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Generate impression based on findings. | 51 year old female status post left lumpectomy in 2005 for HER-2 positive invasive ductal carcinoma with DCIS,presents today for routine follow up. Patient received radiation and chemotherapy. No current breast complaints. Family history of breast carcinoma in her maternal aunt and cousin. 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. A linear marker has been placed on the scar overlying the left breast with expected underlying postsurgical changes and volume loss of the central outer aspect of the breast. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae, including the partially calcified nodes within the left axilla, likely related to treatment effect. | Stable postsurgical changes of the left 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.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 79 years old Reason: Evaluate for degenerative changes. Worsening pain left SI joint past year or two. History: Worsening pain left SI joint past year or two. Bone mineralization is slightly decreased. There are mild to moderate osteoarthritic changes in the SI joints, left greater than right. There is sclerosis and minimal osteophyte production.There are degenerative changes of the lower lumbar spine. | Osteoarthritis of the sacroiliac joints. |
Generate impression based on findings. | Cervical stenosis on MRI, assess bony anatomy The cervical vertebral bodies are appropriate height. Alignment is maintained. No fractures are identified in the cervical spine. No suspicious bony lesions are identified in the cervical spine. There is evidence of diffuse idiopathic skeletal hyperostosis with bulky anterior flowing osteophytes from C3 to C7 with relative preservation of intervertebral disk spaces. There is evidence of calcification involving the posterior longitudinal ligament at the C5 level. There are small disk osteophyte complexes at C2-C3, C3-C4, C4-C5, C5-C6, C6-C7 as well as ligament of flavum thickening at these levels which are better seen on prior MRI from 8/11/2014.Individual levels as below:C2-3: There is mild spinal canal stenosis related to disk osteophyte complex and ligamentum flavum thickening. There is no significant neural foramina stenosis.C3-4: There is moderate spinal canal stenosis related to disk osteophyte complex. There is mild bilateral neural foraminal narrowing related to uncovertebral hypertrophy. C4-5: There is disk osteophyte complex with moderate to severe spinal canal stenosis. There is moderate right and mild to moderate left neural foraminal narrowing related to uncovertebral hypertrophy.C5-6: There is ossification of the posterior longitudinal ligament and disk osteophyte complex. There is moderate spinal canal stenosis. There is mild left neural foramina stenosis and and no significant right foraminal narrowing.C6-7: There is disk osteophyte complex with mild narrowing of the spinal canal. There is mild left neural foramina narrowing. No significant right neural foramina narrowing.C7-T1: There is moderate bilateral neural foramina stenosis related to facet arthropathy. There is minimal anterolisthesis. No significant spinal canal stenosis.There is evidence of facet arthropathy at multiple levels, relatively worse at the C7-7 T1 level where there is moderate bilateral neural foramina stenosis. | 1. Multilevel degenerative changes in the cervical spine as detailed above. There are multilevel disk osteophyte complexes, with at least moderate spinal canal stenosis at C3-C4, C4-C5, and C5-C6, better appreciated on prior MRI.2. Evidence of diffuse idiopathic skeletal hyperostosis. There is also ossification of the posterior longitudinal ligament at the C5 level. 3. Neural foramina narrowing relatively worst at the C7-T1 level where there is up to bilateral moderate foraminal narrowing related to advanced facet arthropathy. |
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. 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. | 13-year-old male status post physeal bar resection Interval osteotomy with a defect extending through the majority of the physeal bar. There are small foci of residual bridging adjacent to the resection cavity as well as lateral to the osteotomy cavity. Gas is noted in the soft tissues, compatible with recent surgery. | Interval osteotomy removing the majority of the sclerotic physeal bar with small foci of residual bridging adjacent to the cavity as well as lateral to the cavity as described above. |
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. Stable benign intramammary lymph nodes are present in the left upper outer quadrant. 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. | Male 75 years old; Reason: 75 yo male with hx of liver resection for HCC; ultrasound shows liver nodule; please do CT liver triphasic and please evaluate for abnormalities and/or recurrence History: HCC ABDOMEN:LUNGS BASES: Evaluation of lung bases demonstrate areas of bibasilar scarring and peripheral fibrosis.LIVER, BILIARY TRACT: Diffuse hepatic steatosis. At site of postoperative defect at level of right hepatic dome are multiple radiodensities likely iatrogenic. Alongside postoperative defect medially is wedge-shaped area of increased attenuation with numerous superimposed small arterially enhancing nodules. Additional multiple arterially enhancing foci are seen in both hepatic lobes. These were not present on the prior study. Reference focus seen adjacent to gallbladder fossa in hepatic segment 5, measuring 1.2 x 0.9 cm on image 39 series 9. On portal venous and delayed phases of imaging the aforementioned arterially enhancing foci become isodense to the background liver, no definite associated washout seen. Previously described wedge-shaped area medial to the surgical cavity remains relatively increased in attenuation on the subsequent delayed phase imaging, likely reflecting vascular injury secondary to prior surgery. Main right and left portal veins patent. Visualized hepatic veins patent. No definite evidence of cirrhosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement. RETROPERITONEUM, LYMPH NODES: Stable mild upper abdominal/periceliac and portacaval lymphadenopathy. Reference lymph node measuring 2.1 x 1.2 cm on image 40 series 9, previously measured 2.1 x 1.2 cm. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal postsurgical changes. | 1. Numerous new arterially enhancing bilobar hepatic foci as described, differential considerations include regenerative nodules (particularly in wedge shaped area alongside postsurgical defect alluded to above) but considering patient's history of HCC resection and nodular configuration of the lesions, findings are worrisome for multifocal malignancy or dysplastic nodules, perfusional defects considered less likely. Further evaluation with dedicated contrast enhanced MRI recommended for better characterization. 2. Stable mild lymphadenopathy, may be reactive in etiology. |
Generate impression based on findings. | 63 years, Male. Reason: 63 y/o dermatomyositis s/p g tube, concern for ileus History: not tolerating tube feeds Gastrostomy tube balloon projects over the gastric fundus near the gastroesophageal junction. Cholecystectomy clips noted. Nonobstructive bowel gas pattern with moderate stool burden in the rectum. | Gastrostomy tube balloon projects near the gastroesophageal junction. If there is concern for gastrostomy tube tip location, enteric contrast can be injected into the G tube and AP and lateral views can be obtained. |
Generate impression based on findings. | 45 years, Female. Reason: Pancreatic pseudocysts s/p cystogastrostomy tube placement and NJT with nausea/vomiting/diarrhea and abdominal cramping. Please evaluate for NJT placement, ileus/partial obstruction. History: As above NJ tube tip extends past the ligament of Treitz. Cyst gastrostomy tube noted. Suture material projects over the right upper quadrant. Mild centralization of bowel loops compatible with ascites. Nonobstructive bowel gas pattern. | Enteric feeding tube tip extends beyond the ligament of Treitz. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Scoliosis.VIEWS: Spine standing PA, spine right lateral bending, spine left lateral bending (3 views) 03/05/15 Right curve between T3 and T12 measures 55 degrees. Left curve between L1 and L5 measures 31 degrees. With right lateral bending the right curve decreases to 40 degrees. With left lateral bending the left curve decreases to 13 degrees.A moderate amount of feces is seen in the rectosigmoid and in the ascending colon. | Right thoracic and left lumbar curves with right curve decreasing from 55 degrees to 40 degrees with right lateral bending. |
Generate impression based on findings. | Male 67 years old Reason: prostate cancer and liver cancer History: please compare with last scans CHEST:LUNGS AND PLEURA: Mild dependent atelectasis. No pleural effusions. No suspicious nodules or masses. MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No significant hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Given the difference in technique between this single phase study and the previous liver protocol studies, the liver dome mass is stable to slightly decreased size. The liver dome mass measures 2.4 by 3.7 cm (series 3, image 69), previously 2.6 x 3.4 cm. The lesion measures 2.0 cm on coronal images (series 80240, image 52) previously 2.6 cm. There is redemonstration of surrounding liver morphology with nodular surface contour and widening of hepatic fissures. There is an additional hypodense lesion which are unchanged. There is increased heterogeneity of the liver, most prominent in the right lobe which is similar to prior exam.SPLEEN: Spleen size is at the upper limit of normal measuring up to 13 cm.11 orPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes not meeting size criteria for lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Right hip arthroplasty. Unchanged sclerotic lesions of the right pubic symphysis, and the T1, T7, L5 vertebral bodies.OTHER: No significant abnormality notedPELVIS: Male. Beam hardening artifact from right hip arthroplasty limits evaluation of pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Questionable bladder wall thickening. Correlate clinically for evidence of cystitis.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: See abdomen section.OTHER: No significant abnormality noted | 1.Stable to mild decrease in size of the hepatic dome lesion given the single phase imaging. Recommend subsequent surveillance follow-up with dedicated liver protocol imaging.2.No new hepatic lesion identified.3.No new osseous lesions. |
Generate impression based on findings. | 78 years, Female. Reason: ngt placement History: ngt placement Dilated loops of small bowel measuring up to 3.4 cm not significantly changed since the prior exam. Interval placement of NG tube with tip projecting over the proximal gastric body. | Persistent small bowel dilatation compatible with small bowel obstruction. |
Generate impression based on findings. | Male 53 years old Reason: bilateral knee pain History: bilateral knee pain Right knee: Bone mineralization is normal. Alignment is anatomic. There are very tiny medial compartment osteophytes.Postsurgical changes, partially imaged with an IM nail with proximal interlocking screws. There is a healed fibular fracture.Calcification is noted within the quadriceps tendon. No joint effusion.Left knee: Bone mineralization is normal. Alignment is anatomic. There is moderate medial compartment joint space loss and small tricompartmental osteophytes. No joint effusion. Postsurgical changes with an IM nail and proximal interlocking screws affixing a tibial fracture, partially imaged.There is calcification in the quadriceps tendon. | Mild right, moderate left knee osteoarthritis. |
Generate impression based on findings. | Female 66 years old; Reason: Patient with recent fall and increased right shoulder pain, weakness Mild to moderate osteoarthritis affects the shoulder. There is no fracture or malalignment. | Osteoarthritis. |
Generate impression based on findings. | Knee pain Moderate osteoarthritis affects the right knee with small osteophytes, similar to prior. A possible small joint effusion is present.Moderate osteoarthritis affects the left knee, as seen on frontal views. | Moderate osteoarthritis, similar to prior. |
Generate impression based on findings. | Reason: Para-pneumonic process History: Chest pain LUNGS AND PLEURA: Small right pleural effusion and basilar atelectasis. Round, somewhat nodular opacities along the posterior right pleural surface have an appearance compatible with rounded atelectasis.Additional scattered benign appearing micronodules.The left lung is clear.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.Scattered small mediastinal and hilar lymph nodes. No lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Punctate, nonobstructing left renal calcification. | Small right pleural effusion. Round, opacities along the posterior right pleural surface have an appearance compatible with rounded atelectasis. 6 - 12 month imaging followup is recommended to ensure stability. |
Generate impression based on findings. | Right total hip arthroplasty revision. The right total hip arthroplasty device is situated in near-anatomic alignment, without radiographic evidence of hardware complication. Surgical drain and overlying devices reflect recent surgery.Degenerative arthritic changes are present in the visualized lower lumbar spine. Marked osteoarthritis affects the left hip, as seen on the frontal view. | Right total hip arthroplasty. |
Generate impression based on findings. | 46 years, Female. Reason: s/p ureteral stent removal History: location of ureteral stent s/p kidney transplant Interval removal of abdominal drains and right pelvic nephroureterostomy stent. Nonobstructive bowel gas pattern. | Interval removal of abdominal drains and nephroureterostomy stent. |
Generate impression based on findings. | 57 years, Female. Reason: dilated bowel History: diffuse tenderness Nonobstructive bowel gas pattern. Less than average stool burden in the colon. | Nonobstructive bowel gas pattern without findings to account for patient's pain. |
Generate impression based on findings. | Lung cancer status for CRT. Evaluate response. CHEST:LUNGS AND PLEURA: Right upper lobe mass inseparable from the mediastinal and apical pleural surface with new internal air bronchograms is significantly smaller. It measures 33 x 36 mm, previously 55 x 61 mm (series 5, image 21). Faint ground glass opacities around the mass and bilateral paramediastinal regions likely represents post-radiation change.Trace right apical pneumothorax has resolved.Calcified nodules consistent with healed prior infection. Noncalcified scattered micronodules, unchanged and likely post-inflammatory.MEDIASTINUM AND HILA: Decreased size of the mediastinal and right hilar lymphadenopathy. Reference right hilar lymph node is 17 mm (series 4, image 36), previously 23 mm.Normal heart size with trace focal anterior pericardial fluid.Moderate coronary calcification.Nonspecific unchanged thyroid nodules.CHEST WALL: Minimal degenerative changes of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No suspicious hepatic lesion. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Punctate nonobstructive left kidney stone.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy. Calcified atherosclerotic disease of the aorta without aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Significantly decreased size of right upper lobe primary lung malignancy and intrathoracic lymphadenopathy. No new sites of disease. |
Generate impression based on findings. | Male 72 years old Reason: knee djd? History: pain creps valgus Right knee: Bone mineralization is normal. There is genu valgus. There is severe right knee osteoarthritis with bone on bone apposition and tricompartmental osteophytes. There is a small joint effusion.Left knee: Bone mineralization is normal. There is genu valgus. There is severe left knee osteoarthritis with bone on bone apposition and tricompartmental osteophytes. No significant joint effusion.No acute fracture. | Genu valgus and severe bilateral knee osteoarthritis |
Generate impression based on findings. | History of metastatic renal cancer. There is pathological fracture with near complete collapse of the C6 vertebral body with approximately 6 mm retropulsion into the spinal canal and associated severe spinal canal stenosis with apparent increase of the angular kyphosis. The associated soft tissue component appears to be unchanged, accounting for differences in technique. There is extension into the left C4-5 and C5-6 neural foramina and epidural space. The soft tissue component extends into the prevertebral space and along the course of the left brachial plexus. There is also no significant change in the lytic lesion in the C7 vertebral body. There is persistent diffuse sclerosis in the rest of the imaged axial skeleton. There is redemonstration of multiple thyroid nodules. The major salivary glands are unremarkable. There is no evidence of significant cervical lymphadenopathy. There is atherosclerotic calcification at the bilateral carotid bifurcations. There is mild bilateral carotid bifurcation plaque. The airways are patent. There appears to be decrease in size of nodules in the partially imaged lungs. There is a left maxillary sinus mucus retention cyst. The imaged intracranial structures are unremarkable. | 1. Osseous metastases, including severe spinal canal stenosis at C6 persists in association with the pathologic compression fracture and increased angular kyphosis.2. Multiple nonspecific thyroid nodules.3. Partially-imaged pulmonary metastases appear to be slightly smaller. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | 39 year old with history of left mastectomy in 2005 for IDC. Known metastatic disease to the right hip. Patient received chemotherapy and radiation therapy. History of right breast augmentation. No new breast complaints Three standard and pushback 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 elements, unchanged in pattern and distribution. Retropectoral saline implant is unchanged in position and contour.No new masses, suspicious microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 24 years old Reason: eval for lateral process of talus fx History: L ankle pain. There is a comminuted fracture of the lateral process of the talus extending to the posterior facet of the subtalar joint with approximately 3 mm of lateral displacement of the distal fracture fragment. There is soft tissue swelling along the lateral aspect of the ankle. No additional fractures are identified. | Comminuted fracture of the lateral process of the talus as described above. |
Generate impression based on findings. | 44 years, Female. Reason: Eval stool burden History: Constipation Nonobstructive bowel gas pattern with moderate stool burden in the colon, ascending colon greater than descending. | Nonobstructive bowel gas pattern with moderate stool burden. |
Generate impression based on findings. | 48-year-old male with history of Crohn's disease status post completion proctocolectomy now with abdominal pain, evaluate for infection. ABDOMEN:LUNG BASES: Mild basilar atelectasis. No pleural effusions. Scattered nonspecific pulmonary micronodules.LIVER, BILIARY TRACT: Hepatic steatosis without focal lesions. The gallbladder is mildly distended but without adjacent inflammatory changes.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal simple cyst with additional bilateral subcentimeter renal attenuation lesions too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of proctocolectomy and end ileostomy. Surgical drain present with tip in the midline pelvis. Enteral contrast traverses the small bowel without evidence of obstruction. No loculated fluid collections to suggest abscess. A few mildly prominent mesenteric lymph nodes are present in the right lower quadrant with minimal surrounding induration, likely post-surgical. There is also a small soft tissue attenuation nodule (series 3, image 64) in the right lower quadrant mesentry which may represent a small postoperative hematoma or additional lymph node. BONES, SOFT TISSUES: Midline postsurgical changes to the anterior abdominal wall. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Partially collapsed bladder with foci of air likely from recent instrumentation, decreased from prior.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative changes of proctocolectomy and end ileostomy. Surgical drain present with tip in the midline pelvis. Enteral contrast traverses the small bowel without evidence of obstruction. No loculated fluid collections to suggest abscess. There is mild induration in the presacral space similar to prior.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Expected postoperative changes of recent proctocolectomy and end ileostomy. 2.No evidence of bowel obstruction or abscess. Mild induration in the presacral space is thought to be postsurgical with prostatitis less likely, correlate clinically. 3.Hepatic steatosis. 4.Mildly distended gallbladder without adjacent inflammatory changes. If there is high clinical suspicion for cholecystitis, could evaluate with ultrasound. |
Generate impression based on findings. | Clinical question: Seizure day zero. Signs and symptoms: Seizure day zero with new seizure. Nonenhanced head CT:There is no detectable acute intracranial process. CT of is insensitive for detection of acute nonhemorrhagic ischemic strokes. There are extensive periventricular and subcortical low attenuation white matter as well as left basal ganglia on left thalamus highly suggestive of age indeterminant small vessel ischemic strokes. Prominence of cortical sulci and supratentorial ventricles which may be the normal range for age however underlying volume loss cannot be excluded.Mild large vessel intracranial vascular calcification is presentunremarkable calvarium, orbits and paranasal sinuses. Postoperative changes of a prior fracture of right orbit as was noted on prior studies. | 1.No acute intracranial process.2.Excessive age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Follow-up abnormal CXR. RUL opacity. Smoker. LUNGS AND PLEURA: Severe upper lobe paraseptal emphysema with large left apical bulla. Mild centrilobular emphysema.Right upper lobe peribronchiolar nodular opacity is 14 mm (series 4, image 39), previously approximately 25 mm on prior CXR. It is favored to represent resolving infection.Right basilar groundglass opacities, likely represents aspiration.Calcified nodules consistent with prior healed infection. Scattered noncalcified micronodules, likely also post-inflammatory.MEDIASTINUM AND HILA: Calcified mediastinal and left hilar nodes consistent with healed prior infection.Scattered noncalcified small mediastinal lymph nodes. Normal heart size without pericardial effusion. Mild coronary artery calcification.Nonspecific large left thyroid goiter with substernal extension and causing rightwards tracheal deviation.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Right upper lobe nodular opacity is significantly smaller compared to prior CXR. It is favored to represent a resolving infection; short term interval follow up in 3 months is recommended to confirm its continued involution.2. Right lung base groundglass opacities related to aspiration.3. Severe paraseptal emphysema with large left apical bulla. |
Generate impression based on findings. | 88-year-old male with history of fall. Extensive metallic artifact from patient's right cochlear implant limits evaluation of the right cerebral hemisphere. Within this limitation, 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 age-related volume loss. The basal cisterns are intact. There is no midline shift or mass-effect. There is no evidence of calvarial fracture. The basal cisterns are intact. The imaged paranasal sinuses are clear. There is evidence of a right sided mastoidectomy and cochlear implant. The orbits are unremarkable. | 1. Limited exam secondary to extensive artifact from right cochlear implant.2. No evidence of acute intracranial hemorrhage, mass, or mass effect.3. Mild chronic small vessel ischemic disease. |
Generate impression based on findings. | 69 year-old female with history of metastatic breast cancer, evaluate for progression. CHEST:LUNGS AND PLEURA: Upper lobe predominant centrilobular and paraseptal emphysema. Small right pleural effusion has resolved. Multiple bilateral pulmonary and subpleural nodules compatible with metastatic disease, decreased from prior. For reference, largest right lower lobe subpleural nodule measures 0.7 x 1.1 cm (series 5 image 46), previously 1.2 x 1.5 cm. MEDIASTINUM AND HILA: Multiple enlarged mediastinal lymph nodes, markedly decreased in size and number. Anterior mediastinal soft tissue mass (series 3, image 26) measures 1.3 x 2.0 cm, previously 5.8 x 4.2 cm. Right hilar lymph node (series 3, image 36) measures 1.3 x 1.8 cm, previously 3.7 x 2.7 cm. Moderate coronary artery calcifications.CHEST WALL: Postsurgical changes of right mastectomy and axillary lymph node dissection. There is a nonspecific soft tissue attenuation mass in the right breast (series 3, image 38) measuring 3.2 x 5.2 cm, previously 2.6 x 5.3 cm. Previously enlarged left axillary and supraclavicular lymph nodes have decreased in size and number. The largest left axillary node (series 3, image 25) now measures 1.0 x 1.4 cm, previously 1.7 x 2.6 cm. Interval placement of cervical and upper thoracic spinal stabilization hardware. Many of the previously seen lytic lesions in the sternum and spine have become partially sclerotic. Additional new sclerotic lesions are present, for example in the T11 and L3 vertebral bodies.The previously seen soft tissue mass invading the spinal canal at C4 has significantly decreased in size. ABDOMEN:LIVER, BILIARY TRACT: Multiple ill-defined hypoattenuating foci within the liver suspicious for metastatic disease, decreased in size. For reference, segment 8 lesion (series 3, image 72) measures 2.2 x 2.3 cm, previously 4.2 x 4.9 cm. SPLEEN: No significant abnormality noted. Multiple splenules, stable. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cysts. Additional small subcentimeter hypoattenuating foci in both kidneys are too small to characterize. RETROPERITONEUM, LYMPH NODES: Previously enlarged retroperitoneal lymph nodes are decreased in size and number. Enlarged portacaval lymph node (series 3, image 84) measures 1.0 x 1.0 cm, previously 2.4 x 2.4 cm.Atherosclerotic calcification of the abdominal aorta. Infrarenal abdominal aortic aneurysm measures 4.7 x 4.5 cm (series 3, image 121), unchanged. New infrarenal IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Many of the previously seen lytic lesions in the sternum and spine have become partially sclerotic which may be related to treatment effect. Additional new sclerotic lesions are present, for example in the T11 and L3 vertebral bodies. Anterior abdominal wall soft tissue nodules presumably related to injections.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Nonspecific right adnexal cystic lesion measuring measuring 1.9 x 2.9 cm (series 3, image 161), previously 4.1 x 3.1 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Many of the previously seen lytic lesions in the spine and pelvis have become partially sclerotic.OTHER: No significant abnormality noted. | 1.Interval increase in size of non-specific right breast soft tissue mass. 2.Diffuse metastatic disease within the chest, abdomen, and pelvis overall significantly decreased from prior as described above. 3.Interval sclerosis of diffuse osseous metastatic disease which is likely treatment effect. 4.Stable infrarenal abdominal aortic aneurysm. |
Generate impression based on findings. | History of bilateral breast masses, likely cysts on exam. Three standard views of both breasts and bilateral spot views 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. Obscured masses are seen underlying the palpable markers in the upper inner quadrant of each breast. There is been interval decrease in a left upper outer breast mass compatible with involution of a cyst. Numerous bilateral benign calcifications are present, not significantly changed compared to prior studies. At least some of these probably represent benign milk of calcium. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND | Bilateral simple cysts. The patient admits to some pain related to the left breast cyst. If she desires, this could be aspirated for symptomatic relief. No mammographic evidence of malignancy. As long as the patient's physical examination remains benign, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: 66F with smoking Hx eval for malignancy History: weight loss, 30+ yr 1/2ppd, pleuritic pain LUNGS AND PLEURA: Mild apical predominant centrilobular emphysema. A solid, noncalcified left upper lobe nodule measures 8 x 7 mm (series 5, image 26). Additional scattered calcified granulomas.Mild basilar scarring/atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification. Scattered calcified mediastinal and hilar lymph nodes, compatible with prior granulomatous disease. No lymphadenopathyCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic hypodensities measure near water density, likely benign cysts, although incompletely evaluated on noncontrast imaging. | An 8mm solid left upper lobe nodule appears grossly similar to the prior chest radiograph dated 12/2013 accounting for differences in technique. This may represent a noncalcified granuloma, but malignancy is not excluded. Annual screening is recommended given the smoking history and emphysema. |
Generate impression based on findings. | Anaplastic large cell lymphoma. There continued involution of the lesion left posterior superior neck subcutaneous tissues with residual tissue that measures 4 x 12 mm, previously 5 x 15 mm. There is no significant cervical lymphadenopathy. The Waldeyer ring structures are not enlarged. The thyroid gland and salivary glands appear unremarkable. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. There is persistent opacification of the left maxillary sinus. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Continued incolvution of the treated left posterior upper neck subcutaneous lesion and no evidence of recurrent cervical lymphadenopathy. |
Generate impression based on findings. | Breast cancer. Again seen is widespread osseous metastatic disease involving the skull, thoracolumbar spine, numerous bilateral ribs, sacrum, iliac, and ischial bones, not significantly changed. There is likely urine contamination overlying the soft tissues adjacent to and overlying the right femoral diaphysis. No new lesions are identified. | Widespread osseous metastatic disease without significant interval change. |
Generate impression based on findings. | Evaluate lung nodule gradeRADIOPHARMACEUTICAL: 12.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 75 mg/dL. Today's CT portion grossly demonstrates interval reduction in the size of the right medial lung base pulmonary nodule which measures 6 mm compared to 11 mm previously, indicating more likely an infectious/inflammatory etiology. Additional small pulmonary nodules are noted along the left lung base and are unchanged. Postsurgical changes and clips are noted throughout the pelvis. Endplate degenerative changes are noted about the lower lumbar spine. A metallic fragment is embedded in the lower thoracic spine which may represent a bullet fragment. Postsurgical changes are noted in the pelvis of a bladder reconstruction.Today's PET examination demonstrates no abnormal FDG avid focus to indicate tumor activity. Specifically, the medial right lower lobe lung nodule demonstrates no appreciable FDG accumulation. Symmetric mild increased activity is noted about the supraclavicular regions bilaterally indicating brown fat. | No FDG avid abnormal focus to indicate tumor activity. Specifically, the medial right lower lobe lung nodule demonstrates no appreciable FDG accumulation. Furthermore, it is decreasing in size and most likely represents a benign resolving post inflammatory nodule. However, tumor component cannot be entirely excluded and continued CT follow-up is recommended to ensure stability/resolution. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Lower left intercostal area pain. Evaluate VAD pump damage, fluid collection, infection, rib fracture. CHEST:LUNGS AND PLEURA: Upper lobe predominant paraseptal emphysema, unchanged.New small right pleural effusion with adjacent discoid atelectasis.No evidence of infection or edema.MEDIASTINUM AND HILA: Increased severe cardiomegaly with LVAD and ICD. Within limits of significant streak artifact from LVAD, no discrete fluid collection around the device is identified.Severe coronary artery calcifications are present.Prominent mediastinal lymph nodes, unchanged.CHEST WALL: Skin thickening at the entry site of the drive line and circumferential mild soft tissue thickening along its course through the upper abdominal wall, unchanged. No loculated fluid collection is identified along the drive line course within limits of LVAD streak artifact.Median sternotomy.Left posterior chest wall ICD lead.No rib fracture is identified.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: Subcentimeter renal hypodensities bilaterally, too small to characterize, unchanged and likely cysts.Left renal cortical scar.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracic spine.OTHER: No significant abnormality noted. | 1. Unchanged soft tissue thickening along the LVAD drive line without loculated fluid collection to suggest abscess. No rib fracture or specific findings to explain the patient's symptoms.2. Small right pleural effusion. |
Generate impression based on findings. | Female 66 years old Reason: r/o fracture History: swelling. Three views of the right ankle show diffuse soft tissue swelling about the ankle joint, without evidence of fracture or dislocation. | Soft tissue swelling without underlying fracture evident. |
Generate impression based on findings. | Male 31 years old Reason: humeral shaft fx ORIF History: ORIF. Two views of the right humerus show two side plate and screws device is affixing a distal humerus fracture in near anatomic alignment without radiographic evidence of hardware complication. The fracture line appears less distinct when compared to the prior exam, suggestive of interval healing. Heterotopic bone formation seen in the soft tissues. | Orthopedic fixation of a healing distal humeral fracture. |
Generate impression based on findings. | 44-year-old female with right lower quadrant pain and urinary tract infection, evaluate for appendicitis and renal stone. Exam somewhat limited by a paucity of intra-abdominal fat.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is mild right greater than left prominence of the renal collecting systems. No nephrolithiasis. The kidneys enhance symmetrically. The ureters do not appear dilated but are difficult to follow due to paucity of intra-abdominal fat.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber small bowel without evidence of obstruction. Appendix visualized and unremarkable. Above average stool burden within the colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber small bowel without evidence of obstruction. Appendix visualized and unremarkable. Above average stool burden within the colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic free fluid, likely physiologic. | 1.Exam mildly limited by paucity of intra-abdominal fat.2.No bowel obstruction or appendicitis. Above average stool burden in colon. 3.Mildly prominent right greater than left renal collecting systems, favor prominent extrarenal pelves. If clinically warranted, could be further evaluated with ultrasound. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of recurrent breast carcinoma in her sister at ages 31 and 39 (triple negative). Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Given her family history, please consider referral to cancer risk clinic, as she may benefit from additional testing including breast MRI.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Shortness of breath, hypoxia, and known PA hypertension. LUNGS AND PLEURA: Mild apical predominant centrilobular emphysema. Scattered benign appearing micronodules, unchanged. No new suspicious pulmonary nodules or masses.Mild basilar scarring/atelectasis. Scattered mosaic attenuation and groundglass, compatible with known pulmonary hypertension. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. Severe coronary artery calcification. Status post CABG. The main pulmonary artery is enlarged, suggesting pulmonary hypertension.Scattered mildly prominent mediastinal lymph nodes. A subcarinal lymph node measures 13 mm (series 4, image 35), not significantly changed.CHEST WALL: Degenerative disease of the thoracic spine.Status post median sternotomy. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the abdominal aorta and its branches. Splenomegaly. | 1. Scattered mosaic attenuation and groundglass, compatible with known pulmonary hypertension. 2. Mild emphysema.3. Scattered benign-appearing pulmonary micronodules and mildly prominent mediastinal lymph nodes are unchanged. |
Generate impression based on findings. | There are again postoperative changes from previous posterior fossa surgery. There are scattered punctate foci of intracranial susceptibility, not significantly changed. There is stable extensive ill-defined FLAIR hyperintensity along the margins of the surgical tract within the midline cerebellum. There has been further decreased size of an irregularly enhancing lesion along the superior aspect of the cerebellar vermis, with prominent peripheral susceptibility. This measures 1.6 x 2.6 cm in greatest axial dimensions compared to 1.5 x 2.8 cm in March 2014 and previous 2.1 x 2.7 cm in December 2012. There is a decreased extent of the central cystic appearance compared to prior exams.On perfusion imaging, there is no elevated rCBV an area of irregular enhancement.There is a stable right posterior temporal approach ventriculostomy catheter with tip in the body of the left lateral ventricle. The ventricles and sulci are stable. There are stable punctate and minimally confluent areas of T2/FLAIR hyperintensity within the periventricular and subcortical white matter, left slightly greater than right side. There is also persistent left temporal lobe volume loss. These are nonspecific. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is diffuse calvarial thickening. There is inferior left mastoid fluid signal. | 1. Evolving postoperative changes from previous posterior fossa surgery for tumor resection. Further decreased size and central cystic appearance of superior vermian lesion which does not demonstrate evidence of hyperperfusion.2. Stable pattern of white matter lesions which are nonspecific. |
Generate impression based on findings. | 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. Discontinuity is visualized in the neck portion 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. | Discontinuity of the catheter at the level of the neck. |
Generate impression based on findings. | Female 26 years old Reason: fracture or other cause of wrist pain History: Pain with palpation of the dorsal ulna Left forearm: Bone mineralization and alignment are normal. Small lucency in the ulnar styloid is unchanged and has nonaggressive features. No acute fracture.Left wrist: Bone mineralization is normal. Small lucent foci in the carpal bones likely represent small bone cyst.Acute fracture or malalignment. The joint spaces are normal. | Unremarkable left forearm and left wrist radiographs. |
Generate impression based on findings. | Male 74 years old; Reason: NHL, re-eval and compare to previous History: NHL CHEST:LUNGS AND PLEURA: Stable micronodules, best seen on maximum intensity projection images.MEDIASTINUM AND HILA: Index lymph node anterior to the right main bronchus previously measures 1.5 x 1 cm, now measuresthe same. No new nodes.CHEST WALL: No significant abnormality noted. Stable small bilateral axillary lymph nodes.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodensities in both kidneys are too small to accurately characterize, but likely cysts. Unchanged nonobstructive right lower pole nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.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: Suggestion of focal colonic thickening near the cecum and proximal ascending colon (coronal image 59) likely secondary to underdistention.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable examination. |
Generate impression based on findings. | Female 54 years old Reason: r/o spur/abnormality History: heel pain with remote injury one year ago. Three views of right foot show no acute fracture or dislocation. Note is made a plantar calcaneal spur and enthesopathic changes along the posterior calcaneus. Mild degenerative arthritic changes affect the midfoot. | No acute fracture or dislocation. |
Generate impression based on findings. | 15 year old female with history of thyroid/neck ultrasound with normal thyroid lobes and isthmus. Posterior to the right lobe there is a round, well circumscribed homogeneously hypoechoic structure not vascularized. Question pain right thyroid, no nodules palpated in the neck. RIGHT LOBE MEASUREMENTS: 4.8-cm x 1.4 cm x 1.2 cm.LEFT LOBE MEASUREMENTS: 4.6 cm x 1.6 cm x 0.7 cm.ISTHMUS MEASUREMENTS: 0.2 cm in thickness.RIGHT LOBE: Posterior to the inferior pole of the right thyroid lobe there is a hypoechoic well circumscribed structure measuring 0.8 cm x 0.5 cm x 0.6 cm with no internal vascularity. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: In the left lateral neck there is a small lymph node measuring 1.0 cm x 0.6 cm x 1.4 cm.OTHER: No significant abnormality noted. | Nonspecific hypoechoic subcentimeter structure along the posterior aspect of the inferior pole of the right thyroid lobe may represent a colloid cyst. |
Generate impression based on findings. | Male 68 years old Reason: history of right ankle fracture History: history of right ankle fracture. Three views of the right ankle show a spiral fracture of the distal fibula in near anatomic alignment. There is overlying callus formation suggestive of partial healing. There is diffuse soft tissue swelling about the ankle and mild arthritic changes affect the midfoot. | Partial healing of distal fibular fracture as described above. |
Generate impression based on findings. | Female, 52 years old. Ventral abdominal wall debridement. RFO trigger: BMI over 40 Suspected RFO location: ABDOMEN Name of suspected RFO: N/A Attending Surgeon name/pager: DR. HUSSAIN/ PAGER 9269 Body Mass Index (BMI): 56.38 The upper abdomen and the lateral abdominal tissues are excluded from the field of view. There is residual contrast within the colon and rectum. Within these limitations, there is no unexpected radiopaque foreign object. | Based on the limited field of view, there are no unexpected radiopaque foreign object.Findings including the limited field of view were discussed by telephone with the attending surgeon, Dr. Mustafa Hussain, at 4:30 p.m. 3/5/2015. |
Generate impression based on findings. | CT CARD CORONARY ART CTA/CALC SCORE, 3/5/2015 2:25 PM Coronary arteries: LM: The left main coronary artery arises from the left sinus of valsalva, at the level of the sinotubular junction, and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no severe stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no severe stenoses in the LAD. The mid and distal LAD demonstrate diffuse mild multifocal mixed plaque.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no severe stenoses in the LCx. There is diffuse mild multifocal mixed plaque in the distal LCx.RCA: The right coronary artery is normal size and arises normally from the right Sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no severe stenoses in the right coronary artery. There is diffuse mild multifocal mixed plaque in the mid and distal RCA.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 123ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four right pulmonary veins draining separately to the left atrium: two inferior, one middle, and one superior. There are two left pulmonary veins draining normally to the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is mild aortic calcification in the non-coronary sinus.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Lungs: There is limited coverage of the lungs. The visualized parenchyma is unremarkable. | 1.There are no significant coronary artery stenoses present; however, there is diffuse mild multifocal mixed plaque in the mid to distal LAD, distal LCx, and mid to distal RCA.2. Mild aortic annulus calcification.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 14 year old male with gunshot wound to left arm. Evaluate for pneumothorax.VIEWS: Left humerus AP and Lateral, Left shoulder AP and Lateral, Chest AP (5 views) 3/5/2015 Radiopaque foreign body likely a bullet projecting over the noted along the anteromedial aspect of the proximal humerus representing the bullet. Alignment is normal. No soft tissue swelling or joint effusion. No evidence of fracture or dislocation.Left-sided aortic arch, cardiac apex and stomach. Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax. | Based on these radiographs, bullet noted along the anteromedial aspect of the proximal humerus with no evidence of fracture or dislocation. Please note that a transthoracic left shoulder radiograph was subsequently obtained which confirmed that the bullet is actually along the posterior aspect of the proximal humerus. Findings were discussed with Dr. Laura Humphries by phone on 3/5/2015 on 5:00 PM. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Follow up post chemoradiation for cervical cancerRADIOPHARMACEUTICAL:11.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING):112 mg/dL. Today's CT portion grossly demonstrates cholecystectomy clips.Today's PET examination demonstrates no abnormal FDG activity to indicate tumor. | No abnormal FDG avid activity to indicate tumor. |
Generate impression based on findings. | Cephalic VeinMaximum velocities:Left: 45.7 cm/sec, 39.7 cm/sec, 45.1 cm/secMinimal velocities:Left: 21.6 cm/sec, 21.6 cm/sec, 19.8 cm/sec | Patent shunt. Cephalic vein velocities as above. |
Generate impression based on findings. | Male 69 years old Reason: S/p revision Lt TKA History: S/p revision Lt TKA Postsurgical changes in the left knee with a left knee arthroplasty in near-anatomic alignment. No acute fracture or dislocation. Skin suture staples and joint drain indicate a recent postoperative state. | Postsurgical changes in the left knee without radiographic evidence of hardware complication. |
Generate impression based on findings. | Small cell lung cancer clinical trial cycle 1 day 11. RADIOPHARMACEUTICAL: 12.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates multiple right sided pulmonary nodules, many of which are adjacent to the right mediastinum. Multiple right hilar lymph nodes are noted. A right chest port catheter terminates in the SVC. There is a right total hip arthroplasty. Today's PET examination demonstrates progression in size and metabolic activity in essentially all lesions within the right chest including the right lung apex, right hilum, right anterior mediastinum, right infrahilar region, and medial right lung base, compared to the previous examination. For example, a right lung apex lesion has increased in size and metabolic activity (max SUV = 10.7, previously 7.6). A right hilar lymph node has increased in size and metabolic activity (max SUV = 17.1, previously 11.1). A right infrahilar lymph node metastases has increased in size and metabolic activity (max SUV = 13.5, previously 7.5). Note, the baseline SUVmax values have been normalized to account for significant differences in mean normal background liver activity. No left thoracic or extrathoracic FDG avid tumor is identified. There are no new lesions. Mild heterogeneity throughout the spine is noted but no discrete lesion. | 1.Significant progression of size and metabolic activity of multiple right thoracic metastatic lesions. 2.No FDG avid tumor in the left thorax, extra-thoracically, or new hypermetabolic metastases. |
Generate impression based on findings. | Male 76 years old Reason: eval for arthritis /stenosis History: back pain Bone mineralization is normal. There is straightening of the lumbar spine. Degenerative disk disease affects the L3 - L4, L4 - L5 and L5 - S1 disk spaces with small ridge osteophytes. There are facet hypertrophic changes involving the lower lumbar spine. | Degenerative changes as detailed above. |
Generate impression based on findings. | 69 years, Female, Reason: chemotherapy response History: cancer. CHEST:LUNGS AND PLEURA: Resolution of large right pleural effusion. Right lower lobe atelectasis. Right apical scar like opacity.MEDIASTINUM AND HILA: Right chest port tip terminates in the SVC. Small mediastinal nodes. Mild coronary artery calcifications. Filling defect in the right lower lobe segmental branch likely represents pulmonary embolus.CHEST WALL: Right chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation. There is no obstructing mass, however there is a duodenal diverticulum arising from the second portion of the duodenum near the ampulla, possibly resulting in a mild degree of obstruction.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal hypodensities are too small to characterize, likely cysts.RETROPERITONEUM, LYMPH NODES: Ill defined right para-aortic soft tissue density adjacent to a surgical clip (3/104) is new since the prior exam. Additional shotty retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large anterior abdominal incision with fat stranding and fluid along the incision. No drainable fluid collections.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Status post hysterectomy. There is ill-defined scattered soft tissue density at the vaginal cuff extending into the parametrial tissues (3/163).BLADDER: No significant abnormality noted.LYMPH NODES: Presacral nodule measuring 1.5 x 1.2 cm (3/175) is suspicious for tumor.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Minor degenerative changes of the visualized spine. No suspicious osseous lesions.OTHER: No significant abnormality noted. | 1.Age indeterminant right lower lobe pulmonary embolus. 2.Presacral nodule likely represents a metastases.3.Ill-defined soft tissue at the vaginal cuff may represent postsurgical change, however recurrent tumor cannot be excluded. There is also ill-defined periaortic which also may represent postsurgical change versus tumor. A PET-CT may be helpful for further evaluation.Findings discussed with Dr. Fatunde at 5:15 p.m. on 3/5/2015 |
Generate impression based on findings. | 14 year male status post gunshot wound to left upper extremity.VIEWS: Left shoulder transthoracic (one views) 3/5/2015 Radiopaque foreign body likely bullet is again seen and projecting over the posterior aspect of the humerus. There is no evidence of fracture or dislocation. | Radiopaque foreign body likely bullet projecting over the posterior aspect of the humerus. No fracture or dislocation.Findings were discussed with Dr. Laura Humphries by phone on 3/5/2015 on 5:00 PM. |
Generate impression based on findings. | Male 67 years old Reason: History metastatic renal cancer on pazopanib, assess for disease status History: none CHEST:LUNGS AND PLEURA: Stable size of pulmonary metastatic disease. The reference left upper lobe lesion measures 0.7 x 0.6 cm (series 4, image 23), previously 0.8 x 0.6 cm.MEDIASTINUM AND HILA: Hypoattenuating right thyroid lobe nodule is unchanged from prior exam.Right mediastinal mass measures 2.7 x 1.6 cm (series 3, image 29), previously 3.3 x 1.9 cm.Heart size is unremarkable without pericardial effusion. Mild coronary artery calcifications.Main pulmonary artery is at the upper limit of normal in size measuring up to 31 mm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Reference right hepatic lobe lesion measures 3.2 x 4.3 cm (series 3, image 77), previously 3.3 x 4.5 cm and does not appear significantly changed from prior exam. Additional non-reference lesions appear similar in size.Enhancing polypoid gallbladder lesions is not visualized on this examination.SPLEEN: No significant abnormality notedPANCREAS: Diffuse pancreatic atrophy. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right renal heterogenous mass with enhancing nodularity is increase in size and measures 7.1 x 6.5 cm (series 3, image 117), previously 6.1 x 6.1 cm.There is persistent tumor thrombus with extension of tumor into the right renal vein and IVC which is not significantly changed compared to CT study from 5/29/2014. RETROPERITONEUM, LYMPH NODES: Multiple prominent subcentimeter retroperitoneal lymph nodes are not changed from prior exam. Heavy aortoiliac atherosclerotic calcifications.BOWEL, MESENTERY: No bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Peritoneal soft tissue lesion superior to the dome of the liver measures 2.6 cm (series 80296, image 41) and previously measured 2.5 cm, appears grossly unchanged from prior exam.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left femoral head lytic lesion, unchanged from prior exam.OTHER: Heavy aortoiliac atherosclerotic calcifications. | 1.Interval increase in the size of the right renal mass. There is persistent extension of tumor thrombus into the right renal vein and IVC which is similar to previous contrast enhanced study from May 2014. 2.Stable chest, mediastinal, peritoneal, liver and osseous metastatic disease. |
Generate impression based on findings. | Corresponding to the area of extensive abnormal low density on CT centered in the right temporal lobe, there is extensive T2/FLAIR hyperintensity involving predominantly white matter, although there is some cortical involvement as well. There is localized sulcal effacement in this area. There is mild effacement of the adjacent portions of the right lateral ventricle. There is extension of abnormal FLAIR hyperintensity into the right external, extreme, and internal capsules. There is gyral thickening of the mesial right temporal lobe, with corresponding focal diffusion restriction in this area. There is also relative diffusion restriction along the insular cortex with gyral thickening, without evidence of T2 shine through. Abnormal hyperintense signal extends into the tail of the right hippocampus in a subtle asymmetric fashion.The ventricles and sulci are otherwise prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. There is a chronic lacunar infarct in the right cerebellum. There is also a prominent perivascular space versus less likely chronic lacunar infarct along the left anterior commissure. There is no pathological enhancement. There is no diffusion abnormality to suggest acute ischemia. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered mucosal thickening throughout the paranasal sinuses and a partially opacified right sphenoid sinus. There is trace fluid in the right mastoid air cells. There is fluid within the dependent nasopharynx. | 1. Extensive abnormal signal with gyral thickening and localized mass effect involving the right temporal lobe with areas of focal diffusion restriction in the right mesial temporal lobe and right insular cortex most suggestive of an infiltrative nonenhancing primary brain neoplasm. Perfusion imaging should be considered on follow-up exam.2. No acute infarct, with underlying mild to moderate chronic small vessel ischemic changes. Chronic small right cerebellar infarct. |
Generate impression based on findings. | Male; 61 years old. Reason: Uncontrolled HTN with renal insufficiency, assess for RAS RIGHT KIDNEY: The right kidney measures 8.6 cm in length. No evidence of renal stone or hydronephrosis. There is a 2.8 x 2.6 x 2.6 cm hypoechoic, cystic lesion with a thin septation (previously 2.2 x 2.4 x 2.2 cm).LEFT KIDNEY: The left kidney measures 9.9 cm in length. No evidence of hydronephrosis or hydroureter. No caliculi or suspicious lesion evident.BLADDER: The bladder is nondistended.DOPPLER VASCULAR KIDNEYSAORTA: Peak systolic velocity of 0.79 m/sec.RIGHT RENAL ARTERY:The right renal artery is patent. The peak systolic velocity of the right renal artery is 0.76 m/sec at the origin, 0.73 m/sec in the midportion and 1.1 m/sec distally with resistive indices ranging from 0.56 to 0.75. Resistive indices within the arcuate arteries vary between 0.49 and 0.62.RIGHT RENAL VEIN: The right renal vein is patent.LEFT RENAL ARTERY:The left renal artery is patent. The peak systolic velocity of the left renal artery is 0.59 m/sec at the origin, 0.41 m/sec in the midportion and 0.44 m/sec distally with resistive indices ranging from 0.56 to 0.63. Resistive indices within the arcuate arteries vary between 0.52 and 0.53.LEFT RENAL VEIN: The left renal vein is patent.INFERIOR VENA CAVA: The IVC is patent. | 1.Normal renal vasculature without evidence of renal artery stenosis.2.Complex right upper pole renal cyst, stable. |
Generate impression based on findings. | Movement disorder with loss of balance and fall. The patient would not tolerate proper positioning and insisted on PET camera somewhat distant from his head. This limits the exam. However within this limitation there is apparent significantly decreased activity involving both putamen. Symmetric caudate activity is noted. | Limited exam but considered more likely abnormal and suggestive of Parkinson's disease given the history. |
Generate impression based on findings. | Left hand tremor. There is minimal decreased activity within the posterior left putamen; when reviewing a recent MRI, this correlates with a T2 hyperintense area which may represent a prior lacunar infarct or prominent perivascular space. The remaining distribution of radiotracer is physiologic. | Negative examination. No evidence of nigrostriatal dopaminergic dysfunction. Given the history, these findings are suggestive of essential tremor. |
Generate impression based on findings. | Male; 68 years old. Reason: evaluate aortic aneurysm History: vague abdominal pain; patient has PAD and had enlarged abdominal aorta in 2011 AORTA:Irregular aortic wall with shadowing mural calcification.Aortic dimensions as follows:Proximal: 3.0 x 3.3 x 3.4 cmMid: 3.4 x 5.0 x 4.3 cmDistal: 4.4 x 4.2 x 4.4 cmRight iliac artery: 3.2 x 3.8 x 4.7 cmleft iliac artery: 1.7 x 2.1 x 2.3 cm | Aneurysmally dilated aorta, most significant in the distal portion which measures up to 4.4 cm. Aneurysmal dilation of the bilateral iliac arteries. |
Generate impression based on findings. | Rule out infection or signs of malignancy. Pre-transplant evaluation. Multiple teeth are absent. I see no large cavities, although dental caries would be better assessed with dedicated dental radiographs. A lucency at the root of the second right maxillary incisor is nonspecific and may in part be artifactual due to midline blurring artifact inherent to Panorex technique. | Lucency at the root of the right secondary maxillary incisor is nonspecific and may not be of any clinical significance. However, if there is strong clinical concern for infection, then dedicated dental radiographs may be considered. |
Generate impression based on findings. | Pain to proximal digit. Rule out fracture. There is dorsal dislocation of the middle phalanx with respect to the proximal phalanx. I see no fracture. | PIP joint dislocation. I see no fracture. |
Generate impression based on findings. | Pain. Fracture? I see no fracture or malalignment. I see no specific findings to account for the patient's shoulder pain. | No fracture or other findings to account for the patient's shoulder pain are evident. |
Generate impression based on findings. | Abrasions status post fall. Rule out fracture. Four views of the left elbow are provided. There is narrowing of the radiocapitellar articulation with underlying subchondral cysts indicating osteoarthritis. There is elevation of the anterior fat pad of the distal humerus indicating fluid within the joint. There is a step-off along the lateral aspect of the articular surface of the radial head which could conceivably represent a minimally displaced fracture, although I see no underlying radial head fracture line. Alternatively, this may reflect mild deformity due to an old fracture or simply osteophyte formation from osteoarthritis. There is also a small density along the medial epicondyle of the distal humerus that could conceivably represent a nondisplaced fracture if the patient complains of pain at this site; however, there is little if any overlying soft tissue swelling and therefore I suspect that this density simply represents a small enthesophyte. A 13-mm ossific density seen on the lateral view along the anterior aspect of the joint may represent a large intra-articular loose body. A smaller density seen projecting anterior to the distal humeral diaphysis on the lateral view may represent a small focus of dystrophic or arterial calcification, with a foreign body considered less likely.Four views of the right knee show severe osteoarthritis appearing similar to that seen on the prior study. There is a small joint effusion which likewise appears similar to that seen on the prior study. A large ossicle projecting superior to the patella may either represent an intra-articular loose body in the joint or heterotopic ossification along the distal quadriceps tendon. I see no acute fracture. Arterial calcifications are noted in the posterior soft tissues.Four views of the left knee are provided. Severe osteoarthritis affects the left knee appearing similar to that seen on the prior study. I see no acute fracture. An ossicle projecting superior to the patella may either represent a loose body in the joint or heterotopic ossification in the distal quadriceps tendon. Arterial calcifications are noted in the posterior soft tissues. | Osteoarthritic changes as described above. There is mild deformity of the radial head that could conceivably represent a nondisplaced fracture if this corresponds to the site of the patient's pain; alternatively, it may represent the sequela of old trauma or osteoarthritis. Small density along the medial epicondyle of the humerus is favored to represent an enthesophyte, but could conceivably represent a small nondisplaced fracture as well. These findings can be further evaluated with repeat radiographs or CT, if clinically warranted. Other findings as above. |
Generate impression based on findings. | Prior SAH grade 3, day#6, Post stent assisted coiling for the ruptured right distal ICA aneurysm. Decreased mental status, suspicious for vasospasm. NONCONTRAST CT HEADMild to moderate ventriculomegaly with IVH and left EVD inserted.Right EVD has been removed.Bilateral frontal lobe ICH appear to be stable.Amount of SAH has been decreased since prior exam.IVH amount does not appears to be changed.No evidence of new acute ischemic or hemorrhagic lesion on this scan. CTA HEAD The distal right ICA stented segment is widely patent without any evidence of in-stent stenosis or filling defect.There is no evidence of recanalization of aneurysm.There is no evidence of contrast extravasation.The size of intracranial arteries in particular distal ICAs, bilateral MCAs, bilateral ACAs beyond Acom artery, distal vertebral arteries, basilar artery and bilateral PCAs' P1 segments appear to be normal or at least the same size with prior exam.There is however focal luminal narrowing of the right PCA P1-P2 junction which was seen on prior exam likely represent atherosclerotic stenosis.No evidence of aneurysm, dissection, or vascular occlusion is noted.There is normal superficial and deep intracranial venous drainage.CT perfusionThe CBV, MTT, TTP and CBF maps were created with the AIF at the distal left ICA and VOF at the torcular.Calculated perfusion maps demonstrated no evidence of perfusion asymmetry comparing bilateral hemispheres.There was no focal perfusion defects.Measured perfusion parameters on MCA territories were within normal limits. | 1. Stable post stent assisted coiling status of ruptured right distal ICA aneurysm, no change of mild to moderate ventriculomegaly, IVH amount and bilateral frontal ICH. 2. Left EVD tube location is stable, no change and the right EVD tube has been removed.3. Normal caliber of intracranial arterial system.4. No evidence of in stent stenosis or in stent blood clot formation, widely opened deployed stent. No evidence of aneurysm recanalization.5. Normal perfusion scan. |
Generate impression based on findings. | Post left total knee arthroplasty Components of a left total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of complication. Skin staples and foci of gas within the anterior soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty as described above. |
Generate impression based on findings. | Left hip pain and right hip pain. Rule out occult fracture or avascular necrosis. Right knee pain/effusion, fever. Assess for complications status post right knee replacement. Two views of the left hip are provided. I see no fracture. I see no specific radiographic features of avascular necrosis. Mild osteoarthritis affects the hip; there is also chondrocalcinosis within the hip.The AP view of the pelvis reveals the aforementioned degenerative arthritic changes of the left hip. Similar degenerative arthritic changes affect the right hip. Calcifications along the ischii bilaterally likely reside within the hamstring origins. The bones appear slightly demineralized suggesting osteopenia. There is orthopedic fixation of the lower lumbar spine. I see no fracture or or radiographic features of osteonecrosis.Four views of the right knee are provided. Components of a medial compartment arthroplasty are situated in near-anatomic alignment without radiographic evidence of hardware complication. There is a moderate sized joint effusion, nonspecific. Moderate osteoarthritis affects the patellofemoral and lateral compartments. There is also chondrocalcinosis of the lateral meniscus. I see no erosions. | 1.Mild osteoarthritis and chondrocalcinosis of the hips. I see no fracture or avascular necrosis. If there is strong clinical concern for fracture or avascular necrosis, then MRI may be considered for further evaluation.2.Unicompartmental right knee arthroplasty situated in near-anatomic alignment with nonspecific joint effusion. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of cutaneous burn involvement the left breast. Two standard digital views, with additional bilateral CC and MLO views, of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | congestive heart failure, unresponsive 4 hours after ICU desation. No evidence of acute ischemic or hemorrhagic lesion.Minimal non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | facial numbness and extremity numbness, new onset. No evidence of acute ischemic or hemorrhagic lesion.Multifocal focal encephalomalacias involving bilateral inferior parietal lobules and left cerebellar hemispheres.Brain MRI can be considered for further evaluation.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Multifocal chronic ischemic lesions with encephalomalacia involving bilateral inferior parietal lobules and left cerebellar hemisphere as described above. |
Generate impression based on findings. | near syncope There is about 8mm sized soft tissue like attenuation on the right para and supraclinoid area subarachnoid space with stippled calcification (series 4, image 13/35). This lesion could represent partial volume artifacts for ectatic, tortuous and calcified distal ICA. However, possibility of calcified distal ICA aneurysm cannot be completely excluded. Thus, if clinically indicated, head CT angiography or MR angiography can be considered.Otherwise there is no evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. Minimal non specific small vessel ischemic disease.There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | Prominent right distal ICA around anterior clinoid process, possibility of aneurysm or partial volume artifacts. Follow up imaging such as CTA or MRA can be considered for further evaluation.Otherwise unremarkable CT scan.discussed with Dr. Grueger |
Generate impression based on findings. | 84 years, Male, Reason: r/o aortic enteric fistula History: gi bleed. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic hypodensities are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonspecific perinephric stranding. Punctate nonobstructing stones bilaterally.RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic aneurysm with aortobiiliac stents. The excluded aneurysm sac measures 5.2 x 4.8 cm. No evidence of endo- leak. Severe atherosclerotic calcifications of the proximal aorta and multiple branches.BOWEL, MESENTERY: Blush of contrast within the lumen of the distal pylorus which disperses on delayed phase is compatible with of hemorrhage.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Fat-containing left inguinal hernia. Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate to severe degenerative changes of the visualized spine with laminectomy at L4 and L5.OTHER: No significant abnormality noted | Active hemorrhage in the distal pylorus. |
Generate impression based on findings. | Right hip pain. Right hip femoral acetabular impingement. There is a lucent lesion with sclerotic margins in the posteromedial aspect of the proximal tibial metaphysis with disruption of the overlying cortex. The lesion contains foci of ossification as well. Its appearance is benign. It may represent a healing nonossifying fibroma or less likely sequela of remote infection.MEASUREMENTS: CAM location : No cam deformity evidentAlpha angle : 45 degreesCoronal center-edge angle : 25 degreesSagittal center-edge angle : 49 degrees as measured to the anterior acetabular rimFemoral neck-shaft angle : 126 degreesAcetabular version (1 o’clock) : 5 degreesAcetabular version (2 o’clock) : 15 degreesAcetabular version (3 o’clock) : 26 degreesFemoral version angle (+anteverted, -retroverted) : 13 degreesMcKibbin index : 39 degreesAIIS width : 1 cmDistal base of AIIS to acetabular rim : An upsloping spine extends to the acetabular rim. | No specific findings to account for the patient's pain. Measurements as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. There is asymmetry within the outer right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present in the left breast. | Asymmetry within the outer right breast, visualized on the CC view. Correlation with prior mammograms is recommended. If prior mammograms cannot be obtained, further evaluation with true lateral and spot compression views, and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OC - OLD FILM FOR COMPARISON |
Generate impression based on findings. | 59 years, Male, Reason: eval for liver laceration History: right abdominal pain. CHEST:LUNGS AND PLEURA: Patchy opacities in the bilateral basis and right middle lobe. No pleural effusions. No suspicious nodules or masses.Lower lobe bronchiectasis bilaterally.MEDIASTINUM AND HILA: Scattered small mediastinal nodes with an enlarged precarinal node measuring 2.0 x 1.2 cm. No coronary artery calcifications. Mild atherosclerotic calcifications of the aorta and its branches. Enlarged subcarinal node.CHEST WALL: No significant abnormality notedABDOMEN:LUNG BASES: For findings in the chest, please see dedicated chest CTLIVER, BILIARY TRACT: Irregular linear hypodensity along the hepatic dome, segment 4a, is suspicious for a laceration. There is no associated subcapsular fluid. The laceration approaches the middle hepatic vein, which appears intact. Portal venous system is intact area noSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Nonspecific sclerotic foci in the right femoral neck and left ilium. Mild degenerative changes of the spine with fusion of L3-L4. OTHER: No significant abnormality noted | 1.Linear hypodensity in the hepatic dome is suspicious for laceration. No subcapsular fluid or hemorrhage is present and this is considered age indeterminate2.Lower lobe bronchiectasis with patchy basilar opacities, likely aspiration/infection. |
Generate impression based on findings. | Inflammation of the left buttock, perineum and left lower extremity. UTERUS, ADNEXA: Intrauterine device is visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Note is made of stranding/inflammatory changes about the left perineum, left vagina and extending along the left medial gluteal fold. No loculated fluid collection or abscess. | Inflammation along the left perineum, vagina and left medial gluteal fold without loculated fluid collection or abscess. |
Generate impression based on findings. | Male 5 months old Reason: eval lung fields, expansion History: infant with tracheostomy, pulmonary HTN, chronic lung diseaseVIEW: Chest AP (one view) 3/5/15 1746 hrs. Tracheostomy tube terminates below thoracic inlet. NG tube tip is at the stomach. Cardiac silhouette size is normal. Right middle lobe atelectasis on a background of chronic lung disease. | Right middle lobe atelectasis on a background of chronic lung disease. |
Generate impression based on findings. | 34 years, Male. Reason: r/o bowel obstruction History: N/V, ab and back pain Probable mineralized debris in a diverticula in the left upper quadrant. Nonobstructive bowel gas pattern. Lung bases are clear. Average stool burden. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | syncopal episode, on coumadin with history of head trauma. No evidence of acute ischemic or hemorrhagic lesion.Evidence of prior right craniotomy with multiple surgical clips on the right distal ICA area with low attenuation on the right frontal lobe indicating chronic ischemic lesion.Small focal encephalomalacia on the right cerebellar hemisphere, no change since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The paranasal sinuses and mastoid air cells are clear. | Evidence of prior surgical clipping and multifocal ischemic lesions, no change since prior exam.No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | RUQ and epigastric pain. Rule out cholelithiasis/cholecystitis, pancreatitis, SBO. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis with gallbladder wall thickening and pericholecystic inflammation indicating acute cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral small cystic lesions, likely benign renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Multiple uterine masses with central hypoattenuation likely representing degenerating fibroids. A cystic lesion is seen posterior and superior to the bladder which measures 24 x 2.7 cm and more likely represents a right ovarian cyst, less likely is right ureterocele or bladder diverticulum.BLADDER: Mild right ureteral prominence. 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.Findings compatible with acute calculus cholecystitis.2.Right adnexal cystic lesion, likely ovarian cyst, which can be correlated with pelvic ultrasound if clinically warranted. |
Generate impression based on findings. | 24 years, Male. Reason: SBO/ileus History: abdominal distension Low lung volumes. Bibasilar opacities. Tracheostomy tube and left IJ catheter is in place. Spinal fixation hardware is unchanged. Ventriculo-gall bladder catheter is again noted coiled in the right upper quadrant. Left pigtail catheter, vascular coils and IVC filter are again noted. Bilateral femoral vascular catheters are noted. Diffusely dilated loops of small and large bowel in an ileus type bowel gas pattern. No pneumoperitoneum. | Decrease in degree of distention likely representing resolving obstruction when compared prior. |
Generate impression based on findings. | Female 4 years old Reason: r/o fracture History: tv fall on foot, non-weight bearingVIEWS: The fourth AP, lateral and oblique and left tibia-fibula AP and lateral 3/5/15 (5 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Pre-desaturations.VIEW: Chest AP (one view) 03/05/15, 1704 Tracheostomy tube tip is below thoracic inlet. Two feeding tubes are present. Giant omphalocele is again seen. Left upper extremity PICC has its tip in junction of brachiocephalic veins.Perihilar air space disease has worsened on the right. Focal opacity in the left base continues. Cardiac silhouette size is normal. Abnormal configuration of the chest with increased leg and decreased with from giant omphalocele is again noted. | Worsening opacity on the right. Persistent left base opacification. |
Generate impression based on findings. | 81 years, Male. Reason: Ileus, distention History: Above Moderate cardiomegaly. Low lung volumes. Small right pleural effusion. No pneumothorax. No pneumoperitoneum. Scattered loops of gas distended small and large bowel. Nonobstructive bowel gas pattern. Probable bone island in the right femoral neck. | Findings compatible with ileus type bowel gas pattern. |
Generate impression based on findings. | 48 years, Female. Reason: eval if patency capsule is still in small bowel (stuck at stenotic anastomosis) or in colon or passed History: Crohn's' disease with anastomotic stricture Nonobstructive bowel gas pattern. Suture material projects over the right hemiabdomen. Radiopaque patency capsule is in the area of the suture line, unchanged since the prior exam. | Radiopaque patency capsule is in the area of the suture line, unchanged since the prior exam. |
Generate impression based on findings. | Male 14 months old Reason: pneumonia History: fever, tachycardic/tachypneicVIEWS: Chest AP/lateral (two views) 3/5/15 Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Peribronchial thickening and subsegmental atelectasis of both lung bases. No focal lung opacities. No effusions or pneumothorax. | Bronchiolitis pattern with superimposed subsegmental atelectasis at both lung bases. |
Generate impression based on findings. | multiple episode of epistaxis, eye pain and headache. No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | Normal head CT scan. |
Generate impression based on findings. | 44-year-old male with tooth pain. Panorex view of the mandible demonstrates a large cavity affecting the right second mandibular molar. Reabsorption noted along the root of the left second mandibular molar with loss of bone along the alveolar ridge indicating periodontal disease. Partially erupted third maxillary molars bilaterally. | Dental caries and periodontal disease as described above. If further evaluation is clinically indicated, then dedicated dental radiographs may be obtained. |
Generate impression based on findings. | Assess dislocation reduction, post reduction The previously seen PIP joint dislocation has been reduced to anatomic alignment. There is swelling of the soft tissues of the finger, but I see no fracture. | Reduction of PIP joint dislocation. |
Generate impression based on findings. | 48 years, Female. Reason: eval location of patency capsule History: Crohn's disease with anastomosis, stricture at anastomosis Nonobstructive bowel gas pattern. Suture material projects over the right hemiabdomen. Patency capsule projects over the area containing the sutures. | Patency capsule projects over the area of the suture material in the right hemiabdomen. |
Generate impression based on findings. | Pain, swelling. Fracture? Two views of the right femur are provided. I see no fracture or other specific findings to account for the patient's pain.Two views of the right tibia/fibula are provided. There is a transverse fracture of the proximal fibular diaphysis with fracture fragments in near-anatomic alignment. I see no additional fracture. | Proximal fibular fracture as above. |
Generate impression based on findings. | Shoulder pain. Possible AC joint separation.VIEWS: Right shoulder internal/external rotation (two views) 03/05/15 The humeral head is normally positioned with respect to the glenoid fossa. No fracture is identified. | Normal examination. |
Generate impression based on findings. | 72-year-old female status post fall. Evaluate for fracture. Left hip:Two views of the left hip demonstrate no acute fracture or malalignment. The left hip joint appears normal for patient's age. Small enthesophyte along the greater trochanter, which may not be of any clinical significance.Left femur:Two views of the left femur demonstrate no acute fracture or malalignment. Small focus of mineralization adjacent to the medial condyle of the femur may represent old MCL injury. Mild osteoarthritis affects the left knee. Pelvis:One view of the pelvis demonstrates no acute fracture or malalignment. Both hips appear normal for age. Sclerosis involving the pubic symphysis likely is degenerative in etiology. Moderate degenerative arthritic changes affect the visualized lower lumbar spine. Evaluation of the sacrum is limited by overlying bowel contents. | Degenerative changes as described above without fracture evident. |
Generate impression based on findings. | Female 25 years old Reason: s/p thoracotomy, chest tube placement, line placement History: port placementVIEW: Chest AP (one view) 3/5/15 at 1829 hrs. Left-sided chest tube, epidural catheter and left subclavian Port-A-Cath with the tip in the RA/SVC junction the note that. Subcutaneous emphysema is present. Cardiac silhouette size is normal. Interval removal of left upper mediastinal mass , surgical clips are noted in region.No focal opacities, effusions or pneumothorax. | Status post surgery as described. |
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