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Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A pacemaker generator obscures the left axilla and a Port-A-Cath obscures the right axilla. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 61-year-old with history of benign biopsies. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable benign masses bilaterally, including in the 6 o'clock position of the left breast. Benign calcifications are present bilaterally.Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 59 years old; History: pain LEFT ANKLE: Soft tissue swelling is noted about the ankle. No fracture or malalignment is present. LEFT FOOT: A moderate hallux valgus deformity is noted. No fracture or malalignment is present. No significant arthritic changes or specific findings are otherwise seen to account for the patient's pain. | No fracture or malalignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: 56 yo male with pancreas mass; please do pancreatic protocol CT scan with chest images to evaluate for changes and or abnormalities History: pancreas mass CHEST:LUNGS AND PLEURA: Multiple scattered calcified and noncalcified pulmonary nodules and micronodules are redemonstrated. The largest lesion in the right lower lobe is grossly stable, previously measuring 1.6 x 1.0 cm, now measuring the same. Coronary artery calcifications.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Redemonstration common bile duct stent with persistent dilatation of the bile ducts. Persistent portal vein stenosis at the portal confluence, not significantly changed.SPLEEN: Thrombosed splenic vein with collaterals.PANCREAS: Body and tail atrophic. Stable appearance of the pancreatic head with no definitive mass. Interval resolution of a cystic lesion in between the pancreatic tail and spleen.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left pelvic kidney.RETROPERITONEUM, LYMPH NODES: Mild narrowing of the proximal celiac artery, with minimal poststenotic dilatation. Peripancreatic lymphadenopathy is redemonstrated. The index node previously measured 1.0 x 3.0 cm (3:87), now measuring1.0 x 3.0 cm (11:92). Additional periportal node measures 2.0 x 1.8 cm (11:104.) subjectively slightly increased in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Grossly stable exam. No definite pancreatic mass identified, although subtle malignancy cannot entirely be excluded.Interval resolution of cystic lesion between the pancreatic tail and spleen.Stable pulmonary nodules. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Bilateral retropectoral saline implants appear unchanged. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 17 year-old female with desaturation, evaluate for consolidation. History of surgery for bowel obstruction secondary to small bowel herniation into lesser sac.VIEW: Chest AP (one view) 3/5/1511:01 Enteric tube tip and side-port in the stomach. The cardiothymic silhouette is normal.Low lung volumes with patchy basilar opacities and retrocardiac consolidation and bibasilar atelectasis.Dilated loops of small bowel in the upper abdomen. Midline skin staples. | Retrocardiac consolidation and bibasilar atelectasis. |
Generate impression based on findings. | Pain. Preoperative. Severe osteoarthritis affects the left hip, with joint space narrowing, subchondral sclerosis, and subchondral cysts. No fracture or dislocation is present.Mild osteoarthritis affects the right hip. | Osteoarthritis. |
Generate impression based on findings. | 12-year-old male with scoliosisVIEWS: Thoracolumbar spine upright in brace, PA (one view) 3/5/15 11:04 27 degrees dextroscoliosis from T8 to L3. The spinous process of T2 is 9 cm to the left of the spinous process of S1. No segmentation defects. Mild to moderate colonic stool burden. | Flexible thoracolumbar curve. |
Generate impression based on findings. | 40 year-old male with end stage renal disease, evaluation for renal transplant. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Evaluation of the lung parenchyma somewhat limited by motion. No consolidation or pleural effusions. Small hiatal hernia. LIVER, BILIARY TRACT: Subcentimeter low attenuation hepatic segment 6 lesion too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: End stage, atrophic kidneys. Multiple bilateral simple renal cysts with additional low-attenuation lesions too small to characterize. Nonobstructive punctate calyceal calculi without obstructing calculi or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant atherosclerotic disease of the abdominal aorta, common iliac arteries, and external iliac arteries. Moderate atherosclerotic calcifications affect the internal iliac arteries.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. There is submucosal fat deposition involving the ascending and transverse colon likely related to prior inflammation.BONES, SOFT TISSUES: Diffuse sclerosis of the bones compatible with renal osteodystrophy. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above. BONES, SOFT TISSUES: A 1.7 cm nonspecific soft tissue nodule is present within the superficial soft tissues along the left inguinal crease (series 3, image 131). Diffuse sclerosis of the bones compatible with renal osteodystrophy. | 1.No significant atherosclerotic disease of the abdominal aorta, common iliac arteries, and external iliac arteries.2.End stage native kidneys with multiple renal cysts.3.Submucosal fat deposition in the colon likely from prior inflammation.4.Nonspecific soft tissue nodule in the superficial tissues along the left inguinal crease, recommend correlation with physical exam. |
Generate impression based on findings. | Femoral osteotomy.VIEW: Pelvis AP (one view) 03/05/15 In the interval, a right femoral valgus osteotomy has been performed. Plate and screws compression device is noted. The right femoral head remains dislocated from the dysplastic acetabulum. The left femur is abducted and the femoral head is well directed into the acetabulum.A moderate amount of feces is seen in the rectosigmoid.A spica obscures bone detail. | Osteotomy of the proximal femur with no evidence of complication. |
Generate impression based on findings. | Breast cancer restaging.IMAGES: Submitted for interpretation are FDG PET/CT images from the skull vertex through the thighs labeled Edward hospital dated 1/20/15. (The nonenhanced CT images were obtained solely for purposes of completing the PET scan, are not of diagnostic quality and are thus not interpreted or used to diagnose disease independently of the PET images.) Today's CT portion grossly demonstrates a right occipital craniotomy defect. There has been a right mastectomy. Left chest Port-A-Cath with tip in the SVC. Layering sludge is seen within the gallbladder. Multiple enlarged retroperitoneal and mesenteric lymph nodes are seen. The patient is apparently post vertebroplasty at L3. Significant facet degenerative changes are seen at L4/5 with high-density extension on the left into the posterior soft tissues which may represent associated calcification or ossification.Today's PET examination demonstrates multiple small to medium sized abnormally markedly hypermetabolic lymph nodes in the abdominal retroperitoneum and pelvic mesentery. The largest such focus is seen just anterior to the iliac bifurcation (SUV max = 10.1). This is highly suspicious for tumor such as metastatic breast cancer or conceivably lymphoma.Markedly increased activity involves the anterior vertebral body of L3 (SUV max = 10.1). This activity surrounds apparent methacrylate from vertebroplasty. Given the overall PET/CT appearance, benign postprocedural remodeling / inflammatory activity is favored, although tumor involvement cannot be entirely excluded. Conceivably however, vertebroplasty could have been performed through tumor-involved bone.Linear activity at the inferior endplate of L4 as well is prominent involvement of bilateral L4/5 facets (SUV max = 8.6) is considered more likely benign degenerative although again tumor cannot be entirely excluded. No additional suspicious FDG avid lesion. Focus of activity in the left Port-A-Cath hub represents residual radiotracer. Diffuse mild muscle activity adjacent to both scapulae is also benign inflammation. Focus of increased activity at the left mid cervical facets are benign degenerative. Decreased activity from a prior right occipital craniotomy is also noted. | 1.Multiple markedly hypermetabolic abdominal and pelvic lymph nodes are highly suspicious for tumor. While these may reflect metastatic breast cancer, given the somewhat atypical location, other etiologies such as lymphoma are conceivable.2.Multiple hypermetabolic lumbar spine lesions could conceivably represent tumor but are considered more likely benign unless vertebroplasty was performed through preexistent tumor. Correlation with any pathologic samples which may have been obtained during that procedure would be useful. |
Generate impression based on findings. | 41 year old female with history of left lobular breast carcinoma with axillary nodal involvement status post left lumpectomy in July 2014 followed by chemotherapy and radiation. Patient reports recent swelling, pain, erythema at the site of prior lumpectomy. A targeted left ultrasound was performed for the patient’s area of concern, demarcated by Dr. Chhablani in clinic. There is a complicated fluid collection in the approximate 7 o'clock position of the left breast, along the inframammary fold, immediately subjacent to the lumpectomy scar. Complete measurement is difficult, however this collection measures at least 5.8 cm in transverse dimension. | Complicated fluid collection at the 7 o'clock position of the left breast, subjacent to the lumpectomy scar, measuring at least 5.8 cm, likely representing a seroma with possible superimposed infection.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 84 years, Female. Reason: evaluate G tube placement and for obstruction History: vomiting Gastrostomy tube balloon and tip project over the gastric antrum. There is elevation of the right hemidiaphragm with interposition of bowel loops over the liver. Nonobstructive bowel gas pattern with above average stool burden in the sigmoid colon and rectum. | Gastrostomy tube projects over the gastric antrum. Elevated right hemidiaphragm and interposition of bowel loops over the liver is of uncertain chronicity and current clinical significance. Recommend correlation with diaphragmatic paralysis and right upper quadrant symptoms. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images with tomosynthesis (2/5/15, 2/19/15), ultrasound images (2/19/15), images from ultrasound guided biopsy of right breast (2/25/15), post-procedural right digital mammographic images (2/25/15) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (2/4/14, 2/26/14), ultrasound images (2/26/14) are available. DIGITAL MAMMOGRAPHIC IMAGES WITH TOMOSYNTHESIS (2/5/15, 2/19/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There is a new cluster of calcifications at posterior upper outer quadrant in the right breast. Scattered benign appearing calcifications are seen in right breast. A circumscribed benign mass is present in the right breast at anterior upper outer aspect.In the left breast, circumscribed round masses are present at upper outer quadrant and upper inner quadrant.ULTRASOUND IMAGES (2/19/15):There is an irregular hypoechoic "lesion" with shadowing, measuring 3 x 8 x 8 mm, at 9:00 position, 2 cm from nipple, in the right breast. This "lesion" might be just a shadowing artifact. A few cysts are visualized in the right breast; at 8:00 and 10:00 position. Multiple simple cysts are visualized in the left breast; at 2:00, 3:00 and 9:00 position.Those simple cysts correspond to the circumscribed masses on the mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST (2/25/15):Ultrasound guided biopsy was performed for the right 9:00 lesion. A coil clip was placed after the biopsy.POST-PROCEDURAL RIGHT DIGITAL MAMMOGRAPHIC IMAGES (2/25/15):Per outside radiology report, stereotactic biopsy was performed for the small cluster of calcifications at posterior upper outer quadrant in the right breast, in addition to the ultrasound guided biopsy of right breast.A coil clip from ultrasound guided biopsy is present at anterior 8 - 9 o'clock position, and a dumbbell clip from stereotactic biopsy is present at posterior upper outer quadrant. Per outside report, pathology for stereotactic biopsy included ADH and LCIS, and the pathology of ultrasound guided biopsy was benign. The result of ultrasound guided biopsy is concordant, as the imaging findings suggest an artifactual "lesion". | Biopsy proven ADH and LCIS at posterior upper outer quadrant in the right breast. Multiple cysts in both breasts. No mammographic or sonographic evidence for malignancy in the left breast. BIRADS:4 - Suspicious Abnormality. RECOMMENDATION:X - No Letter. |
Generate impression based on findings. | Female 78 years old; Reason: Patient s/p lap left renal cyst unroofing. Pain near left port site, evaluate for port site hernia, having nausea and vomiting and pain ABDOMEN:LUNGS BASES: Severe calcified coronary artery disease. Heart borderline in size. Small left basilar consolidation/atelectasis.LIVER, BILIARY TRACT: Hepatic calcified granulomata.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild left greater than right adrenal thickening, some of the prior study.KIDNEYS, URETERS: Small fluid/stranding seen at expected level of patient's left-sided renal cyst with small foci of localized air and hyperdensity present, likely postsurgical in etiology. Subcentimeter renal parenchymal lesions seen on prior contrast-enhanced imaging not well visualized.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Scattered foci of pneumoperitoneum, likely related to patient's recently postoperative state. Moderate-sized hiatal hernia. Contrast seen in hernia and in esophagus, may reflect reflux and correlation with patient's clinical history recommended. Findings consistent with small bowel obstruction related to left ventral abdominal hernia. Dilated small bowel, measuring up to 3.1 cm with dilated small bowel seen entering left ventral abdomen and collapsed loop of bowel seen exiting hernia sac, image 77 series 3. No evidence of pneumatosis. Decreased progression of enteric contrast, likely due to patient's small bowel obstruction. Colonic diverticulosis without evidence of acute diverticulitis.PELVIS:UTERUS, ADNEXA: Calcified fibroid uterus. BLADDER: Underdistended bladder, making assessment suboptimal.BONES, SOFT TISSUES, OTHER: Scattered areas of subcutaneous emphysema, particularly in ventral upper and lower abdomen as well as in left abdomen including flank and groin region. Perihepatic and small pelvic ascites. Multilevel degenerative changes of spine. 3 cm fat containing right inguinal hernia. | 1. Findings consistent with small bowel obstruction secondary to left ventral abdominal hernia. Findings discussed with Dr. B. Alberts of urology service at 12:15 p.m. on 3/5/15. 2. Moderate-sized hiatal hernia including partially intrathoracic stomach. Contrast seen in hernia and in esophagus, may reflect reflux and correlation with patient's clinical history recommended. |
Generate impression based on findings. | DCIS.IMAGES: Submitted for interpretation are images from a right breast lymphoscintigraphy labeled Lakeland Medical Center St. Joseph, dated 2/12/15. Several injections are seen to have been made in the right breast. Multiple small foci of activity are noted in the right axilla, consistent with draining sentinel lymph nodes. No additional lymphatic drainage is identified. The supraclavicular, internal mammary, and contralateral left axilla demonstrate no activity. | Multiple sentinel nodes identified in the right axilla. |
Generate impression based on findings. | Some areas are slightly less than optimally distended but between the two views adequate distension is achieved. Moderate residual fluid throughout the colon is weakly tagged. Mild residual mobile particulate fecal matter is identified within the colon. The sigmoid colon and descending colon are tortuous. No polyps > 6 mm or colonic masses are identified. Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny polyps < 5 mm), the presence or absence of which will not change management of the patient.EXTRACOLONIC | No polyps > 6 mm or colonic masses are identified. Abdominal aortic aneurysm measuring 4.8 cm in maximum dimension.Diffuse hepatic steatosis.Findings discussed with Dr. Lissoos (by Dr. Ward) and by myself with the patient including need to address the abdominal aortic aneurysm with comparison to prior exams and follow up.*OPTIONAL C-RADS CLASSIFICATION:C-1E- 3*(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than three 6-9mm polyps or can't exclude >6mm in technically adequate study. Surveillance CTC or colonoscopy recommended.C3: Polyp, possibly advanced adenoma. (polyp >10mm or >three 6-9mm). Colonoscopy recommended.C4: Colonic mass, likely malignant. |
Generate impression based on findings. | Male 62 years old; Reason: evaluate for HCC History: cirrhosis s/p therapsheres ABDOMEN:LUNG BASES: Scattered subcentimeter micronodules, largest measuring 5 mm in the left lung base.LIVER, BILIARY TRACT: Cirrhosis. Nonenhancing segment 7 hypodense lesion previously measuring 3.5 x 3.6 cm, now measures the same (11:23). An additional heterogenous enhancing segment 7 lesion measures 2.8 x 2.6 cm (11:28)previously measuring 2.7 x 2.4 cm (11:25). It is difficult to accurately determine measurement due to the adjacent theraspheres and associated change in enhancement pattern. Cholelithiasis.New 1.4 x 1.3 cm arterially enhancing lesion just anterior to the previous described hypodense lesion (9:22) with washout and an associated mildly dilated biliary duct, suspicious for HCC.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable unchanged prominent scattered gastrohepatic and porta hepatis lymph nodes, the lateral which is enlarged, likely reflective of chronic liver disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable slight buckling of the cortex of the right iliac wing and subcentimeter lytic focus (9:93 and 9:83). OTHER: No significant abnormality noted. | 1.New 1.4 cm hepatic lesion suspicious for HCC. |
Generate impression based on findings. | Female 75 years old Reason: r/o fx History: pain s/p fall 6 months ago- constant LE pain Bone mineralization is normal. Alignment is anatomic. No acute fracture or malalignment.Osteoarthritis affects the knee joint. | No acute fracture. |
Generate impression based on findings. | Female 0 days old Reason: is umbilical line placed properly, eval lung fields History: Term infant on CPAPVIEW: Chest and abdomen AP (two views) 3/5/15 at 1221 hrs UVC terminates at the RA/IVC. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Minimal diffuse lung haziness. No focal lung opacities. No effusions or pneumothorax.Normal abdominal gas pattern. No evidence of obstruction or free air. Minimal to intestinalis or portal venous gas. No ascites. | Minimal diffuse lung haziness, likely TTN.UVC positioning as described. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial abnormality. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended. |
Generate impression based on findings. | Status post fall with right facial bruise. There is no evidence of acute intracranial hemorrhage or mass effect. There is parenchymal volume loss. There is no midline shift or herniation. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is moderate mucosal thickening of the left maxillary sinus. The other imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. Unchanged left parietal sclerotic focus. There is no calvarial fracture. Incidentally noted are bilateral lens implants. | 1. No evidence of acute intracranial hemorrhage or mass effect. No skull fracture. If there is suspicion for maxillofacial fracture, dedicated maxillofacial CT can be obtained.2. Mild chronic small vessel ischemic changes. |
Generate impression based on findings. | Male 65 years old; Reason: restaging scans 18 months post investigational immunotherapy History: hx of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules nonspecific and unchanged, no suspicious lung nodule. No pleural effusion.MEDIASTINUM AND HILA: No enlarged mediastinal or hilar adenopathy. Stable prevascular lymph nodes, including reference lymph node measuring 7 x 4 mm, image 34 series 3, previously measured 7 x 5 mm. Moderate calcified coronary artery disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Punctate calcified splenic granuloma. Splenule present.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Posterolateral to the right kidney is postsurgical sequela including fat necrosis, no definite enhancing soft tissue nodularity seen and appearance is similar to earlier study. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Stable accounting for differences in technique reference left external iliac lymph node, measuring 1.2 x 0.9 cm, previously measured 1.1 x 1 cm. Asymmetric atrophy of left iliopsoas muscle.BOWEL, MESENTERY: Small hiatal hernia.PELVIS:Been hardening artifact from bilateral postsurgical hip hardware makes assessment of pelvic structures suboptimal.PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Spinal fixation hardware with associated artifact, making assessment of adjacent structures suboptimal. Visualized osseous structures stable in appearance with multiple sites of expansile mixed lytic/sclerotic lesions seen, e.g., in sternum/manubrium, ribs and spine and pelvis. Subjectively speaking osseous metastatic disease without significant change, please refer to concomitant nuclear medicine bone scan from same day for additional findings. | 1. Stable exam as above. 2. Please refer to concomitant nuclear medicine bone scan from same day for additional findings. |
Generate impression based on findings. | Tongue cancer. Post induction chemo. Measurements. CHEST:LUNGS AND PLEURA: Stable scattered micronodules, most likely postinflammatory.No suspicious nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: Right inferior T11 vertebral body sclerotic focus, nonspecific, unchanged and likely benign. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No suspicious hepatic lesion. Gallbladder sludge/stones. 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 metastatic disease. |
Generate impression based on findings. | 78 year old female status post left mastectomy in 1990 for breast carcinoma, presents today for routine follow up. Patient received chemotherapy. No current breast complaints. No family history of breast cancer. Three standard 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. Arterial calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 65-year-old with history of benign masses but no new problems. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Stable mass in the right upper breast best seen on the MLO and ML views. Benign intramammary lymph nodes are also noted. Faint residual mass in the right medial breast is not enlarged.Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 78 years old Reason: bilateral knee pain History: bilateral knee pain. Right knee: Bone mineralization is normal. Alignment is anatomic. There is mild to moderate medial compartment joint space loss, moderate extensor compartment joint space loss and tricompartmental osteophytes. No joint effusion. No acute fracture or malalignment.Left knee: Bone mineralization is normal. Alignment is anatomic. There is mild to moderate medial compartment joint space loss, moderate extensor compartment joint space loss, and tricompartmental osteophytes. No joint effusion. No acute fracture or malalignment. Intra-articular loose bodies are noted posterior in the knee. | Moderate bilateral knee osteoarthritis. |
Generate impression based on findings. | History of of prostate cancer with rising PSA level. There is a new small focus of activity in the right fourth posterolateral rib, new from previous. While this could represent a new fracture, it has some features (i.e. wider than tall) of some suspicion for a metastasis. The patient describes a recent fall with pain to the left knee but denies pain around the posterior upper rib. No other suspicious osseous lesions are visualized. Increased activity in the lateral left tibial plateau may be degenerative or post-traumatic in nature. Activity in the superior posterior bladder is a diverticulum as confirmed on recent CT. | A single new right rib lesion is indeterminate and could represent a new fracture or a metastasis. A non-contrast chest CT can be performed for further evaluation. |
Generate impression based on findings. | History of ethesioneuroblastoma and thyroid cancer. Evaluate disease status.RADIOPHARMACEUTICAL: 9.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 114 mg/dL. Today's CT portion grossly demonstrates post-surgical changes of bilateral antrectomies with mucosal thickening of the bilateral maxillary sinuses. There are postsurgical changes in the thyroid bed. Atelectasis/scarring is noted in the left upper lobe. A hypodense right renal lesion likely represents a cyst. There is long segment narrowing, wall thickening, and surrounding inflammatory changes of the descending colon. There is suggestion of a subtle soft tissue lesion in the thecal sac posterior to the sacrum.Today's PET examination demonstrates a large markedly hypermetabolic soft tissue density lesion in the inferior spinal canal/thecal sac extending from the level of L5 to the mid-body of the sacrum. This may represent a drop metastases from ethesioneuroblastoma or other metastatic disease. This was subtly present previously but has increased significantly in size and metabolic activity (max SUV = 48.4, previously 3.9). No additional abnormal foci of FDG activity to suggest tumor elsewhere.There is uniform colonic activity extending from the splenic flexure to the anus consistent with history of inflammatory bowel disease, which is similar to previous.There is a focus of decreased activity in the right inferoanterior medial frontal cortex which is presumably post-therapeutic, unchanged. | Large markedly hypermetabolic mass in the inferior spinal canal from the L5 to mid sacral level is markedly progressed from the previous examination. This is compatible with tumor progression, likely a drop metastasis from ethesioneuroblastoma. Conceivably, but less likely, this could represent a synchronous primary tumor. Further definition of the lesion could be made with MRI. |
Generate impression based on findings. | Personal history of bilateral renal tumors and pulmonary cysts. LUNGS AND PLEURA: Multiple pulmonary cysts distributed throughout the lungs bilaterally.No pneumothorax.Calcified nodules consistent with prior infection.Noncalcified scattered micronodules, likely also post-inflammatory, though special attention should be paid on follow-up scans to confirm stability.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes. No lymphadenopathy.Severe coronary calcification. No pericardial effusion.Nonspecific left thyroid lobe enlargementCHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Refer to separately dictated CT abdomen/pelvis report. | Multiple pulmonary cysts, which given history of multiple renal masses, raises the possibility of Birt-Hogg-Dube syndrome, although lymphangioleiomyomatosis or simple cysts would be more common diagnoses. Scattered micronodules, likely post-inflammatory, special attention on follow-up scans to confirm stability. |
Generate impression based on findings. | History bilateral reduction mammoplasty in 1997 with axillary surgery. History of benign left breast biopsy. No current breast complaints. Family history of breast carcinoma in her sister at age 46 and maternal aunt at age 65. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Left index finger slammed in door. Rule out fracture.VIEWS: Left hand PA, left index finger oblique/lateral (3 views) 03/05/15 Moderate soft tissue swelling is present around the index finger. No fracture is identified. The bones are normal in appearance. | Soft tissue injury. |
Generate impression based on findings. | Adenoma on ultrasound. Just posterior to the inferior right thyroid pole there is a small vague focus of activity which appears to correspond to the thyroid nodularity on ultrasound. This is suspicious but equivocal for a right sided parathyroid adenoma. | Findings suspicious but equivocal for a right sided parathyroid adenoma posteroinferiorly. |
Generate impression based on findings. | Female 71 years old; Reason: 71F with history of bilateral renal masses, s/p LEFT partial nephrectomy; please assess for left sided recurrence and growth of right sided mass History: as above ABDOMEN:LUNG BASES: Mild cystic changes. Stable pulmonary micronodule in the periphery of the left lower lobe (8:7)LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable nonspecific nodular thickening of the left adrenal gland.KIDNEYS, URETERS: Punctate calcifications in both kidneys are likely vascular calcifications. Bilateral hypodensities are too small to actually characterize and could represent small cysts. Status post partial left nephrectomy with expected postsurgical changes. Heterogenous enhancing renal mass in the mid right kidney previously measured 2.3 x 2.3 cm, and today measures 2.7 x 2.7 cm (coronal image 48 compared to prior coronal image 39) RETROPERITONEUM, LYMPH NODES: A few prominent retroperitoneal lymph nodes are not enlarged by size criteria. Moderate calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic/nonvisualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Slight interval increase in size of right enhancing renal mass, suspicious for renal for carcinoma. Status post partial left nephrectomy with expected postsurgical changes. |
Generate impression based on findings. | 90 year old male with history prostate cancer with rising PSA, evaluate for metastatic disease. ABDOMEN:LUNG BASES: Cardiomegaly. Reference right lower lobe subpleural nodule (series 4, image 30) measures 1.0 x 1.8 cm, previously 1.0 x 1.8 cm. Reference left lower lobe/lingular nodule (series 4, image 18) measures 0.6 x 1.0 cm, previously 0.6 x 1.0 cm. Mild basilar atelectasis. Calcified granuloma. No pleural effusions. Mild gynecomastia.LIVER, BILIARY TRACT: Unchanged calcified granulomas in the liver. Unchanged nonspecific hypodensity in the lateral segment of the left lobe.SPLEEN: Calcified granulomas in the spleen.PANCREAS: There is mild relative prominence of the tail of the pancreas which probably represents focal sparing and can be followed on subsequent examinations.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease of the abdominal aorta and its branches. Small retroperitoneal lymph nodes not pathologically enlarged by size criteria and similar to prior.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Scoliosis and severe degenerative changes of the lumbar spine unchanged. No osseous lesions suspicious for metastases. Post surgical changes in the anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate measures 3.4 x 4.7 cm (coronal series, image 47), previously 3.7 x 4.8 cm and contains course calcifications. BLADDER: Superior bladder diverticula and appearance prior.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate left inguinal hernia containing nonobstructed large bowel. No osseous lesions suspicious for metastases. Degenerative changes of the lumbar spine unchanged. | 1.Stable enlarged prostate without specific evidence of new metastatic disease. Nuclear medicine bone scan more sensitive for detection of osseus metastases. 2.Stable nonspecific basilar pulmonary nodules. 3.Moderate left inguinal hernia containing nonobstructed large bowel. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: any evidence of local, regional, or distant recurrence of NSCLC History: prior non small cell lung cancer of the right middle lobe CHEST:LUNGS AND PLEURA: Moderate apical predominant centrilobular emphysema.Right middle lobe necrotic mass measures approximately 59 x 35 mm (series 3, image 51), previously 74 x 35 mm, mildly decreased using similar measurement technique. Surrounding fibrosis and traction bronchiectasis, decreased in prominence from prior, compatible with radiation reaction.Interval resolution of various small pleural effusion, with minimal residual diffuse pleural thickening.No new pulmonary nodules or masses.Left lower lobe bronchiectasis, unchanged.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.Prominent mediastinal lymph nodes, stable to slightly decreased. Reference right paratracheal lymph node measures 10 mm in short axis (series 3, image 32)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: Bilateral renal hypodensities, unchanged, incompletely evaluated on nondedicated imaging, likely benign cystsPANCREAS: 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Mild decrease in right perihilar necrotic mass, with stable to mildly decreased mediastinal lymph nodes.2. No new sites of disease identified. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. Diffuse bone metastases are again noted affecting the axial and proximal appendicular skeleton, including the spine, skull, ribs, pelvis and right proximal femur which are stable. No new lesions are seen. | Diffuse bone metastases without significant interval change and no new lesions. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a stable focal asymmetry in the medial right breast with an adjacent biopsy clip, representing the known fibroadenoma. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 3-year-old male, evaluate healingVIEWS: Right forearm AP and lateral (2 views) 3/5/15 13:38 Circumferential callus formation and periosteal reaction involving the distal radius and ulnar diaphyseal fractures compatible with healing. Alignment is near-anatomic. | Healing both bone forearm fracture in near-anatomic alignment. |
Generate impression based on findings. | Female 68 years old; Reason: lumbar fusion T10-S1 Posterior stabilization rods with screws entering T10, T11, T12, L1, L2, L3, L4, L5, and S1, with decreased scoliosis compared to the prior study. Intervertebral disk spacer devices are present at L1/L2, L2/L3, L3/L4, and L4/L5. No radiographic evidence of hardware complication. Severe degenerative disk disease affects the remaining intervertebral disks.A left total hip arthroplasty is noted, though incompletely visualized. | Postoperative changes of the thoracolumbar spine, as above. |
Generate impression based on findings. | There is herniation of a portion of right medial orbitofrontal gyrus measuring up to 9 mm in width into the right ethmoid air cells through a defect in the right anterior cranial fossa measuring 7 mm. There is mild scattered paranasal sinus mucosal There are multiple prominent arachnoid granulation in the bilateral greater sphenoid wings. There is ptosis of the bilateral lacrimal glands. | Subcentimeter right anterior cranial fossa encephalocele. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. Stable calcified masses are seen in both breasts No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Metastatic thyroid cancer. CHEST:LUNGS AND PLEURA: Diffuse pulmonary metastases, some of which are mildly decreased in size.Reference left upper lobe nodule is 13 mm (5/24), previously 15 mm.Second left upper lobe nodule is 10 x 13 mm (5/26), previously 13 x 14 mm.Right upper lobe nodule is 9 x 10 mm (series 5, image 28), previously 12 x 12 mm.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes, similar to prior.Right hilar lymphadenopathy, not significantly changed.Moderate to severe coronary artery calcification.Mild cardiomegaly with left ventricular enlargement, unchanged. No pericardial effusion.Post surgical findings of total thyroidectomy and neck dissection. Unchanged ill-defined soft tissue along the inferior right carotid sheath, refer to same day CT head/neck report for further details.CHEST WALL: Nonspecific subcentimeter lucency in the T12 vertebral body (series 3, image 93), unchanged.Mild degenerative changes of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 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.Partially calcified lesion in the right lower quadrant mesentery with mild desmoplastic reaction to adjacent bowel loops, unchanged. BONES, SOFT TISSUES: Faint lucency in the left aspect of L1 vertebral body and diffusely in L3 and L4, unchanged.Previously noted right iliac bone lesion is not included in the scan range.OTHER: No significant abnormality noted. | Mild decreased size of some of the diffuse pulmonary metastases. Additional findings, including intrathoracic lymphadenopathy and nonspecific bone lesions, not significantly changed. No new sites of disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Brain: No CT evidence of acute large territorial ischemia. No acute intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. Mild mucosal thickening of the maxillary sinuses bilaterally; otherwise, visualized portions of the paranasal sinuses and mastoid air cells are clear. Head CTA: Moderate atherosclerotic calcifications of the cavernous carotid arteries bilaterally and mild calcifications of the supraclinoid carotid arteries. There is normal contrast opacification through the anterior circulation (bilateral petrous/cavernous/supraclinoid internal carotid arteries, anterior and middle cerebral arteries), posterior circulation (vertebral-basilar, posterior-inferior cerebellar, anterior-inferior cerebellar, superior cerebellar, and posterior cerebral arteries), and distal intracranial vasculature. Common trunk of right PICA/AICA is present. There are no intracranial arterial stenoses, occlusions or aneurysms identified. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema.2. Patent anterior and posterior circulations without significant stenosis of disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | History of metastatic renal cell cancer. Restaging scans 18 months post investigational immunotherapy. There is a stable distribution of multiple foci of increased radiotracer uptake within the manubrium, sternum, right inferior ribs, left superior ribs, bilateral humeri, and mid left tibia. No new lesions are identified.Areas of photopenia in the thoracolumbar spine and hips represent the patient's spinal fixation rods and bilateral hip prostheses, respectively. | Stable multifocal osseous metastases without new lesion. |
Generate impression based on findings. | 49 year old woman with history of end-stage renal disease with innumerable bilateral renal cysts on recent CT, evaluate for malignancy. ABDOMEN:LUNGS BASES: Trace pericardial effusion, similar to prior. LIVER, BILIARY TRACT: Liver measures 18 cm in craniocaudal dimension.SPLEEN: There is an approximately 1 cm low-attenuation lesion in the spleen which is nonspecific.PANCREAS: No significant abnormality notedADRENAL GLANDS: There is nodular thickening of the right adrenal gland measuring 1.2 x 3.2 cm (series 3, image 29) with an internal attenuation < 0 HU compatible with benign adenoma. KIDNEYS, URETERS: Numerous cystic lesions of varying sizes are present in both kidneys, the majority which measure simple fluid. There are, however, several lesions which have an attenuation higher than simple fluid but enhance less than 10 HU. *Right midpole lesion (series 8, image 42)*Right lower pole lesion (series 8, image 53)*Right lower pole lesion (series 8, image 63)*Left midpole lesion (series 8, image 39) Bilateral renovascular calcifications and nonobstructing intrarenal nephrolithiasis, measuring up to 4 mm. Severe atherosclerotic calcifications affects the bilateral renal arteries.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse osseous sclerosis compatible with renal osteodystrophy. | 1.Innumerable renal cysts bilaterally which may reflect acquired cystic disease, most of which are simple benign cysts. There are, however, at least 3 lesions on the right and one lesion on the left which are higher in attenuation than simple fluid but enhance less than 10 Hounsfield units. Favor benign complex cysts, but cannot completely exclude minimally vascular neoplasm and continued follow up is recommended.2.Severe atherosclerotic calcifications of the abdominal aorta and its branches. |
Generate impression based on findings. | Refractory Hodgkin's Lymphoma RADIOPHARMACEUTICAL: 9.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates no definite lymphadenopathy in the neck, chest, abdomen or pelvis. Right chest wall port with catheter extending to the right atrium. Again seen is a stable mixed lytic and sclerotic lesion diffusely involving the T10 vertebra. Scattered lytic osseous iliac lesions are again noted appearing similar to the prior exam.Today's PET examination demonstrates complete resolution of previously hypermetabolic activity in the left neck, bilateral axillae, mediastinum, abdomen and pelvis without convincing FDG avid tumor currently. There is a punctate focus of moderate activity immediately posterior to the right retrocrural region which has an SUVmax of 4.2. This is more prominent than seen previously but is considered more likely of a benign inflammatory etiology. | Essentially complete interval response to therapy without convincing FDG avid tumor currently. Punctate right retrocrural hypermetabolic focus is considered most likely inflammatory but attention can be paid to this region in future follow-up exams. |
Generate impression based on findings. | Elevated calcium and PTH levels. Please assess for parathyroid adenomas. There is heterogeneous uptake of radiotracer in the mid to lower pole of the right thyroid gland which is likely related to known thyroid cancer. There is suggestion of subtle punctate focus of increased activity posterior to the right upper pole which is suspicious for a parathyroid adenoma but equivocal. Alternatively, there is also very subtle activity in the left upper and lower pole regions which may all reflect hyperplasia. | 1. Findings suspicious but equivocal for a parathyroid adenoma posterior to the right upper pole vs parathyroid hyperplasia as described above. 2. Heterogeneous right mid to lower pole uptake is presumably related to known thyroid cancer. |
Generate impression based on findings. | 67-year-old female history of vertigo. Evaluate posterior circulation. Head without contrast: There is no evidence of acute intracranial hemorrhage. There is mild periventricular and subcortical white matter hypoattenuation. The gray-white differentiation is preserved. There is a 6-mm round focus of hypoattenuation in the area of the left medial temporal lobe which likely represents an arachnoid/choroidal cyst. There is no mass effect or midline shift. The basal cisterns are intact. The calvarium and soft tissues are within normal limits. Angiography: There is mild atherosclerotic calcifications of the cavernous carotid arteries bilaterally. There is no evidence of flow limiting stenosis or intracranial aneurysm. The ACOM and PCOMs are intact. The posterior circulation appears unremarkable. | 1. Mild age indeterminant small vessel ischemic disease. If there is clinical concern for acute ischemic infarction, an MRI should be obtained.2. Mild atherosclerotic calcifications of the cavernous carotid arteries bilaterally, but otherwise unremarkable CT angiogram. |
Generate impression based on findings. | Female, 49 years old s/p debridement and distal Propella flap. RFO Trigger: incorrect count. Suspected RFO Location: Abdomen. Suspected RFO: 8 needles missing. Per Dr. Gottlieb, needles were not microneedles. Bilateral percutaneous nephroureterostomy tubes noted. Bilateral nephroureterostomy stents draining to right lower quadrant also noted. Multiple surgical staples in the right upper quadrant and midline pelvis. No unexpected radiopaque foreign bodies. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign bodies. Findings were discussed with microsurgery fellow at 1333 on 3/5/2015. |
Generate impression based on findings. | Reason: SCLC restaging History: restaging LUNGS AND PLEURA: Severe apical predominant paraseptal emphysema.Multilobulated perihilar mass in the left upper lobe is decreased from the prior exam, measuring 3.3 x 2.6 cm (series 7, image 60), previously measuring 4.6 x 3.8 cm. no new pulmonary nodules or masses.Basilar subsegmental atelectasis/scarring. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Moderate coronary artery calcification.Left hilar lymph node measures 12 mm (series 6, image 70), previously 18 mm. Additional smaller mediastinal and hilar lymph nodes appear similar to the prior exam.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. A left adrenal nodule measures up to 2.0 x 1.9 cm (series 6, image 113), previously 2.6 cm. | 1. Interval decrease in size of left upper lobe mass compatible with the known history of small cell lung cancer.2. Mildly decreased hilar lymphadenopathy, and decreased size of a presumed metastatic left adrenal nodule. No new sites of disease identified.3. Severe emphysema. |
Generate impression based on findings. | Bilateral internal jugular veins are well opacified without evidence of thrombus as clinically questioned. The right internal jugular vein is larger than the left, a normal variant. The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified and there is no airway compromise. Previously noted thyroid nodules are better appreciated on the previous sonographic evaluation. The lung apices are clear. There is no clinically significant adenopathy. There are no soft tissue masses. | No evidence of a left internal jugular vein thrombus as clinically questioned. |
Generate impression based on findings. | Male 72 years old; Reason: hx of kidney cancer s/p nephrectomy, now with vomiting x 3 months History: see above ABDOMEN:LUNG BASES: Partially visualized fluid-filled and concentrically thickened distal esophagus is nonspecific. The gastric cardia may also be slightly thickened.LIVER, BILIARY TRACT: Segment 5 hepatic lesion, measuring 1.5 cm is Prevacid characterize as a hemangioma from the prior MRI dated 6/1/2013. Two new subcentimeter hepatic hypodensities (7:25 and 7:41) are too small to accurately characterize, but not definitively seen on prior MRI from 6/11 2012 and most recent comparison contrast and noncontrast CTs.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post left adrenalectomy.KIDNEYS, URETERS: Status post left nephrectomy. No evidence of recurrence within the left renal fossa. No suspicious lesions in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Heterogenous enhancement and mild enlargement of the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: Stable subcentimeter pelvic and retroperitoneal lymph nodes.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of recurrent disease.2.Gastroesophageal wall thickening, and fluid filled esophagus, further described above, are nonspecific, but endoscopy is suggested for further evaluation to exclude neoplastic/infectious process. |
Generate impression based on findings. | 70 years, Male. Reason: eval dobhoff advancement, interval insertion of OGT History: above Dobbhoff tube tip projects over the distal descending duodenum. Orogastric tube tip projects over the gastric body and the sidehole projects over the gastroesophageal junction. Nonobstructive bowel gas pattern with moderate stool burden in the colon. | Dobbhoff tube tip projects over the distal descending duodenum. Orogastric tube tip projects over the gastric body and the sidehole projects over the gastroesophageal junction. |
Generate impression based on findings. | Grade 1 retrolisthesis of L1 over L2. Grade 1 anterolisthesis of L4 over L5. Mild leftward curvature of the lumbar spine. No acute fracture or traumatic subluxation. Vertebral body heights are well-maintained. The visualized intra-abdominal and paraspinal contents are unremarkable.T12/L1: Mild disk bulge without significant central spinal canal stenosis or neural foraminal narrowing.L1/2: Severe disk height loss with endplate degenerative changes on the left. Left lateral osteophyte formation and mild right lateral grade 1 listhesis (series 8030, image 36). Facet arthropathy, lateral and far lateral broad-based disk osteophyte complex results in significant left and moderate right neural foraminal narrowing. No significant spinal canal stenosis.L2/3: Mild disk height loss. No significant neural foraminal or central spinal canal stenosis.L3/4: Mild disk height loss, facet arthropathy, and ligamentum flavum thickening. No significant neural foraminal or central spinal canal stenosis.L4/5: Advanced disk disease with height loss, vacuum disk phenomena, and mild disk bulge. There is a large air bubble in the epidural space along the right paramedian canal, likely vacuum phenomena escaped from the disk space. Mild left lateral displacement of L4 on L5. Moderate facet arthropathy and ligamentum flavum thickening results in moderate right neural foraminal narrowing and mild central spinal canal stenosis.L5/S1: Significant vacuum disk phenomena with vacuum into the left lateral recess. Mild facet arthropathy and ligamentum flavum thickening results in mild to moderate neural foraminal narrowing. No significant central spinal canal stenosis. | 1.Multilevel degenerative changes with no significant central spinal canal stenosis.2.Multilevel neural foraminal narrowing as detailed above. |
Generate impression based on findings. | Female 69 years old Reason: 69 y/o F with FL grade IIIb s/p chemo now with ?evidence of disease. Please reassess History: please compare with previous PET/CT from 12/2014 from OSH to determine whether the abdominal LAD has progressed. Thanks. CHEST: LUNGS AND PLEURA: Bibasilar atelectasis. No suspicious masses or nodules. No pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Normal heart size without pericardial effusion. Mild coronary artery calcifications.Distal esophageal thickening with corresponding increased metabolic activity on prior PET imaging which may represent lymphomatous involvement of the distal esophagus.CHEST WALL: Right chest wall port with tip at the cavoatrial junction.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: Bilateral moderate hydronephrosis, unchanged. Bilateral nephroureteral stents. TheRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Segment of small bowel in the pelvis with significant wall thickening and a narrowed contrast-filled lumen. This segment of bowel likely corresponds to the hypermetabolic focus seen on the PET scan from December 2014 and is suspicious for lymphomatous involvement. The extent of small bowel involvement has increased and measures up to 10 cm in length (series 3, image 49).There is prominent small bowel just proximal to the segment of small bowel with lymphomatous involvement concerning for a partial small bowel obstruction. The narrowed lumen is best visualized on coronal images (series 80252, image 35).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: FemaleUTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New small free fluid in the pelvis. | 1.Findings consistent with lymphomatous involvement of the small bowel which has increased since prior exam from December 2014. Questionable lymphomatous involvement of the thickened distal esophagus.2.Partial small bowel obstruction with prominence of small bowel just proximal to the segment affected with lymphomatous involvement.3.Mild iodinated contrast reaction as detailed above in the Technique section. |
Generate impression based on findings. | 11-year-old female with history of headache and altered mental status. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No mass or mass effect. The basal cisterns are intact. There is moderate mucosal thickening of the right sphenoid sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. The calvarium and scalp are within normal limits. | No evidence of acute intracranial hemorrhage, mass, or mass-effect. |
Generate impression based on findings. | 62 year old female with history of persistent asthma. Evaluate for nasal polyposis. There is a small amount of fluid within the dependent aspect of the right sphenoid sinus with an air-fluid level. The frontal sinuses are under-pneumatized. The remaining paranasal sinuses are clear with atrophic appearing sinonasal mucosa. No evidence of nasal polyps. The ostiomeatal units, frontoethmoidal, and sphenoethmoidal recesses are patent. The mastoid air cells are unremarkable. The orbits are normal. The lamina papyracea are intact. There is no significant nasal septal deviation. | Small amount of fluid within the right sphenoid sinus, but otherwise atrophic appearing sinonasal mucosa without evidence of nasal polyps. |
Generate impression based on findings. | History of MALS syndrome, status post release. Now with persistent abdominal pain. Visually there was significantly delayed gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 75 % of peak activity (normal >70 %)1 hour: 75 % of peak activity (normal 30-90 %) 2 hours: 75 % of peak activity (normal <60 %) 4 hours: 70 % of peak activity (normal <10 %) | Markedly delayed current gastric emptying. |
Generate impression based on findings. | 74 years, Female. Reason: ALS pt having PEG placement, r/o ileus History: ALS pt having PEG placement, r/o ileus Nonobstructive bowel gas pattern. Note that the transverse colon overlies the stomach. Wire closure material projects over the lower abdomen and pelvis. Numerous wires are fractured with migration of some wire fragments into the left hemipelvis as well is in the left upper quadrant. Dystrophic calcifications in the pelvis likely represent uterine fibroids. Vascular calcifications and degenerative changes in the lower lumbar spine noted. | Nonobstructive bowel gas pattern. Note that the transverse colon overlies the stomach. |
Generate impression based on findings. | 58 years, Male. Reason: dobhoff History: dobhoff Dobbhoff tube tip and OG/NG tube tip project over the gastric body. General paucity of bowel gas noted. Numerous drains and tubes project over the abdomen and pelvis. | Dobbhoff tube tip and OG/NG tube tip project over the gastric body. |
Generate impression based on findings. | There is a small left PICA territory hypoattenuation which is new compared to the prior examination but too small to characterize if this is an acute finding. Additional remote small left superior cerebellar stroke. There is a region of encephalomalacia corresponding to the previously noted low attenuation in the left frontal cortex consistent with remote stroke. No acute intracranial hemorrhage, mass, midline shift, or edema. Moderate periventricular and subcortical low attenuation white matter is consistent with age indeterminate small vessel ischemic disease. No change in the prominence of the ventricles and sulci consistent with age-related volume loss. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.New small left PICA territory stroke which is too small to determine for age. If further characterization is needed, MRI examination may be considered.2.No acute intracranial hemorrhage. 3.Left frontal lobe encephalomalacia consistent with remote stroke.4.Findings consistent with moderate small vessel ischemic disease of indeterminate age. |
Generate impression based on findings. | 22 day old male with localized swelling. Evaluate line placement.VIEW: Chest and Abdomen AP (two view) 3/5/3015 12:26 Feeding tube with side port at the GE junction. Right upper extremity PICC tip in the right atrium. ET tube tip at the thoracic inlet. Left upper extremity PICC tip in the cephalic vein.Cardiothymic silhouette is normal. Coarse bilateral pulmonary opacities unchanged likely atelectasis and PIE. No pleural effusion or pneumothorax.Disorganized bowel gas pattern. Inguinal hernia is noted. | 1. Bilateral pulmonary opacities unchanged.2. ET tube at the thoracic inlet. Feeding tube with side port at the GE junction. |
Generate impression based on findings. | 40 years, Male, Reason: SCLC restaging History: SCLC restaging. ABDOMEN:LUNG BASES: For findings in the lung, please see dedicated chest CT performed on the same day.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: There is diffuse pancreatic hypoattenuation with minimal adjacent fat stranding. This corresponds to diffuse hyperactivity on recent PET. No focal lesions are identified.ADRENAL GLANDS: Left adrenal mass measures 2.6 x 2.4 cm.KIDNEYS, URETERS: Left hepatic hypodensity is too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Hypermetabolic node seen on prior PET is not well visualized and may be obscured by collapsed bowel loops.There is a small implant along the anterior peritoneum (9/47) which is hypermetabolic on PET and suspicious for carcinomatosis. There may be some additional soft tissue inferior to this (9/54) which was avidly hypermetabolic on PET.Nodules are also seen in the right paracolic gutter and adjacent to the spleen. Peri-splenic nodule measures 1.1 x 0.9 cm for reference (9/36).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Enlarged presacral node measures 1.3 x 1.1 cm (9/116), previously 1.2 x 1.3 cm. Left internal iliac node measures 1.5 x 1.0 cm (9/110), previously 1.5 x 1.1 cm. Prominent node in the left inguinal region is unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Left adrenal lesion, suspicious for metastases.2.Pelvic lymphadenopathy.3.Peritoneal implants are suspicious for carcinomatosis.4.Diffuse pancreatic hypoattenuation corresponding to diffuse increased activity on PET may represent pancreatitis versus diffuse infiltration of tumor.5.For findings in the lung, please see dedicated chest CT performed on the same day. |
Generate impression based on findings. | Shortness of breath. PULMONARY ARTERIES: Large saddle pulmonary embolus extending into the bilateral main pulmonary arteries and all lobar branches. Extension into many segmental and subsegmental arteries. The main pulmonary artery is upper normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Mild basilar subsegmental atelectasis/scarring. Mild dependent atelectasis. No focal airspace consolidation. No pleural effusion.MEDIASTINUM AND HILA: The heart is mildly enlarged, without significant pericardial effusion. There is evidence of right heart strain, with maximum right ventricular diameter of 5.7 cm and maximum left ventricular diameter is 3.1 cm. 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. Left renal cysts. | Large saddle pulmonary embolus extending into the bilateral main pulmonary arteries and all lobar branches and multiple segmental branches. Findings compatible with right heart strain. No specific evidence of pulmonary infarct.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Positive. Findings discussed via telephone with Dr Sabir, the ordering provider, at 2:50 PM |
Generate impression based on findings. | 25-day-old male with abdominal distention. Evaluate bowel gas pattern. VIEW: Chest and Abdomen AP (two view) 3/5/2015 12:52 ET tube tip at the thoracic inlet. Feeding tube with side port at the GE junction. Interval removal of UVC catheter. Mediastinal clips unchangedCardiothymic silhouette is normal. Large lung volumes with multifocal patchy opacities are unchanged. No pleural effusion or pneumothorax.Disorganized nonspecific bowel gas pattern. No free air. | 1. Multifocal patchy pulmonary opacities unchanged. Disorganized nonspecific bowel gas pattern. 2. ET tube tip at the thoracic inlet. Feeding tube with side port at the GE junction. |
Generate impression based on findings. | 58 year old female who has a complaint of palpable abnormality within the right breast in July 2014, demonstrated to be oil cysts on sonographic examination, presents for follow-up right breast ultrasound and routine annual bilateral mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of two oil cysts within the upper central to inner right breast, unchanged from prior examination. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | Stable oil cysts within the upper central to inner right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable minimal chronic small vessel ischemic changes. A small focal area of low density in the anterior limb of the right internal capsule has decreased in conspicuity likely represents a chronic area of ischemia. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial hemorrhage. Stable mild chronic small vessel ischemic changes. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended. |
Generate impression based on findings. | Female 36 years old; right knee pain and popping. Foot drop and pain. RIGHT KNEE: No fracture or malalignment is present. No significant degenerative changes are noted. No joint effusion is evident.RIGHT FOOT: The bones appear demineralized. The distal aspect of the great toe distal phalanx is irregularly marginated, likely secondary to prior erosions/osteomyelitis seen in 2013. However, given the apparent soft tissue swelling about the great toe, this may reflect ongoing osteomyelitis in the appropriate clinical setting. Deformity at the base of the fifth metatarsal likely reflects old trauma. No acute fracture or dislocation is present.LEFT FOOT: The bones appear demineralized. Moderate hallux valgus deformity is again noted. No fracture or dislocation is present. The lucency in the lateral cuneiform is unchanged since 2013 and likely benign. | 1. Irregular margins of the right great toe distal phalanx, which may reflect prior erosions/osteomyelitis seen in 2013. However, given the apparent soft tissue swelling about the great toe, this may reflect ongoing osteomyelitis in the appropriate clinical setting. 2. No specific findings in the right knee or left foot to account for the patient's pain |
Generate impression based on findings. | Bilateral profound sensorineural hearing loss . Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. There is perhaps mild stenosis of the round window. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There is mild plagiocephaly and an arachnoid cyst in the right cerebellomedullary angle cistern. | 1. Perhaps mild stenosis of the round window, which is of indeterminate significance. Otherwise, no evidence of bony inner ear anomalies.2. RIght cerebellomedullary angle cistern arachnoid cyst. |
Generate impression based on findings. | One day old male with increased FiO2 requirements, desaturation. Evaluate lung fields or evidence of worsening pneumothorax.VIEW: Chest and abdomen AP (two views) 3/5/2015 13:05 Esophageal temperature probe is noted. ET tube tip at the thoracic inlet. Feeding tube tip in the stomach. UAC tip unchanged. UVC tip in the IVC. Bladder foley catheter is present. Cardiothymic silhouette cannot be assessed due to overlying pulmonary opacities. Complete opacification of the left hemithorax and near complete opacification of the right hemithorax likely a combination of atelectasis and pleural effusion. No pneumothorax.Centralization of the bowel loops consistent with ascites. Disorganized nonspecific bowel gas pattern.Transverse fracture of the proximal diaphysis of the left humerus is again noted. | Bilateral atelectasis and pleural effusions with abdominal ascites raise the question of fluid overload. |
Generate impression based on findings. | 68-year-old female with history of recurrent sinusitis. There are postoperative changes of bilateral ethmoidectomy, bilateral uncinectomy/antrostomies, bilateral anterior maxillary wall defects and right inferior turbinate resection. There is mild mucosal thickening of the remaining ethmoid air cells. There is moderate to severe mucosal thickening of the maxillary sinuses appearing similar to prior. The surrounding bones of the paranasal sinuses are thick and sclerotic suggestive of longstanding sinus disease. There is a small nasal septal defect. The lamina papyracea are intact. The orbits are unremarkable. | 1. Moderate to severe mucosal thickening of the maxillary sinuses with adjacent osseous findings suggestive of chronic sinus disease.2. Extensive postoperative changes of the paranasal sinuses as above. |
Generate impression based on findings. | Syncope and left leg weakness No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is hypoattenuation involving the left frontoparietal centrum semi-ovale and corona radiata compatible with chronic infarcts, as seen on prior MRI dated 10/31/2012. There is global parenchymal volume loss, which is prominent for age. No extra-axial collections. There are moderate areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic disease. More focal areas of hypoattenuation in the bilateral basal ganglia are compatible with small lacunar infarcts. There are prominent vascular calcifications involving the bilateral internal carotid and the distal vertebral arteries.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Chronic small vessel ischemic disease with lacunar infarcts in the basal ganglia. Chronic infarcts involving the left frontoparietal corona radiata and centrum semi-ovale also noted. Of note, prior MRA from 2/6/2013 demonstrates chronic occlusion of the left internal carotid artery. |
Generate impression based on findings. | 49-year-old female with intermittent epigastric pain, evaluate for obstruction/adhesions The scout radiograph demonstrated a biliary drain in the right upper quadrant. Scattered, mildly dilated small and large bowel loops with air-fluid levels. Amorphous stool is noted in the descending colon. Evaluation of small bowel showed diffuse dilation of small bowel with decreased peristalsis (cine series 17). In the right lower quadrant, likely distal ileum, there is a fixed, angulated loop of small bowel. In this area, there is an approximate 7-cm segment of small bowel, likely distal ileum, with an irregular contour along the mesenteric aspect suggestive of additional adhesive disease (series 11, 12).Transit time to the terminal ileum was 3 hours and 30 minutes. Spot films of the terminal ileum were within normal limits. The terminal ileum and ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 9:44 minutes | Diffuse dilation of small bowel without a notable transition point. Partially obstructive adhesive disease in the right lower quadrant with pain on palpation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 64 years old; Reason: evaluate for distal fibula fracture. Again seen is the nondisplaced spiral fracture of the distal fibula, which appears similar to the prior study. The medial and lateral aspects of the ankle mortise appear normal. These soft tissue swelling about the ankle is minimally decreased. | Right fibular fracture, as above. |
Generate impression based on findings. | There are lobulated areas of intrinsic T1 hyperintensity which appear overall similar to the prior exam along the posterior inferior margin of the left thalamic known AVM. This is consistent with embolic material. There is slight decreased extent of irregularly shaped intrinsic T1 hyperintensity at the level of the atrium as seen on 601/14 is compared to prior outside 6/14. Overall, there appears to be decreased number of tiny flow-voids in the region of the left sided AVM, although there is significant increased extent of T2/FLAIR hyperintensity within the adjacent white matter, extending towards the internal and external capsule on the left as well as the mesial left temporal lobe. FLAIR hyperintensity extends caudally into the left dorsal lateral midbrain. There is again prominence of the draining vein extending medially with an enlarged internal cerebral veins bilaterally, although with decreasing caliber since previous outside exam.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA Head: Images are severely degraded by inflow artifact. In addition, a rarely used high resolution sequence MRA of the whole head was utilized rather than the usual 3-D time-of-flight MRA given the history of AVM.There has been interval decrease in overall size of the AVM nidus within the posterior body of the left lateral ventricle. For example, this component of the AVM measured 1.5 x 2.2 cm in greatest axial dimensions, now measuring 1.1 x 1.7 cm. There is also overall decreased degree of flow related enhancement in the left posterior lateral thalamic component of the AVM. A small artery originating near the expected origin of the left PCOM is again seen coursing towards the left mesial temporal AVM nidus, although overall decrease flow related enhancement in this location as well. The left posterior cerebral artery remains asymmetrically enlarged.The intracranial internal carotid arteries are grossly normal in course and caliber, with poor flow related enhancement along the distal internal carotid arteries which likely is artifactual. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise grossly normal in course and caliber. There is no evidence of high-grade stenosis or large aneurysm. | 1. Interval significant increased extent of perinidal vasogenic edema extending into the left internal and external capsules as well as the mesial left temporal lobe white matter, although overall nidal dimensions are clearly decreased. Findings may relate to interval change in venous drainage/thrombosis associated with the AVM and subsequent venous congestion.2. Suboptimal MRA secondary to technical factors, overall demonstrating decreased flow-related enhancing vessels in the area of the left posterior thalamic AVM extending to the mesial left temporal lobe. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Diffuse benign calcifications are unchanged in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 79 years old; Reason: S/p Rt TKA Two views of the right knee demonstrate hardware components of a right total knee arthroplasty device situated in near-anatomic alignment. There is no radiographic evidence of hardware complication. Skin staples, surgical drain, and foci of soft tissue gas reflect recent surgery. | Right total knee arthroplasty. |
Generate impression based on findings. | Female 77 years old; Reason: right knee pain Moderate osteoarthritis affects the right knee with tricompartmental joint space narrowing and osteophytes, similar to the prior study. A large right knee joint effusion is present.Moderate osteoarthritis affects the left knee as seen on frontal views. | Osteoarthritis, as above |
Generate impression based on findings. | 57-year-old female with history of headache. There is no evidence of acute intracranial hemorrhage. The gray white differentiation is preserved. The basal cisterns are intact. There is no mass or mass effect. There is a small osteoma within the right frontal sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. The calvarium and soft tissues are within normal limits. | No evidence of acute intracranial hemorrhage, mass or mass effect. |
Generate impression based on findings. | Head CT: There are multiple supratentorial and infratentorial metastatic lesions, some of which are essentially stable in size and some of which have grown since December 2014. No new discrete lesions are identified. Low attenuation surrounding the largest lesion in the left paracentral lobule consistent with vasogenic edema has also slightly increased. There is no midline shift. The ventricles are unchanged in size. The calvarium is intact. There is mild leftward nasal septal deviation with a spur. There is a right lens implant.Neck CT: There are postoperative findings related to total thyroidectomy and neck dissection. There is unchanged ill-defined soft tissue along the inferior right carotid sheath and in the region of the thyroidectomy bed. Otherwise, there is no evidence of new mass lesions or significant cervical lymphadenopathy. The salivary glands are unchanged. The right internal jugular vein is partially absent. There is degenerative cervical spondylosis. The airways are patent. Numerous nodules are present within the partially imaged lungs. | 1. Multiple intracranial metastases, some of which have increased slightly in size. Please refer to the concurrent brain MRI brain for additional details. 2. Stable postoperative findings related thyroidectomy and neck dissection with persistent ill-defined soft tissue along the inferior right carotid sheath, which may represent residual tumor and/or treatment effects. 3. Multiple lung metastases are partially imaged. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Fracture Again seen is a nondisplaced oblique fracture of the distal aspect of the little finger proximal phalanx. The fracture line is less distinct, indicating some interval healing. | Healing fifth finger fracture, as above. |
Generate impression based on findings. | Female 50 years old Reason: sl fixation History: pain and stiff. Three views of the right wrist show an orthopedic screw traversing the scaphoid and lunate bones without radiographic evidence of hardware complication. Suture anchors overlying the first metatarsophalangeal joint are compatible with prior ligamentous repair, and unchanged from the prior exam. A discrete cortical cyst of the distal lateral radius appears unchanged from prior exam. There is no acute fracture or dislocation. Mild arthritic changes with narrowing of the basilar joint appear unchanged from the prior exam. | Scapholunate fixation without radiographic evidence of hardware complication. |
Generate impression based on findings. | 5 year old female with headaches, occasional vomiting. History of VP shunt Delta valve. Evaluate connections.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 3/5/2015 14:23 Right posterior parietal ventriculoperitoneal shunt with tip projecting into the frontal horn of the lateral ventricle. The shunt catheter exits the skull and courses through the subcutaneous tissues along the right lateral neck, right hemithorax and coursing along the left hemi abdomen abdomen with catheter tip coiling in the right upper quadrant and terminating in the right lower quadrant. No evidence of kinking or discontinuity is visible in the radiopaque portions of the catheter.Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax.Moderate to large amount of colonic stool burden. Nonobstructive bowel gas pattern. | No evidence of shunt malfunction. |
Generate impression based on findings. | Male 65 years old Reason: pre-op History: pain There is severe medial compartment joint space narrowing with bone on bone apposition. There are tricompartmental osteophytes. No joint effusion, acute fracture.Mechanical axis of the left knee is 13 degrees of varus.In the right knee there is severe medial compartment joint space narrowing. | Severe left knee osteoarthritis and mechanical axis as detailed above. |
Generate impression based on findings. | Male 28 years old; Reason: left knee pain There is no fracture or malalignment. No degenerative changes are seen. No joint effusion is evident. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | Male 56 years old Reason: right sided back pain, hx of smoldering multiple myeloma, r/o myelomatous lesions History: right sided back pain Thoracic spine: The bones are demineralized. There is a mild scoliosis. No acute compression fracture is evident.Lumbar spine: The bones are mildly demineralized. There are mild degenerative facet changes of the lower lumbar spine. No acute compression deformity. | No acute compression deformity. If pain persists consider MRI. |
Generate impression based on findings. | Female 54 years old Reason: 54 y/o GastroEsophageal Ca, on chemo. Compare to prior. History: see above CHEST:LUNGS AND PLEURA: Calcified and noncalcified micronodules, unchanged.No pleural effusions. No suspicious nodules or masses.MEDIASTINUM AND HILA: Redemonstrated is asymmetric thickening of the distal esophagus consistent with the patient's known history of esophageal cancer. The esophageal stent has migrated distally and now lies within the gastric body and antrum. No evidence of perforation. Oral contrast progresses past the stent, without evidence of obstruction. The heart size is normal without pericardial effusion. CHEST WALL: Left chest wall port with tip at the cavoatrial junction. Again seen is a haziness adjacent to the distal esophagus with a cluster of gastrohepatic ligament nodes, which do not meet the size criteria for lymphadenopathy. However, the lymph nodes are metabolically active on recent PET scan and are again worrisome for metastatic disease (series 3, image 72). ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating hepatic lesions are most consistent with simple hepatic cysts and were not were not metabolically active on the most recent PET examination from 1/9/2015.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference peri-pancreatic lymph node measures 0.8 x 1.9 cm (series 3, image 81) previously 0.9 x 2.0 cm. Scattered subcentimeter retroperitoneal lymph nodes do not meet the criteria for lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate degenerative changes of thoracolumbar spine.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered pelvic lymph nodes do not meet the size criteria for lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Asymmetric thickening of the distal esophagus consistent with the patient's known history of esophageal cancer2.Interval migration of the esophageal stent into the gastric body/antrum. No evidence of gastric perforation or obstruction.3.Cluster of stable gastrohepatic ligament nodes continue to be suspicious for regional metastatic disease. No new sites of suspected metastatic disease.Findings regarding the migration of the esophageal stent were discussed by telephone with Dr. Polite at 4:45 p.m.. on 3/5/2015. |
Generate impression based on findings. | Female 56 years old Reason: fell on the ice History: rule out fracture. There is anterior wedging of the T12 vertebral body and superior end plate depression of the L4 vertebral body which may represent compression fractures of indeterminate age. Tiny anterior vertebral body osteophytes are seen at L2 and L4. | Compression fractures of indeterminate age. Cross-sectional imaging is recommended for further evaluation. |
Generate impression based on findings. | 6-year-old male status post NG tube placement, unable to flushVIEW: Abdomen AP (one view) 3/5/15 14:39 NG tube side port in the distal thoracic esophagus. A VP catheter is coiled in the right upper quadrant. Cystostomy and Foley catheter tips in the bladder. Catheter overlying the right lower quadrant likely represents a cecostomy catheter.The bowel gas pattern is nonobstructive. | Misplaced NG-tube. |
Generate impression based on findings. | Female 71 years old Reason: pre-op History: pain Osteoarthritis affects the right knee with osteophytes. The mechanical axis is 4 degrees of varus | Mechanical axis as detailed above |
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