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Generate impression based on findings. | 84 years, Female. Reason: eval for obstruction History: abdominal discomfort Average stool burden. No pneumoperitoneum. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 75 years, Male. Reason: Repeat XR for comparison. Now having BMs w/flatulence. Improvement? History: known colonic ileus Enteric feeding tube is looped in the stomach with tip projecting over the gastric antrum. Surgical changes from fundoplications surgery is again noted. Gas distended large and small bowel compatible with ileus type bowel gas pattern. | Persistent ileus type bowel gas pattern. |
Generate impression based on findings. | 53 years, Female, Reason: r/o dissection History: chest pain, back pain, abdomal pain. CHEST:LUNGS AND PLEURA: Diffuse groundglass opacity is nonspecific but may be related to mild edema or poor inspiration, correlate with fluid status.MEDIASTINUM AND HILA: Scattered small mediastinal nodes.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Metallic density in the right hepatic lobe.SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Vascular calcifications within the calices bilaterally. Prominent column of Bertin on the left.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the aorta and its branches, worse than the prior exam.BOWEL, MESENTERY: Large ventral hernia containing multiple bowel loops without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Metallic densities in the left abdominal wall and liverPELVIS: FemalePROSTATE, SEMINAL VESICLES: Prominent prostate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute findings to account for the patient's symptoms. |
Generate impression based on findings. | Basketball injury.VIEWS: Right hand PA, right little finger oblique/lateral (3 views) 03/05/15 Mild soft tissue swelling is present around the proximal interphalangeal joint of the little finger.A nondisplaced volar plate avulsion involving the middle phalanx is present. The fracture fragment a small. | Middle phalanx volar plate avulsion. |
Generate impression based on findings. | 36 years, Male. Reason: X-ray abdomen for abdominal pain to evaluate for fecal loading History: Abdominal pain Below-average stool burden. Nonobstructive bowel gas pattern. Lung bases are clear. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Fall. Evaluate for pneumonia. LUNGS AND PLEURA: Mild upper lobe predominant paraseptal and centrilobular emphysema.Mild lower lobe bronchiectasis and bronchial wall thickening with scattered mucus impaction.Mid to lower zone predominant tree in bud opacities and patchy basilar consolidation consistent with infection, likely related to aspiration.MEDIASTINUM AND HILA: Small scattered mediastinal lymph nodes. No hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification. Mild thoracic aorta calcification.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Refer to separately dictated CT abdomen/pelvis report. | Findings consistent with aspiration pneumonia. |
Generate impression based on findings. | Leg pain. Rule out fracture. There is mild swelling along the lateral aspect of the ankle, but I see no underlying fracture or malalignment. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | Jammed thumb by basketball. Pain in a proximal phalanx and limited range of motion.VIEWS: Right hand PA, right thumb AP/lateral (3 views) 03/05/15 Soft tissue swelling is present around the fall. No fracture is identified. The bones are normal in appearance. | Normal examination. |
Generate impression based on findings. | Evaluate for cause of abdominal pain and acidosis. Note that evaluation of solid organs and lymph nodes in the abdomen and pelvis are limited due to lack of IV contrast.ABDOMEN:LUNG BASES: New bilateral pleural effusions and patchy basilar pulmonary opacities are partially visualized.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Lack of IV contrast limits evaluation for pyelonephritis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Abdominal ascites is noted, including around the kidneys which makes evaluation for pyelonephritis limited. No free air.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites is noted. No free air. | Note that for the evaluation of solid organs and lymph nodes in the abdomen are limited without IV contrast.1.Bilateral pleural effusions and adjacent consolidation which may indicate infection. Please refer to the CT abdomen and pelvis with contrast which has since become available.2.Abdominal pelvic ascites without evidence of a loculated fluid collection, bowel obstruction or free air. |
Generate impression based on findings. | 44-year-old male with pain, lac. Evaluate for fracture. Three views of the right hand were provided. Slightly limited evaluation of fine bone detail due to overlying bandage. Given this limitation, we see no acute fracture or malalignment. | No fracture evident. If better evaluation of the digit is clinically indicated, repeat radiographs without bandage recommended. |
Generate impression based on findings. | 14-year-old male status post gunshot wound to left shoulder. Metallic foreign body compatible with bullet is lodged in the posterior aspect of the glenoid, just behind the joint space. The humeral head is intact. The remaining visualized osseous structures are normal. No significant soft tissue swelling or hematoma is present. No focal opacity or pneumothorax is noted in the visualized left lung. | Bullet lodged within the posterior aspect of the glenoid. No humeral head or joint space abnormality. |
Generate impression based on findings. | Punched wall two weeks ago. Swelling.VIEWS: Right hand PA/lateral/oblique (3 views) 03/05/15 Soft tissue swelling is present on the dorsum. A boxer's fracture of the index finger is present. Periosteal reaction is present laterally. | Healing index finger boxer's fracture. |
Generate impression based on findings. | Right proximal fibular fracture. Evaluate for widening of syndesmosis. Ankle joint alignment is within normal limits. I see no widening of the syndesmosis. There is mild soft tissue swelling along the lateral aspect of the ankle. I see no fracture. | No fracture or malalignment evident. Mild soft tissue swelling. |
Generate impression based on findings. | History of lung cancer, please compare to previous measurements CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema.Upper lobe bronchi demonstrate progressive wall thickening. Right perihilar groundglass surrounding the right middle and central lower lobe bronchi which may be related to interval radiation fibrosis.In the right upper lobe, there is a scarlike density measuring 4 mm in greatest thickness (4/28). When comparing to the outside study, this is not significantly changed; however, the slice thickness on the current exam is 3 mm, as compared to 5 mm on outside study.No new pulmonary nodule or pleural effusion is present.MEDIASTINUM AND HILA: There is high right mediastinal soft tissue compatible with lymphadenopathy, slightly decreased in size from the comparison study of 3/24/14. At the level of the transverse aortic arch, this measures 2.4 x 1.8 cm (3/34), as compared to 2.7 x 2.1 cm. The soft tissue is contiguous with the right mid mediastinum, extending to the right main pulmonary artery, causing mild compression, as before. The right superior pulmonary vein is markedly diminutive, similar to previous. The widest diameter is approximately 3 mm. No central pulmonary embolus is present. Several agoesophageal and right hilar lymph nodes are calcified.The heart size is normal. There is no interval pericardial effusion. Minimal coronary artery calcification is again noted.The majority of the superior vena cava is stented from the central right internal jugular vein to the level of the pulmonary artery bifurcation. Central to this, the superior vena cava is slitlike in caliber with a small channel of contrast draining into the right atrium.CHEST WALL: Multiple collaterals veins drain the bilateral chest and abdominal walls via right hepatic and lumbar veins.Deep to the nipple of the right breast, there is a nodular density measuring 8 x 10 mm (3/53). Correlation to physical examination, mammography and possibly ultrasound is recommended, as this appears more prominent when compared to the previous study.Several clips are noted the base of the neck at the midline and inferior to the isthmus of the thyroid gland.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There has been a cholecystectomy.SPLEEN: Calcified granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right superior pole cyst 2.7 x 2.2 cm, not significantly changed.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic spine.OTHER: No significant abnormality noted. | Right thigh mediastinal lymphadenopathy measuring slightly smaller than the outside comparison examination. At the transverse arch, this measures 2.4 x 1 .8 cm, as compared to 2.7 x 2.1 cm. This causes mild compression of the right main pulmonary artery and significant compression of the right superior pulmonary vein.Right peribronchial ground glass which may related to radiation fibrosis with associated central bronchial wall thickening.No new pulmonary nodule.The majority of the superior vena cava is stented with slitlike caliber at the caval atrial junction secondary to external compression from the mediastinal lymphadenopathy.Extensive centrilobular emphysema. Scarlike opacity right upper lobe measuring 4 mm in greatest thickness, not significantly changed when using similar measurement techniques, despite differences in slice thickness.Nodular density deep to the right nipple of the right breast. Correlation physical examination, mammography and possible ultrasound is recommended. |
Generate impression based on findings. | Male 1 day old Reason: placement of lines History: oxygen support, UAC, UVC in placeVIEW: Chest and abdomen AP (two views) 3/5/15 Esophageal temperature probe terminates at the mid esophagus. NG tube tip is in the stomach. UVC tip is at the RA/SVC junction. UAC terminates at T7.The aortic arch, cardiac apex and stomach left-sided. Cardiac silhouette size is top normal or mildly enlarged. Diffuse lung haziness consistent with TTN versus RDS.Disorganized, likely age-related and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Umbilical lines, esophageal temperature probe and NG tube placement as described.Bilateral diffuse lung haziness consistent with TTN versus RDS.Top normal or mildly enlarged cardiac silhouette size.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | 51-year-old female with pain and swelling. Evaluate for fracture healing. Three weight-bearing views of the right ankle are provided. Again seen is a oblique fracture through the distal fibular diaphysis with one cortical width posterior displacement of the distal fracture fragment. Early callus formation along the fracture indicates attempted healing. Mild soft tissue swelling about the ankle. | Healing distal fibular fracture as described above. |
Generate impression based on findings. | Pain, swelling, bruising.VIEWS: Left foot AP/lateral/oblique (3 views) 03/06/15 No significant soft tissue swelling is identified. The bones are normal in appearance. No fracture is seen. | Normal examination. |
Generate impression based on findings. | Male 1 day old Reason: lung field status History: hypoxiaVIEW: Chest AP (one view) 3/6/15 at 124 hours. Right mainstem bronchus intubation. NG tube and umbilical lines unchanged.Cardiac silhouette size is normal. Large lung volumes and diffuse lung haziness consistent with surfactant deficiency. No evidence of effusions or pneumothorax. | Right mainstem bronchus intubation.Persistent diffuse lung haziness consistent with RDS. |
Generate impression based on findings. | Shortness of breath, immobile, obese. PULMONARY ARTERIES: Technically limited study for evaluating PE due to body habitus. No evidence of pulmonary embolism to the lobar level.Main pulmonary artery is 31 mm suggestive of pulmonary artery hypertension.LUNGS AND PLEURA: Calcified nodules consistent with healed prior infection.No pleural effusion or focal airspace consolidation.Mosaic attenuation of the lungs may relate to small vessel disease.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes consistent with prior healed infection.Mild cardiomegaly. No visible coronary artery calcification. No pericardial effusion.CHEST WALL: Kyphotic thoracic spine with mild to moderate degenerative changes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips. | No evidence of pulmonary embolism to the lobar level or significant acute abnormality. Findings suggestive of pulmonary artery hypertension.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 49 days old Reason: compare to prior History: respiratory insuff , RSV infection.VIEW: Chest AP (one view) 3/6/15 at 238 hours. Cardiac silhouette size is normal. Large lung volumes. Right upper and left lower lobe opacity, likely atelectasis. Interval improvement in left upper lobe atelectasis. Peribronchial thickening. No effusions or pneumothorax. | Multifocal opacities and peribronchial thickening as described. |
Generate impression based on findings. | 76 are old male with cancer at the EG junction. Initial staging CT. CHEST:LUNGS AND PLEURA: There is an irregularly marginated parenchymal density in the left upper lobe on image 21/100 which is associated with bronchiectasis and thickening of the pleura and is consistent with scarring. Patchy groundglass at the left baseMEDIASTINUM AND HILA: Nodular thyroid extends in the superior mediastinum. Tip of a left-sided venous catheter in the SVC. Two enlarged subcarinal nodes, the larger measuring 1.3 x 1.7 cm on image 49/219. Very mild soft tissue thickening involving the distal esophagus. There is slight irregular density in the fat adjacent to the EG junction.CHEST WALL: Port in the left chest. Healed right rib fractures.ABDOMEN:LIVER, BILIARY TRACT: Inion region of the hepatic dome there is an ill -- defined area of rim-like low attenuation measuring 2.1 x 2.3 cm on image 77/219. Although this may represents a benign flow defect, the low circulating contrast levels on this exam limit full evaluation.SPLEEN: No significant abnormality notedPANCREAS: Fatty replacement.ADRENAL GLANDS: Both adrenal glands are enlarged with masses. Most discrete mass on the left measures 2.4 x 3 cm with indeterminate density on single phase CT and. Confluent nodules on the right appear similar.KIDNEYS, URETERS: Bilateral small cysts.RETROPERITONEUM, LYMPH NODES: Focal ectasia of the infrarenal aorta measuring 2.4 x 2.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Laxity of the anterior abdominal wall fascia. Left inguinal hernia containing mesenteric fat.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Seeds present within the prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Laxity of the anterior abdominal wall fascia. Left inguinal hernia containing mesenteric fat.BONES, SOFT TISSUES: Within the right gluteal fat adjacent to the gluteal musculature is an irregularly marginated fatty mass with apparent irregular encapsulation. This measures 5.2 x 8 cm on coronal image 34/153. Presumably this represents a complex lipoma or less likely fat necrosis. Other fatty neoplasm such as liposarcoma appears less likely.OTHER: No significant abnormality noted | 1. Subcarinal adenopathy.2. Slight infiltrative change in the fat about the EG junction.3. Bilateral adrenal masses which are indeterminate on single phase imaging.4. Questionable liver mass. This area would be difficult to visualize by ultrasound, and given the patient's depressed renal function more complete contrast enhanced CT or contrast enhanced MR are contraindicated. Noncontrast MR may be useful for further characterization. |
Generate impression based on findings. | 9-year-old female with right-sided back pain.VIEWS: Lumbar spine AP, lateral, L5/S1 spot view (3 views) , Ribs AP, right and left oblique views (3 views) obtained on 3/6/2015 at 0052 Lumbar spine: There is no acute fracture or malalignment. Vertebral body heights and disk spaces are preserved.Ribs: No displaced rib fractures are identified. No focal pulmonary opacity, pleural effusion, or pneumothorax. Normal cardiothymic silhouette. | Normal radiographs of the ribs and lumbar spine. |
Generate impression based on findings. | Right lower quadrant and right flank pain. Evaluate for appendicitis or kidney stone. ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis.LIVER, BILIARY TRACT: Small gallstones but no evidence of cholecystitis.SPLEEN: Autoinfarction of the spleen compatible with sickle cell disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Normal symmetric renal cortical enhancement without hydronephrosis or nephrolithiasis. Mild prominence of the proximal left ureter but no evidence of obstruction.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status-post tubal ligation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Nonobstructive bowel pattern. The appendix courses posterior to the cecum and superiorly along the right lateral abdomen to the inferior aspect of the liver. The appendix measures 6 to 8 mm in diameter which contains air intraluminally. There is minimal if any wall thickening and mild stranding of the adjacent fat. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of fluid in the pelvis is likely physiologic. | There is minimal inflammation around the appendix. However it would be unusual for appendicitis to present with air within the lumen of the appendix. Continued surveillance is recommended. If symptoms worsen, repeat imaging can be performed for further evaluation. |
Generate impression based on findings. | 78-year-old female with bilateral ankle fractures. Right ankle:Three views of the right ankle are provided. Interval removal of overlying casting material. Again seen is a plate and screw device affixing a distal fibular fracture in near anatomic alignment. The fracture lines are indistinct, which may reflect some healing. Also again seen are two orthopedic screws affixing a medial malleolus fracture in near anatomic alignment. The fracture line is indistinct, which may reflect some healing. Previously seen fracture of the "posterior malleolus" is not seen on the current exam, which may also reflect some healing.Left ankle:Three views of the left ankle are provided. Again seen is a transverse fracture through the tip of the distal fibula in near-anatomic alignment, appearing similar to prior exam accounting for differences in positioning. Soft tissue swelling about the ankle. | Ankle fractures as described above. |
Generate impression based on findings. | History of PE off anticoagulation. Acute shortness of breath and chest pain. History of COPD. Also evaluate for aortic dissection. PE? PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Scattered stable micronodules, most likely benign and postinflammatory.Scattered areas of interstitial scarring with associated mild traction bronchiectasis, such as at the right apex, unchanged.Mosaic attenuation of the lungs may be sequela of prior PE.No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes. Normal heart size without pericardial effusion. No visible coronary artery calcification.Exam is not tailored for evaluation of aortic dissection; given this limitation, no gross abnormality of the thoracic aorta is evident except for mild atherosclerotic calcification.CHEST WALL: Unchanged diffusely dense bones, which may relate to renal osteodystrophy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Colonic diverticula. | No evidence of pulmonary embolism or significant acute abnormality. Mosaic attenuation of the lungs and multifocal lung scarring may be sequela of prior PE.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male; 11 years old. Reason: twisted left ankle History: pain, swelling.VIEWS: Left ankle AP oblique lateral (3 views) 3/6/2015 at 0113 Mild soft tissue swelling is noted about the ankle. No acute fracture or dislocation. A small joint effusion is present. | Soft tissue swelling and small joint effusion without fracture. |
Generate impression based on findings. | headache and vomiting with recently diagnosed ITP CLINICAL INFORMATION:disturbance of skin sensationCOMPARISON: None.TECHNIQUE: MRI brain without contrast and MRA brain without contrast were performed. | 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. |
Generate impression based on findings. | Abdominal pain. Right upper quadrant and flank pain. Evaluate for stones. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal calculi. No hydronephrosisRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No kidney stones. No findings to explain right upper quadrant abdominal pain. |
Generate impression based on findings. | weakness and slurred speech No evidence of acute ischemic or hemorrhagic lesion.Focal encephalomalacia on the left internal capsule anterior limb indicating chronic ischemic infarction.Patchy low attenuation on bilateral mainly frontal subcortical white matter and periventricular white matter could represent non specific small vessel ischemic disease. However, since the distribution is mainly on frontal lobe, other white matter lesions could be considered. Therefore if clinically indicated, brain MRI can be considered for further evaluation.The ventricles, sulci, and cisterns are symmetric but slightly dilated. 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. | 1. Small chronic ischemic infarction on the left internal capsule anterior limb.2. Patchy bifrontal white matter low attenuations could represent non specific small vessel disease but other white matter lesions cannot be completely excluded. thus, brain MRI can be considered for further imaging evaluation if clinically indicated.3. No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | 50 years, Male, Reason: incarcerated hernia History: abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a narrow neck small ventral hernia containing a loop of transverse colon. There is adjacent fat stranding and mild bowel wall thickening but no evidence of obstruction or intra-loop fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Narrow neck ventral hernia containing a loop of transverse colon. There are surrounding inflammatory changes, but no evidence of obstruction. |
Generate impression based on findings. | Abnormal right kidney ultrasound. Please evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No evidence of renal calculi or masses. Slight malrotation of the right kidney which may explain the vague abnormality noted on recent ultrasound exam.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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight malrotation of the right kidney. No evidence of renal calculi or masses. |
Generate impression based on findings. | 2-year-old female with respiratory failure.VIEW: Chest AP (one view) 3/6/2015 at 0533 ET tube tip between the thoracic inlet and carina. Right PICC tip in the SVC. A gastrostomy tube is present. Surgical clips are noted about the GE junction.Normal cardiothymic silhouette. Patchy bilateral pulmonary opacities and probable small right apical pneumothorax appear similar to the prior study. Small bilateral pleural effusions. | Small right apical pneumothorax and patchy bilateral pulmonary opacities, not significantly changed. |
Generate impression based on findings. | Abdominal pain, RLQ. ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No loculated fluid or free air.PELVIS:UTERUS, ADNEXA: Gas and fluid are noted within the endometrial cavity.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal appendix. Nonobstructive bowel pattern. Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No loculated fluid or free air. | Gas and fluid within the endometrial cavity is nonspecific but suspicious for possible endometritis, which be further evaluated with a pelvic ultrasound. |
Generate impression based on findings. | Female; 3 months old. Reason: r/o obstruction History: cryingVIEW: Chest and abdomen AP (two views) 3/6/2015 at 0411 Chest: Normal cardiothymic silhouette. Mild diffuse lung haziness and subsegmental atelectasis in the right upper lobe. No pleural effusion or pneumothorax.Abdomen: Disorganized but nonobstructive bowel gas pattern. No pneumatosis, free air, or portal venous gas. Note is made of an umbilical hernia. | 1.Disorganized but nonobstructive bowel gas pattern.2.Mild diffuse lung haziness and right upper lobe subsegmental atelectasis. |
Generate impression based on findings. | Altered mental status after injury. Head: There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Cervical Spine: There is no evidence of fracture. There is straightening of the cervical spine alignment in the sagittal plane. The vertebral body and disc space heights are preserved. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable. The tyroid gland appears to be mildly enlarged diffusely with a prominent pyramidal lobe. There is nonspecific opacification of the partially-imaged lungs. There are partially-imaged endotracheal and enteric tubes. | 1. No evidence of acute intracranial hemorrhage or skull fracture.2. No evidence of cervical spine fracture.3. Nonspecific opacification of the partially-imaged lungs. |
Generate impression based on findings. | Female 74 years old Reason: Metastatic breast cancer needs re-evaluation and compare to prior scans. Per RECIST 1:1 bi-dimensional measurements where applicable. History: Metastatic breast cancer needs re-evaluation and compare to prior scans. Per RECIST 1:1 bi-dimensional measurements where applicable. CHEST:LUNGS AND PLEURA: Bilateral scattered nodules as noted previously. The index nodule in the right upper lobe measures 9 x 8 mm (image 15; series 6). Some of the nodules are fissure based. Small right-sided pleural effusion.MEDIASTINUM AND HILA: Small mediastinal lymph nodes.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver metastases increased in size and number. The index lesion in the right lobe measures 1.6 x 1.4 cm (image 100; series 4), larger.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland remains enlarged. Reference nodule measures 3.0 x 2.1 cm (image 87; series 4), unchanged. Right adrenal gland remains nodular. 1.6 x 1.4 cm nodule in the right adrenal gland (image 94; series 4) is unchanged.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Upper abdominal adenopathy is roughly stable. Index node measures 1.3 x 1.2 cm (image 91; series 4), unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the thoracic and lumber vertebral bodies consistent with metastatic disease, roughly unchanged to minimally progressed.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic lesions in the pelvic bones consistent with metastatic disease, roughly unchanged.OTHER: No significant abnormality noted. | Liver metastases increasing in size and number. Other metastatic disease appears roughly stable. |
Generate impression based on findings. | 59 year old woman with history of right ILC s/p mastectomy in 1999, no current complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Benign calcifications are stable along with stable focal asymmetry in the upper left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the breast. Stable intramammary lymph node. Benign appearing lymph nodes are projected over the left axilla. | 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. | Chest pain. Malignancy. Metastatic gastric cancer. Evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Scattered stable micronodules, most likely postinflammatory.No suspicious nodules.No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No pericardial effusion.No visible coronary artery calcification.Right chest wall port tip in the SVC.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Periportal lymphadenopathy and incompletely imaged gastroduodenal stent within thickened stomach, similar to prior. Gastroduodenal stent, similar to prior.Bilateral renal cysts. | No evidence of pulmonary embolism or significant acute abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 54 years, Male, Reason: r/o acute intraabdominal process History: sudden onset of hematemesis x 2 and abdominal pain after moving a car yesterday, +ventral hernia, a/so GSW s/p exlap. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Widemouth ventral hernias which are immediately adjacent to each other containing a loop of transverse colon and a loop of small bowel respectively without evidence of obstruction.BONES, SOFT TISSUES: Bullet fragment in the anterior subcutaneous tissues.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No acute abnormalities. Widemouth ventral hernias as noted above. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with slightly progressed mild chronic small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is a heterogeneous salt and pepper appearance of the calvarium, which is stable and nonspecific. | No acute intracranial abnormality. Slightly progressed mild chronic small vessel ischemic changes. if there remains clinical concern for an acute ischemic event, MR brain is recommended. |
Generate impression based on findings. | Fall. Head: There is no evidence of acute intracranial hemorrhage or mass. There are extensive cerebrovascular calcifications. There is extensive nonspecific cerebral white matter hypoattenuation. There are a few scattered chronic lacunar infarcts. There is diffuse cerebral volume loss. There is no midline shift or herniation. The mastoid air cells are clear. There is scattered mild paranasal sinus opacification. The skull and scalp soft tissues are unremarkable. There are right parotid calculi that measure up to 8 mm. There are multiple dental caries. There is an unchanged defect in the left lamina papyracea with orbital fat herniation.Cervical Spine: There is no evidence of fracture. There is mild straightening of the cervical spine alignment in the sagittal plane. The vertebral body heights are preserved. There is multilevel degenerative spondylosis with disc space height loss, posterior disc-osteophyte complexes and uncovertebral spurs. The paravertebral soft tissues are unremarkable. There is extensive atherosclerotic plaque at the carotid bifurcations. There is emphysema in the partially-imaged lungs. | 1. Extensive cerebrovascular calcifications, chronic lacunar infarcts, and nonspecific cerebral white matter hypoattenuation that likely represent small vessel ischemic disease, but no evidence of acute intracranial hemorrhage or skull fracture.2. Extensive degenerative spondylosis without evidence of cervical spine fracture.3. Right parotid calculi that measure up to 8 mm. 4. Multiple dental caries. 5. Unchanged defect in the left lamina papyracea with orbital fat herniation. |
Generate impression based on findings. | 35 years, Female, Reason: r/o acute process History: abd pain, vomiting. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly.SPLEEN: No significant abnormality notedPANCREAS: Cystic lesion in knee pancreatic head measures 1.1 x 1.0 cm, stable. Cystic lesion in the pancreatic tail measures 1.5 cm, stable. These were previously characterized as IPMN's on prior MRCP.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mildly atrophic kidneys bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate to severe abdominal ascites is slightly increased.PELVIS: FemaleUTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality notedLYMPH NODES: Enlarged inguinal lymph nodes bilaterally with the left inguinal node measuring 2.0 x 1.6 cm (3/143). Mildly enlarged right external iliac node measuring 2.5 x 1.1 cm (3/19).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No acute abnormalities.2.Moderate to severe ascites is slightly increased.3.Pancreatic IPMN's are grossly unchanged.4.Non-specific pelvic and inguinal lymphadenopathy. |
Generate impression based on findings. | Suspected sepsis. One year and 10 month old former 29 week gestational age patient with history of NEC and bowel resection.VIEW: Chest AP (one view) 03/06/15, 0829 Lung volumes are large. Mild peribronchial thickening is seen. No focal airspace disease is present. Cardiothymic silhouette is normal.Left central line tip is at junction of brachiocephalic veins. | Bronchiolitis/reactive airways disease pattern, a new finding. |
Generate impression based on findings. | Reason: bleed? mass? History: syncope? The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Periventricular and subcortical white matter hypodensities of a mild to moderate degree are present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Abdominal pain and sepsis. ABDOMEN:LUNG BASES: Scattered bibasilar atelectasis.LIVER, BILIARY TRACT: Cholelithiasis within a collapsed gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild bilateral ureteral dilatation and caliectasis. Nonobstructive left nephrolithiasis. Multiple small hypoattenuating lesions many of which likely represent benign cysts. However a single heterogeneously enhancing renal lesion in the left upper pole measures 1.9 x 1.9 cm and is indeterminate. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is markedly enlarged with a heterogeneously enhancing central hypoattenuating mass measuring 9.6 x 10.0 cm (series 3, image 114). BLADDER: The bladder is collapsed and compressed by the uterine mass.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.Markedly enlarged uterus with a large hypoattenuating mass, likely representing a degenerative fibroid. This mass causes mild ureteral dilatation and caliectasis. CT is non-specific for evaluating uterine masses and can be further evaluated with ultrasound if clinically warranted.2.Heterogeneously enhancing 1.9 centimeter left upper pole renal lesion is incompletely evaluated but could represent focal infection or a mass. Follow up imaging is recommended within 6 months to assess resolution or persistence.3.Cholelithiasis.Findings discussed with Trisha Sheth, NP of the patient's primary service (pager 5150) at the time of this dictation by Dr. Michael Veronesi of the Radiology service at the time of this final dictation. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with stable moderate chronic small vessel ischemic changes. There are again patchy areas of low density in the left brachium pontis and in the pons likely representing areas of chronic small vessel ischemic change. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There are prominent intracranial vascular calcifications. There is mild hyperostosis frontalis interna. | No acute intracranial abnormality. Stable moderate chronic small vessel ischemic changes. If there remains clinical concern for an acute ischemic event MRI of the brain is recommended. |
Generate impression based on findings. | Fracture.VIEWS: Left thumb PA/lateral/oblique (3 views) 03/06/15 Proximal phalanx metaphyseal fracture of has developed more sclerosis. Callus formation is present around the metaphysis and diaphysis. Alignment is unchanged with posterior angulation of the fracture fragment. | Continued healing of fracture of proximal phalanx. |
Generate impression based on findings. | Right pleural effusion with shortness of breath LUNGS AND PLEURA: Large right pleural effusion which appears partially organized. Small left pleural effusion, also partially loculated anteriorly. No specific evidence of empyema. These pleural effusions are new since the previous abdominal exam of 12/2014. Within the inferior aspect of the left upper lobe (4/65), there is a nodular density with surrounding atelectasis that is more prominent than prior study. This is contiguous with the major fissure (80292/77) and may be postinflammatory. Continued observation to insure stability is recommended.Nearly the entire right lower and middle lobes are atelectatic. There is minimal atelectasis involving the inferior aspect of the right upper lobe. MEDIASTINUM AND HILA: Common origin of the innominate and left common carotid arteries. Extensive multifocal atherosclerotic disease involving the descending and descending thoracic aorta. Minimal involvement of the sinus of Valsalva is identified. Extensive coronary artery disease, greatest at the LAD and circumflex coronary arteries. There has been prior coronary artery revascularization with what appears to be the right internal mammary artery utilized (crossing midline at the level of the left brachiocephalic vein) to bypass the left anterior descending artery. There is minimal hematoma/fluid in the anterior superior pericardial space which may be related to recent operation, possibly via robotic approach.The overall heart size is within limits of normal. CHEST WALL: The sternum is intact.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. There is a tablet in the stomach. | Large right and small left, partially organized pleural effusions. No evidence of empyema. These are new since the abdominal examination from 12/2014.Near complete atelectasis of the right middle and lower lobes.Increased nodular density within the in superior aspect of the left upper lobe that is contiguous with the pleura, suspected to be postinflammatory.Postsurgical changes reflect left anterior descending coronary artery bypass via the right internal mammary artery with minimal anterior pericardial fluid and/or hematoma, likely via robotic approach. |
Generate impression based on findings. | Reason: AMS, evaluate for pathology, h/o meningitis History: AMS The lateral ventricles and third ventricle are enlarged. Biventricular diameter on coronal imaging to the level of foramina of Monro is currently 46 mm and was previously 40 mm. Third ventricular diameter has increased from 12 mm to 15 mm appeared the temporal horns of the lateral ventricles are dilated slightly more than on the prior exam There is a moderate degree degree of periventricular and subcortical confluent hyperdense white matter lesions present.Small hypodense foci are present in the right thalamus, brainstem and basal ganglia. These are stable compared to the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.Since the prior exam from end of November the lateral and third ventricles have increased in size.2.Periventricular hypodensities continue to be present and have progressed since the prior exam. One possibility is that these hypodensities represent so-called subependymal migration of cerebrospinal fluid associated with ventriculomegaly raising the question of hydrocephalus. MRI may be helpful in further investigating this.3.No evidence for acute intracranial hemorrhage mass effect or edema.4.Punctate lesions in the basal ganglia, thalami and brainstem are suspected to be vascular related. These are unchaged since November. |
Generate impression based on findings. | Tachycardic, history of lung cancer. Assess for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery diameter is 35 mm suggestive of pulmonary artery hypertension.LUNGS AND PLEURA: Large left perihilar/upper lobe mass invading into the mediastinum and obstructing the left mainstem bronchus approximately 3 cm from its origin. It also encases and significantly attenuates the left main pulmonary artery and distal branches. Given its irregular shape, this mass cannot be reproducibly measured.Patchy groundglass opacities with septal lines in the left lung consistent with a post-obstructive pneumonitis and edema.Complete post-obstructive atelectasis with mucus plugging of the left lower lobe.Left upper lobe nodules, including a 19 mm nodule (series 10, image 22), consistent with metastases.Small likely malignant left pleural effusion.Trace right pleural fluid in the major fissure. 8 mm right lower lobe nodule is indeterminate (series 10, image 78), suspicious for a contralateral metastasis.Mild centrilobular emphysema.MEDIASTINUM AND HILA: Subcarinal and left hilar lymphadenopathy inseparable from the left upper lobe/perihilar mass. Normal heart size without pericardial effusion.Mild coronary artery calcification.CHEST WALL: Minimal degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating renal foci, likely cysts. | 1. No evidence of pulmonary embolism.2. Large left perihilar/upper lobe mass consistent with primary lung malignancy. There is significant mediastinal tumor invasion and obstruction of the left mainstem bronchus. Post-obstructive pneumonitis and edema in the upper lobe and complete collapse of the lower lobe. Ipsilateral pulmonary metastases and suspicious nodule in the right lung.3. Small left pleural effusion, likely malignant. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is a hypoplastic right maxillary sinus which is completely opacified. There is mild mucosal thickening in the left and minimal opacification of right anterior ethmoid air cells. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is a heterogeneous appearance of the calvarium with a fine salt and pepper appearance, likely related to patient's underlying osteogenesis imperfecta. There is mild disconjugate gaze | No acute intracranial abnormality. |
Generate impression based on findings. | Male 56 years old Reason: neuroendocrine cancer of the pancreas. Please measure all measurable lesions using recist criteria 1.1 History: pre chemo ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver, unchanged. Previously described reference lesion in the dome of the right lobe (image 15; series 8) has increased in size and currently measures 1.6 x 1.4 cm. Additional tiny lesions are also evident; subcapsular right lobe punctate lesion (image 29), subcentimeter segment 4 lesion along the fissure (image 29), and subcentimeter lesion inferiorly along the capsule in the right lobe (image 60). All presumed to represent metastases. Cholelithiasis, unchanged.SPLEEN: Status post splenectomy.PANCREAS: Previously described enhancing mass in the region of the pancreatic body again measures 8.8 x 7.6 cm (image 49; series 10), unchanged. Invasion of extrahepatic portal vein and SMV again noted. A second soft tissue mass in the pancreatic head cannot be differentiated from the normal pancreatic parenchyma. It previously measured 3 x 2.6 cm. I cannot measure it on today's examination because I cannot differentiate it from adjacent parenchyma. Overall, the area appears the similar. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bilateral anterior abdominal wall hernias containing small bowel and colon segments. Small amount of fluid within the left-sided hernia sac is again noted. Nodularity in the omentum may reflect carcinomatosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Previously measured right -sided gluteal subcutaneous soft tissue density has resolved.OTHER: No significant abnormality noted | Liver metastases increasing in size and number. Stable pancreatic masses. Possible carcinomatosis. Roughly unchanged hernias. |
Generate impression based on findings. | Male; 2 days old. Reason: Is there evidence of a pneumothorax? History: 38 weeks on vent with history of pneumothorax. VIEW: Chest AP (one view), left humerus AP and lateral (two views) 3/6/2015 0543 Humerus: Complete transverse fracture of the mid humeral diaphysis, with ventral and medial angulation of the distal fracture fragment.Chest: ET tube tip at the thoracic inlet. Feeding tube tip in the stomach. UVC tip in the left hepatic vein/IVC. UAC tip at the level of T9. Esophageal temperature probe is again noted. Normal cardiothymic silhouette. There has been significant interval improvement in bilateral pulmonary opacities. No pleural effusion or pneumothorax. Fracture of the left humeral diaphysis is again visualized. Marked soft tissue edema is noted. | 1.Transverse humeral shaft fracture as described above.2.Significant interval improvement in bilateral pleural effusions and associated atelectasis. |
Generate impression based on findings. | Images are limited by susceptibility artifact along the posterior inferior head. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is focal prominence of CSF signal along the anteromedial aspect of the left middle cranial fossa, with associated thinning of the left lesser wing of the sphenoid at this level, which may represent an arachnoid cyst with bony remodeling. This measures 1.2-cm transverse by 1.4 cm CC. The cortex remains intact, without definite meningocele at this time.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a large mucosal retention cyst in the right maxillary sinus, and a smaller one in the left. There is moderate-severe fluid opacification of bilateral mastoid air cells. There is an overall increased number of face and scalp vessels, although in a symmetric pattern. | 1. No evidence of intracranial metastatic disease.2. Incidental focal prominence of CSF signal along the anteromedial left middle cranial fossa with bony remodeling which may relate to an arachnoid cyst.3. Prominent maxillary sinus mucosal retention cysts with moderate-severe fluid opacification of bilateral mastoid air cells, for which clinical correlation is recommended. |
Generate impression based on findings. | 50 years, Male. Reason: Rule out intestinal obstruction History: Nausea \T\ vomiting Gastrostomy tube projects over the gastric body. Scattered coiled tacks, surgical clips, and a right iliac stent is again noted. Multiple air-fluid levels within dilated bowel. No pneumoperitoneum. | Findings concerning for small bowel obstruction. If symptoms persist, CT may be considered. |
Generate impression based on findings. | Female, 35 years old, status post craniotomy. A left pterional craniotomy has been performed. Skin staples, intracranial air, and a small amount of mixed attenuation extraaxial fluid subjacent to the craniotomy are compatible with recent surgery. An aneurysm clip has been placed along the left anterior clinoid process.No evidence of significant parenchymal edema is seen. No parenchymal hematoma is detected. The ventricles are normal in size and morphology. | Expected findings status post left sided craniotomy and aneurysm. |
Generate impression based on findings. | 50 year-old male with foot pain bilaterally, especially left heel. Right foot:Three views of the right ankle again demonstrate multiple foci of mineralization in the ankle joint compatible with synovial osteochondromatosis, appearing similar to the 2009 study. Small ossicles are now also seen in the soft tissues adjacent to the naviculocuneiform articulation, perhaps representing extension of loose bodies into a tendon sheath. Severe osteoarthritis affects the first MTP joint, appearing similar to prior.Left foot:Three views of the left left are provided. Dorsal midfoot osteophytes indicate mild osteoarthritis. Mild osteoarthritis also affects the first MTP joint. No specific findings to account for the patient's heel pain. | 1.Osteoarthritis as described above.2.Synovial osteochondromatosis of the right ankle as described above. |
Generate impression based on findings. | Newly diagnosed head and neck cancer, compare to previous, post op CT neck for baseline scan CHEST:LUNGS AND PLEURA: Nodular fissural density on the right (5/54) most compatible with an intrapulmonary lymph node.Minimal apical pleural parenchymal scarring. No suspicious pulmonary nodules or pleural effusion.MEDIASTINUM AND HILA: The heart size is within limits of normal. No pericardial effusion. Mild to moderate multifocal coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary or subpectoral lymphadenopathy. Small supraclavicular lymph nodes.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypodensities throughout the hepatic parenchyma which are incompletely characterized but do favor cysts or hemangiomas.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral exophytic cysts, more numerous on the right.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted. Small hiatal hernia.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracolumbar spine with mild kyphosis at the midthoracic level. The subxiphoid process is directed anteriorly.OTHER: No significant abnormality noted. | Small right nodular fissural density compatible with an intrapulmonary lymph node. No suspicious pulmonary nodules.Small supraclavicular lymph nodes. No subpectoral or axillary lymphadenopathy. |
Generate impression based on findings. | 2-day-old male with sepsis, oliguria and increasing creatinine. BLADDER Wall Thickness: The bladder is almost completely collapsed. Contents: Small amount of fluid. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Echogenic renal cortices bilaterally, appropriate for age. Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 1 Left: 2 Length*** Right: 4.9 cm Left: 4.8 cm Mean for age: 4.5 cm Range for age: 3.9 - 5.8 cmADDITIONAL OBSERVATIONS: Echogenic debris is noted within the bilateral collecting systems. Hypoechoic lesion in the spleen may represent infarct or intraparenchymal hematoma, not significantly changed. | 1.Right grade 1 and left grade 2 hydronephrosis with echogenic debris in the bilateral collecting systems, likely secondary to history of sepsis.2.Hypoechoic splenic lesion which may represent infarct or intraparenchymal hematoma, also seen on recent exam.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | 61 years, Male, Reason: 61M hx PCa s/p RALP c/b infected lymphocele s/p IR drain placement. Repeat CT to evaluate resolution of abdominopelvic fluid collection History: IR drain placed for infected lymphocele.. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenule.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney. Scarring of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric band and postoperative changes in the stomach with a small hiatal hernia.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: There is a large collection in the which runs along the right pelvic sidewall into the right inguinal canal. There is been interval drain placement. This collection is slightly increased in the pelvis measuring 10.6 x 6.5 cm (3/106), previously 9.4 x 5.7 cm. However, in the inguinal canal this collection is decreased measuring 8.1 x 5.0 cm (3/158), previously 10.4 x 7.5 cm. There is mild enhancement of the wall and surrounding fat stranding. The right ureter courses along the medial aspect of the collection. A smaller left pelvic collection measures 5.9 x 3.0 cm (3/123), previously 5.8 x 2.0 cm. | Pelvic fluid collections are overall unchanged, likely a lymphocele/seroma. Adjacent fat stranding and wall enhancement again noted. |
Generate impression based on findings. | 58-year-old male with pain in shoulder/clavicle region. Left clavicle:Two views of the left clavicle demonstrate a comminuted fracture of the distal left clavicle. The distal clavicle and fracture fragments are elevated relative to the acromion perhaps indicating disruption of the coracoclavicular ligament and likely the AC joint capsule as well.Bilateral acromioclavicular joints:One view of the bilateral acromioclavicular joints is provided. Again seen is the aforementioned left distal clavicular fracture. Two orthopedic screws are noted in the right clavicle, presumably affixing an old clavicular fracture. | Distal left clavicular fracture as described above. |
Generate impression based on findings. | 76-year-old female with history of subarachnoid hemorrhage and right EVD removal. Stable appearing left frontal EVD catheter. Bilateral anterior frontal and left peripheral cerebellar hematomas and diffuse subarachnoid hemorrhage are stable in size and appearance. Blood products in the dependent portions of the lateral ventricles is slightly less dense indicating continued evolution. There is unchanged mild to moderate ventriculomegaly. There is no CT evidence acute ischemia. No midline shift or evidence of brain herniation. There is partial opacification of the right mastoid air cells. Partially imaged nasoenteric tube. | 1. Unchanged left frontal EVD catheter.2. Stable bilateral anterior frontal, left peripheral cerebellar hematomas and diffuse subarachnoid hemorrhage. |
Generate impression based on findings. | 49-year-old female with history of chronic sinusitis. Postoperative changes of prior sinus surgery including bilateral antrostomies and partial ethmoidectomies.The frontal sinuses are clear bilaterally. Minimal mucosal thickening of the maxillary sinuses bilaterally. Mild mucosal thickening of the anterior and posterior ethmoid sinuses. No osseous changes to suggest chronic sinusitis. The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. Minimal rightward nasal septal deviation. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. Scattered dental caries are noted. | 1.Stable mild sinus opacification without outlet obstruction.2.Status post paranasal sinus surgery. |
Generate impression based on findings. | 83 years Female with right neck dissection with wound infection. Evaluate for abscess. There are extensive inflammatory changes with skin thickening throughout the right neck soft tissues, with multiple small fluid collections suspicious for phlegmon/abscess formation. One such collection inferior to the right parotid gland and lateral to the right carotid space measures 1.5 x 1.2 cm in axial dimension (series 7 image 35) by 1.8 cm in oblique cranial caudal dimension (coronal series image 38). Another more inferior collection just right of midline anterior to and below the cricoid cartilage measures 1.8 x 1.3 cm in axial dimension (series 7 image 50). Curvilinear soft tissue density extending superiorly from this collection terminating in the submandibular subcutaneous tissues may represent a sinus tract.Surgical clips are noted status post neck dissection. A defect in the left nasal soft tissue is consistent with the patient's known resected neoplasm. There is mild nonspecific soft tissue in this region which may represent posttreatment changes. A small nodule in the left parotid gland is unchanged. Status post thyroidectomy. The imaged portions of the orbits and intracranial contents are unremarkable. There is multilevel cervical spondylosis. The imaged lung apices are unremarkable. | 1. Extensive inflammatory changes throughout the right neck soft tissues with likely small abscesses and possible sinus tract formation as described above.2. Postoperative changes of neck dissection and left nasal tumor resection as described. |
Generate impression based on findings. | Thumb injury.VIEWS: Right thumb PA/lateral/oblique (3 views) 03/06/15 A small curvilinear ossification is noted immediately adjacent to the lateral aspect of the epiphysis of the proximal phalanx. No soft tissue swelling is identified. | Accessory center of ossification of the epiphysis of the proximal phalanx. |
Generate impression based on findings. | Female, 35 years old, status post aneurysm clipping. Evidence of recent left pterional craniotomy is again seen. Intracranial air, and a small amount of mixed attenuation extraaxial fluid subjacent to the craniotomy, remain evident and are compatible with recent surgery. An aneurysm clip is in place along the left anterior clinoid process.At most there may be mild edema within the left temporal lobe but this is equivocal. No intraparenchymal hemorrhage is detected. The ventricles are normal in size and morphology. | Redemonstration of expected finding status post aneurysm clipping. |
Generate impression based on findings. | Pain. Follow-up fracture. Again seen is a nondisplaced fracture of the proximal fibular diaphysis, with increased callus formation compared with the prior study, indicating further interval healing. | Healing proximal fibular fracture. |
Generate impression based on findings. | Evaluation is somewhat limited due to lack of intravenous contrast and dedicated vascular imaging.Corresponding to an area of retrospective fat density on prior CT, there is a large pedunculated T1 hyperintense oval structure residing within the posterior nasopharynx extending into the oropharynx, which demonstrates dropout of signal on fat saturated images. There is a small amount of surrounding fluid signal within the pharynx on the T2-weighted images. There is a central area of differential signal which is T1 hypointense and mildly T2 hyperintense on fat saturated images consistent with a fibrovascular stalk. The tail of the mass extends directly into the right eustachian tube along the right lateral nasopharyngeal wall. It traverses the entire distance of the widened right eustachian tube and correlating with prior CT imaging it is noted that it bulges into the anteromedial margin of the right middle ear cavity, which can also be discerned on the thin section axial T1-weighted images. There is slight waisting of the stalk perhaps at the level of entry into the eustachian tube, with the right internal carotid located immediately posteriorly.The pedunculated portion of the mass measures 1.5-cm transverse by 1.0-cm AP, by 2.4 cm CC. The stalk measures 5 mm in greatest thickness and appears located a 3-4 mm from the lateral margin of the right carotid canal. These CT images also demonstrate asymmetric attenuation and poor delineation of the lateral wall of the carotid canal along the distal vertical segment of the petrous right internal carotid artery is seen on 4/11-14, adjacent to the mass, although the exam is slightly limited by patient motion artifact. Areas of focal bony dehiscence cannot be entirely excluded. More cranially, the right carotid canal appears intact although the patient is asymmetrically positioned.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal parenchymal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is no definite atresia of the visualized left internal carotid artery which can be an associated finding. The midline structures and craniocervical junction are within normal limits. There is fluid opacification of bilateral mastoids and middle ears. | Large pedunculated fat signal intensity mass which traverses the entire length of the widened right eustachian tube to bulge into the right middle ear, with pedunculated portion residing in the nasopharynx and oropharynx. Correlation with previous CT imaging demonstrates asymmetric attenuation of the lateral wall of the right carotid canal at the level of the middle ear, with areas of focal dehiscence not entirely excluded. The finding is most suggestive of a hairy polyp/nasopharyngeal dermoid. |
Generate impression based on findings. | Swelling and pain. Knee effusion, fracture? There is a large joint effusion, but I see no acute fracture. Severe osteoarthritis affects the knee, particularly the patellofemoral joint, and there are several small chronic appearing ossicles along the lateral margin of the patella. There is chondrocalcinosis of the menisci. | Degenerative arthritic changes and large joint effusion, without fracture evident. If there is strong clinical concern for fracture, CT may be considered. |
Generate impression based on findings. | Left shoulder pain The acromioclavicular joint appears slightly widened which may reflect prior mild separation, but I see no adjacent soft tissue swelling on the current study to suggest an acute injury. The bones appear slightly demineralized. I see no fracture or frank osteoarthritic changes. Glenohumeral joint alignment is within normal limits. | Slight widening of the acromioclavicular joint may reflect an old injury, but I otherwise see no specific findings to account for the patient's shoulder pain. |
Generate impression based on findings. | Hip pain Two views of the right hip show severe osteoarthritis.The AP view of the pelvis shows severe osteoarthritis of the right hip. Relatively mild osteoarthritis affects the left hip. There is a transitional lumbosacral vertebra with hypertrophy of the transverse processes that articulate with the underlying sacrum. | Osteoarthritis. |
Generate impression based on findings. | Male, 69 years old, squamous cell carcinoma of the left cheek. Mild subcutaneous infiltration and skin thickening/retraction along the left cheek are again seen compatible with the history of a resected squamous cell carcinoma.Since the prior examination, a partial left parotidectomy has been performed along with a left neck dissection. Several previously seen lymph nodes have been removed including a suspicious node which was present at the parotid tail. There is scarring and infiltration through the left neck compatible with surgery, but no new or concerning lesions are detected. Small lymph nodes are again seen on the right side of the neck without significant change.The remaining salivary glands and thyroid are unremarkable. The cervical vessels enhance normally with the exception of the left IJ vein which is not well seen. No osseous lesions are detected. | Findings are seen consistent with prior resection of a squamous carcinoma from the left cheek as well as interval left partial parotidectomy and left neck dissection. No evidence to suggest recurrent primary tumor or new adenopathy is detected. |
Generate impression based on findings. | 45 year old female presents for routine screening mammography. History of breast cancer in maternal aunt and paternal grandmother. Two standard digital views and tomosynthesis 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. Bilateral scattered, regionally distributed calcifications are unchanged. No suspicious masses or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Testicular cancer. Rule out metastases. ABDOMEN:LUNG BASES: No significant abnormality noted. The nodular opacities at the right lung base on the prior examination have resolvedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT evidence of metastatic disease. |
Generate impression based on findings. | Interval increase in the size of the epidural right frontal lesion since the prior study now measuring 1.8 x 1.1 cm in axial dimension (series 3 image 41), now with peripheral enhancement. Additionally, there is apparent mild dural/subdural space widening measuring 3-4 mm along the right frontal convexity. Other mixed sclerotic/lytic lesions within the calvarium affecting the frontal, parietal, and right occipital lobes are otherwise without significant interval change. There is mild mass effect on the right frontal lobe but no evidence of significant vasogenic edema, midline shift, or herniation.There is mild left periorbital soft tissue swelling. However there is no discrete soft tissue or osseous lesion in this location. The left globe, extraocular muscles, and intraconal contents appear unremarkable. | 1. Increased size of right frontal epidural lesion since the prior study. Additionally there is now suggestion of mild dural/subdural space widening which may represent fluid, soft tissue, or a combination of both. This could be further evaluated by MRI as clinically warranted. 2. Other mixed lytic/sclerotic calvarial lesions are without acute interval change. 3. Nonspecific mild left periorbital soft tissue swelling, but no discrete soft tissue or osseous lesion in this location to account for the patient's symptoms. |
Generate impression based on findings. | There are postoperative findings related to prior left cerebral convexity subdural hematoma decompression with a residual subdural collection that measures up to 5 mm in width. Otherwise, there is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There are vascular calcifications. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is irregularity of the right nasal skeleton, which may be related to prior fracture. | Postoperative findings related to prior left cerebral convexity subdural hematoma decompression with a residual subdural collection that measures up to 5 mm in width. Otherwise, no evidence of acute intracranial hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 31 years, Female, Reason: Assess for location of rectovaginal fistula History: Air from the vagina. PELVIS: FemaleUTERUS, ADNEXA: Uterus and vagina are normal appearing. There is a small amount of fluid between the vagina and rectum, however no discrete rectovaginal fistula is identified.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Surgical clips are seen in the distal sigmoid. No perianal fistulas.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of a rectovaginal fistula. |
Generate impression based on findings. | 74 year old woman with history of right breast DCIS s/p lumpectomy 2007, no new complaints. History of sister with breast cancer. Three standard views of both breasts with additional CC and MLO view of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Local volume loss, architectural distortion, and parenchymal thickening is seen in the right upper breast at the site of multiple surgical clips, compatible with history of lumpectomy. A biopsy clip is noted in the posterior lower right breast. Bilateral benign morphology calcifications are unchanged. No dominant mass, suspicious microcalcifications, or areas of architectural distortion are seen in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 75-year-old male. Malignant neoplasm of the penis. Urothelial SCC in remission needs restaging. CHEST:LUNGS AND PLEURA: Calcified granulomas. No suspicious pulmonary nodule or masses. No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts, unchanged. Cholelithiasis again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst unchanged. Additional subcentimeter renal hypodensities are too small to characterize, most likely cysts and unchanged.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine as noted previously.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Sigmoid diverticulosis.BONES, SOFT TISSUES: Thickening and stranding of the anterior pelvic soft tissues, similar to prior exam. Degenerative changes of the thoracolumbar spine, unchanged.OTHER: No significant abnormality noted | No CT evidence of metastatic disease. |
Generate impression based on findings. | 46 years, Female. Reason: ileus? History: distended abd There is gaseous distention of the large and small bowel, compatible with an ileus type bowel gas pattern. A drain projects over the right upper quadrant. Left lower extremity central venous catheter noted. Right basilar lung opacities are better evaluated on chest radiograph on the same day. | Ileus type bowel gas pattern. |
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 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. | 60 year-old female with myeloma, screening survey as baseline prior to start of new chemotherapy. SKULL: Although there are no discrete myelomatous lesions, there is a mottled appearance to the calvarium, which may represent myelomatous deposits, appearing similar to prior. Small lucent lesion in the mandibular ramus may also represent a myelomatous deposit, appearing similar to prior.CERVICAL SPINE: Small lucency in the spinous process of C3 may represent a myelomatous deposit, although this is equivocal, and appears similar to the prior study. We see no additional discrete myelomatous lesions.THORACIC SPINE: The bones appear demineralized. Again seen are multiple compression fractures appearing similar to prior. LUMBAR SPINE: Again seen is compression fracture of L1 with kyphoplasty cement and anterior cement extrusion unchanged from prior examinations. Mild wedge deformity of L2 also appears similar to prior. Facet joint osteoarthritis of the lower lumbar spine. Slight leftward curvature of the lumbar spine.RIBS: The bones appear demineralized. Mild deformities of the right fifth and left seventh and 10th ribs appear similar to prior studies and may represent healed fractures or stable myelomatous deposits. Clavicular and scapular lucencies also appear similar to prior and compatible with myelomatous lesions. Right-sided central venous access device is noted.PELVIS: No discrete myelomatous lesions. Mild osteoarthritis affects both hips.UPPER EXTREMITY: Again seen are several small lucencies of the bilateral humeral diaphyses, which may represent myelomatous deposits, appearing similar to prior allowing for differences in technique.Lucency in the right ulnar diaphysis may represent a myelomatous lesion; it is unchanged compared to prior. Widening of the right scapholunate interval is unchanged. No discrete myelomatous lesions in the left forearm. Widening of the left scapholunate interval is unchanged.LOWER EXTREMITY: No discrete myelomatous lesions in the right femur. A poorly defined lucency in the distal metadiaphysis of the left femur may represent a myelomatous deposit and appear similar to prior.Lucencies in the right tibia and fibula may represent myelomatous deposits and appear similar to prior. No discrete myelomatous lesions in the left tibia/fibula. | Findings compatible with multiple myeloma, appearing similar to the prior exam. |
Generate impression based on findings. | 56 years, Female. Reason: evaluate for obstrucion versus ileus versus gaseous distension History: diffuse abdominal pain, decreased stool output, abdominal distension Centralized loops of air distended compatible with ascites and ileus. TIPS and cholecystectomy clips are unchanged. Interval removal of Dobbhoff tube. Right central venous catheter tip in the superior vena cava. Bilateral pulmonary opacities are better evaluated on recent chest radiograph. | Persistent ileus type bowel gas pattern. |
Generate impression based on findings. | 50 years, Female, Reason: hx of right lower quadrant abdominal pain and microscopic hematuria, evaluate etiology for hematuria and evaluate gallbladder History: abdominal pain (right sided). ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. No renal stones. No focal renal lesions. Normal opacification of the ureters on delayed phase images without focal lesions evident.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. Appendix is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Atrophic/surgically absent uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Minimal mucosal hyperenhancement of the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No findings to account for patient's hematuria.2.Minimal mucosal hyperenhancement of the rectum may suggest a nonspecific colitis. |
Generate impression based on findings. | 54-year-old female with history of benign right breast biopsy. No new breast complaints. No family history of breast cancer. BILATERAL DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of a stable mass in the lower inner right breast which contains a ribbon clip. There has been interval enlargement of a mass within the upper outer left breast, with partially obscured posterior margin. This persists on spot compression imaging. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Other bilateral masses/focal asymmetries are stable. Benign appearing lymph nodes are projected over both axillae.LEFT BREAST ULTRASOUND: On physical examination, there is a firm, mobile 1.5 cm mass at the approximate 2:00 position of the left breast. A targeted left ultrasound was performed for the mammographic and palpable area of concern. At the 2:00 position of the left breast, 6 cm from the nipple, there is a parallel, circumscribed, hypoechoic mass with gentle lobulations measuring 1.6 x 0.8 x 1.9 cm. This mass demonstrates peripheral vascularity on doppler imaging. | Interval enlargement of a hypoechoic mass at the two o'clock position of the left breast. While this may represent a fibroadenoma, ultrasound guided core needle biopsy is recommended for definitive histologic diagnosis. Results recommendation were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 73 year old female patient with failed optical colonoscopy. The scout film shows a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. There is no evidence of obstructing or constricting lesions. Tortuous sigmoid and descending colon was noted. The colonic mucosa is normal in appearance with no evidence of ulceration, edema, or mass lesions. The were scouted right and left colon diverticula, most marked in the sigmoid and descending colon. Small amounts of barium and air were refluxed into the terminal ileum. Spot films of the terminal ileum were normal. The retrocecal appendix was visualized and is normal in appearance. | 1.Tortuous sigmoid and descending colon.2.Diverticulosis most prominent in the sigmoid and descending colon without polyps or masses. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal grandmother with breast cancer. Two standard digital views of both breasts with additional bilateral MLO views were performed 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. | Bone deformityVIEWS: Right hand AP lateral and oblique 3/6/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Three year old female with failure to thrive. Please note that originally scheduled upper GI examination to assess anatomy was canceled given patient's normal upper GI from 2011.VIEW: Abdomen AP (one view) 3/6/2015 at 0929 Feeding tube tip in gastric antrum. Nonobstructive bowel gas pattern. No pneumatosis, pneumoperitoneum, or portal venous gas. Moderate fecal burden in the rectosigmoid colon. | Normal examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral benign biopsies. Maternal grandmother with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Linearly distributed pleomorphic calcifications are seen in the left lower inner breast. There may be an additional subtle cluster closer to the nipple as seen on the CC view. Biopsy clip in left upper inner breast noted. No suspicious mass or architectural distortion is seen in either breast. | Microcalcifications in the left breast for which further evaluation with spot magnification views is recommended. Finding and recommendation were communicated to Dr Oyler via email on 3/6/15.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 41-year-old female with history of Crohn's colitis status post total abdominal colectomy and completion proctectomy with symptoms of intermittent small bowel obstruction. The scout film shows a nonobstructive bowel gas pattern. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, or fistulae. No separation of bowel loops was present to suggest fibrofatty proliferation. The bowel loops were freely mobile during fluoroscopically monitored palpation. Spot films of the ileostomy demonstrates a slight angulation of the ileum approximately 5 cm that increases with respiration. This segment is distensible with brisk injection of contrast. No evidence of active disease. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 9:25 minutes | Normal examination of the small bowel without evidence of active disease. |
Generate impression based on findings. | 72-year-old female with mycosis fungoides here for dysphagia. Scout radiograph of the chest showed tortuous aorta and blunting of the left costophrenic angle, likely a small pleural effusion. Large calcified subcarinal lymph node and additional scattered granulomas compatible with prior granulomatous disease.Tracheal aspiration with absent cough reflex was noted. Partial clearing of contrast was attained with coughing. Double contrast evaluation of the esophagus demonstrates a large mass filling the left pyriform sinus (series 5). There is mass effect on the right vallecula and epiglottis with deviation of the contrast passage to the left (cine series 6 and 10). A prominent cricopharyngeal bar was also noted at the level C4-C5. A diverticulum is noted in the mid esophagus, likely pulsion (series 12).Gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary peristaltic wave at the level of the aortic arch with occasional tertiary waves. Secondary waves were noted with slight proximal escape. TOTAL FLUOROSCOPY TIME: 4:06 minutes | 1.Large mass located in the right pyriform sinus as described above. 2.Silent tracheal aspiration, likely secondary #1. 3.Midesophageal diverticulum.4.Mild motor abnormality of the esophagus. 5.Prominent cricopharyngeal bar at C4-C4 level. Findings discussed with Dr. Curran at the completion of the study by Dr. Dachman. |
Generate impression based on findings. | pT3N1 squamous cell carcinoma of the right oral tongue, status post surgery, FHX completed on 10/30/13, and radiation therapy. There are post-treatment findings in the oral cavity region. There is patchy enhancement in the treatment bed without discernible evidence of a measurable tumor. There is no evidence of residual significant cervical lymphadenopathy and there has been bilateral neck dissection. There is decreased stranding surrounding the right submandibular gland.The airways are patent. The thyroid gland appears unchanged with multiple subcentimeter hypoattenuating nodules. The osseous structures are unchanged. The partially imaged intracranial structures are grossly unremarkable. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The imaged portions of the lungs are clear. | Post-treatment findings in the oral cavity without convincing evidence of locally recurrent tumor or significant cervical lymphadenopathy. |
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. 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: NSC - Screening Mammogram. |
Generate impression based on findings. | 62-year-old female with history of HCV complicated by cirrhosis, hypothyroidism who presents for worsening confusion. Evaluate for cerebral edema. There is a newly apparent subcentimeter focus of hyperattenuation in the pons. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is a partially-imaged enteric tube. | 1.Newly apparent subcentimeter focus of hyperattenuation in the pons. Differential considerations include hemorrhage, a vascular abnormality, or perhaps neoplasm. Further evaluation with MRI may be considered if clinically indicated.2.No convincing evidence of cerebral edema. However, CT is insensitive for evaluation of hepatic encephalopathy and further evaluation with MRI may be considered.Findings relayed to Dr. Reid over the phone at 1036 hours. |
Generate impression based on findings. | 60 year-old male with hepatomegaly and elevated liver function. LIMITED ABDOMENLIVER: Liver is slightly enlarged but normal in echotexture. No focal hepatic abnormality.BILIARY TRACT: The gallbladder contains mobile, echogenic material. On today's study there is vague shadowing suggestive of small gallstones, without gross wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: Mildly echogenic consistent with parenchymal diseaseOTHER: Left kidney is mildly echogenic consistent with parenchymal disease.Bilateral pleural effusions. Trace ascites. | Small gallstones.Patent vasculature.Mild hepatomegaly.Bilateral pleural effusions.Ascites.Mildly echogenic kidneys. |
Generate impression based on findings. | 64 years, Female, Reason: eval of AAA and SMA stenosis History: known AAA and SMA stenosis. ABDOMEN:LUNG BASES: Basilar atelectasis.LIVER, BILIARY TRACT: Hepatic hypodensity is too small to characterize.SPLEEN: Focal hyperenhancing splenic lesion measured 1.1 cm (8/32) is unchanged.PANCREAS: Hypodensity within the head of the pancreas is unchanged measuring 8 mm (9/35). Additional hypodensity within the body of the pancreas is also unchanged (9/27).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal hypodensities are unchanged. Status post left nephrectomy. Mild right-sided hydronephrosis with right-sided nephroureteral stent is unchanged.RETROPERITONEUM, LYMPH NODES: Status post aortobifemoral bypass and right femoral popliteal graft. Large abdominal aortic aneurysm is unchanged in size measuring 5.5 x 4.2 cm (9/39), previously 5.4 x 4.0 cm. There is atherosclerotic calcifications and a large amount of concentric mural thrombus. Aneurysmal dilatation of the right common iliac artery is also unchanged measuring 1.9 cm. The right femoral-popliteal graft is thrombosed, unchanged. There is aneurysmal dilatation of the left femoral artery which is unchanged measuring 1.8 cm (9/105). Aneurysmal dilatation of the right femoral artery is also unchanged measuring 2.0 cm in diameter (8/159). The left internal iliac artery is thrombosed. Irregularity and multiple collateral vessels involving the left common iliac (80760/43) is unchanged.SMA has mural thrombus and atherosclerotic calcifications but is patent. No stenosis at the origin of the SMA. Celiac is patent.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: VP shunt tip in the left upper quadrant.PELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis. | 1.Large juxtarenal abdominal aortic aneurysm and aortobifemoral bypass is stable in size.2.SMA is patent with areas of mural thrombus and calcification.3.Iliac and femoral aneurysms are stable.4.Stable thrombosis of right femoral-popliteal stent and left internal iliac artery.5.Stable right-sided hydronephrosis with nephroureteral stent. |
Generate impression based on findings. | Mesothelioma status post pleurectomy decortication. CHEST:LUNGS AND PLEURA: Postsurgical findings of right pleurectomy and diaphragmatic mesh. Significant nodular pleural soft tissue thickening in the right hemithorax, greatest at the base, and multiloculated fluid collections now consistent with residual mesothelioma. Reference measurements as follows:1. At the level of the aortic arch (series 3, image 24): 1 o'clock position, 25 mm thickness and 2 o'clock position, 6 mm thickness.2. At the level of the left main pulmonary artery (series 3, image 32): 1 o'clock position, 27 mm thickness and 5 o'clock position, 19 mm thickness.Multifocal extrathoracic extension of tumor, including a large lesion in the right anterior lower chest wall (series 3, image 45). No evidence of contralateral pleural disease. No suspicious pulmonary nodules. MEDIASTINUM AND HILA: Large infiltrative mediastinal tumor that encases the ascending thoracic aorta and SVC, which remain patent. Tumor is also contiguous with the right heart border and extends into the right subcarinal and paraspinal area, producing mild mass effect posteriorly on the left atrium.Newly enlarged mediastinal lymph nodes, including a 15 mm right paratracheal node (series 3, image 24).Interval resolution of previously seen central pulmonary emboli.CHEST WALL: Large necrotic right lateral chest wall tumor that is 8.3 x 2.9 cm (series 3, image 69), previously a pigtail drain was a in this location. Increased erosion and mottled sclerosis of right T7 and T8 lateral ribs adjacent to pleural thickening suspicious for direct tumor invasion.Large anterior chest wall mass arising from the right pectoralis major.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No suspicious hepatic mass. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Mild increased size of a right adrenal nodule (series 3, image 87).KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small celiac artery lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Significant right hemithorax pleural nodular thickening consistent with residual mesothelioma, reference measurements provided as above. Multifocal extrathoracic extension of tumor into the right chest wall.2. Large infiltrative mediastinal tumor.3. Mottled sclerosis and erosions of right T7 and T8 ribs suspicious for direct tumor invasion. |
Generate impression based on findings. | Memory loss. Evaluate for organic pathology. There is no definite evidence of intracranial hemorrhage within the limitations of post-contrast technique. There is no evidence of intracranial mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is minimal mucosal thickening in the right maxillary sinus. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No evidence for acute intracranial hemorrhage or mass or edema. |
Generate impression based on findings. | Rule out polyps and signs of malignancy. Given the low radiation dose and lack of IV contrast, the exam is not sensitive for findings outside the colon. Given that limitation, the following observations are made: Cardiomegaly. Changes secondary to LVAD.Hypoattenuating renal lesions likely represents simple cysts. New non obstructing right renal calculus.Contour abnormality to the spleen, may relate to prior infarct. Calcific arteriosclerosis of the abdominal aorta and branch vessels. | Inadequate bowel preparation. The patient will be rescheduled for repeat CT colonography. |
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