Residual bilateral hazy opacity is noted. | Left PICC tip in internal jugular vein. |
Generate impression based on findings. | 20 year-old female, status post surgery for deformityVIEWS: Left foot, AP, oblique, and lateral (3 views) 3/5/15 8:57 Interval removal of cast and K wires. The bones are demineralized. Mild residual hindfoot valgus, now with slight pes cavus. No fracture. | Removal cast and K wires with improved alignment. |
Generate impression based on findings. | Torticollis. Goldenhar syndrome.VIEWS: Cervical spine AP/lateral (two views) 03/05/15 Multiple segmentation anomalies are identified in the upper thoracic spine associated with a right curve. The head is tilted to the right.The odontoid is slightly flexed with respect to the body of C2. The appearance was similar to the prior exam. Pseudosubluxation of C2 on C3 is seen. The atlantodens interval is less than 3 mm. Retropharyngeal soft tissues appear thickened, most likely due to expiration. | Slight flexion of the odontoid on the body of C2 . Flexion and extension views may be helpful now that the anterior arch of C1 is ossified. |
Generate impression based on findings. | Female 75 years old Reason: pain in spine medial to scapulas; hx breast cancer History: pain. There is no acute fracture or subluxation. Vertebral body heights are preserved. There is mild disk space narrowing at the upper thoracic levels. No definite lytic or sclerotic lesions are identified within the thoracic vertebral bodies. There is mild levoscoliosis of the upper thoracic spine. The scapulas are not well visualized on this study. | No acute fracture or subluxation. If further imaging is clinically warranted, a CT is recommended for better visualization of the scapulas. |
Generate impression based on findings. | 50-year-old recall from screening for a focal asymmetry in the right breast. An ML view and spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The area of focal asymmetry largely disperses with spot compression. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: s/p sleeve resection of left distal main bronchus and proximal upper and lower bronchus for management of T1N0 typical carcinoid tumor. History: follow up CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules, unchanged. No new suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.Slight soft tissue bulging of the distal left main bronchus at the resection site, unchanged from 01/2011.MEDIASTINUM AND HILA: The heart is normal in size, with no significant pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 30 year old female who has a complaint of focal right breast tenderness. Her physician palpated an area of thickness in the area of reported tenderness. Family history of breast carcinoma in her mother at age 45. BILATERAL DIAGNOSTIC MAMMOGRAM: 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. RIGHT BREAST ULTRASOUND: A targeted right ultrasound was performed for the patient’s area of concern. A band of dense parenchymal tissue is present subjacent to the area of concern. There is no solid or cystic mass identified. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, to begin at age 35. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 73 years, Male, Reason: 73 yo with hepatic mass of unclear etiology has been stable History: none. ABDOMEN:LUNG BASES: Calcifications of the aortic and mitral valve. Mild coronary artery calcifications. Left lower lobe nodule measures 0.9 x 0.9 cm (21/37), previously 0.8 x 0.8 cm.LIVER, BILIARY TRACT: Status post cholecystectomy. Cirrhotic liver morphology.Wedge-shaped enhancing peripheral focus with surrounding hypoattenuation in segments 5/6 is stable measuring 2.9 x 3.7 cm (18/44), previously 3.7 x 2.7 cm.Focus of arterial enhancement along the falciform ligament measures 0.8 x 0.8 cm (18/42), previously 0.9 x 0.9 cm.Hypodense focus in segment 4b is not seen on this exam.The proximal portal vein is enlarged to 2.4 cm with peripheral nonocclusive thrombus appearing similar to the prior exam. Thrombus extends from the distal SMV which is completely occluded, unchanged. There are multiple collateral vessels consistent with cavernous transformation.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple nonobstructing stones in the left renal pelvis. Left hepatic cysts and other densities which are too small to characterize.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: No significant abnormality noted | 1.Stable hepatic lesions.2.Stable portal vein and SMV thrombosis.3.Left lower lobe nodule is stable. |
Generate impression based on findings. | 64 years, Male, Reason: evaluate for progression History: seminoma s/p RT. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. Scattered calcified and noncalcified micronodules are nonspecific.MEDIASTINUM AND HILA: Right chest port tip terminates in the right atrium. Left thyroid nodules unchanged. Severe coronary calcifications. Prominent right hilar node is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophy of the left kidney is slightly progressed.RETROPERITONEUM, LYMPH NODES: Confluent soft tissue infiltration along the left aspect of the abdominal aorta with scattered calcifications is unchanged from the prior exam. The left renal artery is completely encased and there is partial encasement of the left renal vein, appearing similar to the prior exam. A reference lesion is stable measuring 3.1 x 1.9 cm (/116), previously 2.9 x 2.0 cm. No new lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.PELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable compression deformity of L1. Radiation changes in the lumbar spine. | 1.Stable confluent retroperitoneal soft tissue infiltration.2.Slightly increased atrophy of the left kidney. |
Generate impression based on findings. | Reason: h/p laryngeal ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Mild apical predominant centrilobular emphysema.Scattered benign appearing micronodules, some calcified, unchanged. No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, with a pericardial effusion. Moderate coronary artery calcification.A right hilar lymph node measures 11 mm, unchanged from 03/2014. No other significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Bilateral pars defects of L5/S1, unchanged.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 62 year-old female history of vasovagal episode causing hand numbness/inability to grasp status post vaginal hysterectomy/pelvic organ prolapse repair. CT head without contrast: 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 left maxillary sinus, but otherwise the imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. CT angiography: There is a normal configuration of the aortic arch. There is moderate stenosis of the proximal left vertebral artery with the remaining vessel being relatively hypoplastic when compared to the right. There is a 10 x 5 mm fusiform outpouching of the left periophthalmic internal carotid artery. This aneurysm seems to straddle the optic strut. Additionally, there is a 5 x 4 mm saccular aneurysm of the right paraclinoid internal carotid artery. Approximately 1mm of the aneurysm base lies inferior to the anterior clinoid process. The ACOMs and PCOMs are intact. There is no evidence of intracranial flow-limiting stenosis. | 1. No evidence of intracranial hemorrhage or mass effect. CT is insensitive for the detection of acute ischemic infarction. If patient care warrants further imaging, an MRI may be obtained.2. 10 x 5 mm fusiform aneurysm of the left periophthalmic ICA and 5 x 4 mm saccular aneurysm of the right paraclinoid ICA. Recommend neurointerventional radiology consultation.Results and plan were discussed with Dana Caruso at 0930 on 3/5/15. |
Generate impression based on findings. | There is no acute intracranial hemorrhage, mass effect, or midline shift. The extra-axial spaces appear unremarkable for age. The ventricles, sulci, and cisterns are normal in size and configuration. There is a large scalp complex collection of fluid and blood products crossing sutures compatible with subgaleal hematoma. The high attenuation blood products are primarily situated along the vertex and right side of the scalp, measuring up to 2.1 cm in thickness. The left scalp contains thin areas of hemorrhage but is primarily swelling with near simple fluid attenuation measuring up to 1.1 cm in thickness. There is mild physiologic diastasis of the underlying sutures but no displaced or depressed skull fractures. The imaged portions of the orbits are unremarkable. An endotracheal tube is partially visualized. | No acute intracranial hemorrhage or skull fracture. Large scalp subgaleal hematoma as described above. |
Generate impression based on findings. | There is a low density fluid collection with peripheral enhancement anterior to the mandible on the right (series 3, image 108) measuring 2.4 x 1.9 cm consistent with an abscess. No evidence of underlying osseous erosion to suggest osteomyelitis. There are periapical lucencies involving the right lateral second incisor, right first molar, and left first molar. Parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified and there is no airway compromise. The lung apices are clear. There is no clinically significant adenopathy. | 1.Findings consistent with an abscess anterior to the mandible as above without evidence of osteomyelitis.2.Multiple periapical lucencies suggestive of periodontal disease. |
Generate impression based on findings. | 75 years, Male. Reason: Repeat for improvement in known ileus History: has +BS, nontender on exam NG tube tip projects over the gastric antrum. Postsurgical changes from fundoplications surgery are again noted. No pneumoperitoneum. Multiple air fluid levels, increased since the prior exam. Degree of bowel dilation is unchanged. Note that the pelvis is excluded from the field-of-view. | Ileus type bowel gas pattern not significantly changed since the prior exam. |
Generate impression based on findings. | 4-year-old male with left elbow injury, evaluate for healingVIEWS: Left elbow, AP, oblique, and lateral (3 views) 3/5/15 9:16 Interval removal of cast. Alignment is anatomic. The distal humeral fracture line is longer visible, suggesting healing. | Distal humeral fracture line is no longer visualized, suggesting healing. |
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