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Generate impression based on findings. | Status for 6 month robotic converted to open RUL for T3N1M0 stage IIIA moderate to poorly differentiated adenocarcinoma. LUNGS AND PLEURA: Small partially loculated right pleural effusion.Postsurgical findings of right upper lobectomy.Mild right paramediastinal bronchiectasis related to post-radiation change. There is a medial right lower lobe nodular opacity with internal air bronchograms that is favored to represent post-treatment change; however, it is somewhat disproportionate to adjacent radiation changes and short-term interval follow-up is recommended.Very mild centrilobular emphysema.Scattered indeterminate bilateral micronodules, including an endobronchial lesion at the right base (series 6, image 60), not definitely seen on prior exam though this may in part be due to differences in technique; special attention on follow-up exams to confirm stability.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes. Postsurgical findings of right hilar lymph node dissection.Normal heart size without a pericardial effusion.Moderate coronary artery calcification.Unchanged nonspecific left thyroid hypodense nodule.CHEST WALL: Mild to moderate degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Unchanged nodular thickening of the left adrenal gland. Left upper pole renal cyst. Subcentimeter hyperdense left upper pole renal focus is too small to characterize, unchanged.Colonic diverticula. | 1. Post-surgical findings of right upper lobectomy with paramediastinal post-radiation changes.2. Indeterminate micronodules. Short term interval follow-up in 3 months is recommended.3. Small partially loculated right pleural effusion. |
Generate impression based on findings. | 70 year-old male status post esophagectomy for assessment for anastomotic leak. Scout radiograph of the chest showed pneumoperitoneum and bibasilar atelectasis or consolidation. Nasogastric tube tip projects over the gastroesophageal junction.Single contrast evaluation of the esophagus demonstrates brisk transit of contrast through the esophagus into the stomach without extravasation.TOTAL FLUOROSCOPY TIME: 2:23 minutes | No contrast extravasation to suggest an anastomotic leak. |
Generate impression based on findings. | Lung cancer, now following a nodule. CHEST:LUNGS AND PLEURA: Severe centrilobular emphysema. Posterior segment right upper lobe airways are thickened, with probable associated atelectasis. New 3-mm (3/40) solid nodule surrounded by a larger 7 x 9 mm area of spiculation or pseudo-spiculation right upper lobe posteriorly (5/40), possibly post inflammatory but should be followed.Solid, spiculated nodule right upper lobe measures 18 x 15 mm (4/157), previously 16 x 11 mm. Solid central component of the nodule is without calcification and measures 10 x 11 mm (3/53), previously 9 x 6 mm, increased in size. The lesion appears to be supplied by subsegments of the anterior bronchus but also borders on subsegmental airways of the posterior bronchus.Tubular soft tissue density 12-mm lesion in the right upper lobe posterior to be a focal segmental airway is chronic (4/143); is unclear whether this is a lymph node but lack of significant change would favor a benign lesion (11-mm on 11/28/2012.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aorta and its branches. Right hilar lymph node measures 14 mm, previously 11-mm (please 56). Upper normal subcarinal lymph node not significantly changed. Low right paratracheal lymph node mildly enlarged, lung and millimeter, previously 8-mm (3/48).Mild cardiomegaly. Severe coronary artery calcifications. No pericardial fluid.CHEST WALL: Degenerative changes of the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged subcentimeter hypoattenuating lesion in the tip of the right posterior hepatic segment (3/139). 9-mm hypoattenuating lesion adjacent to a branch of the left portal vein (3/111), probably present previously and unchanged. Subcentimeter hypoattenuating lesions elsewhere too small to characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous cysts bilaterally.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta branches. Penetrating atherosclerotic ulcer (3/144) of the distal abdominal aorta, 2.3-cm right common iliac artery aneurysm (3/159) also with a penetrating atherosclerotic ulcer, chronic and unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Sclerotic foci in the right pelvis, some of which were present on earlier exams, unchanged.OTHER: No significant abnormality noted. | 1. Solid component of the dominant right upper lobe nodule is larger, consistent with known neoplasm. 2. The new smaller opacities in the right lobe appear to be associated with bronchial wall thickening and could be post inflammatory. Three month CT follow-up may be obtained to assess warm resolution.3. Mild right hilar lymphadenopathy and mediastinal, slightly increased compared to prior study, some of this could be reactive given the presence of bronchial wall thickening suggesting superimposed inflammatory change.4. No significant change in hepatic lesions which are incompletely characterized by this technique.5. Right iliac artery aneurysm is unchanged however consider consultation with interventional radiology. |
Generate impression based on findings. | Hypoxemia. Evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Large bilateral pleural effusions with adjacent atelectasis.Septal lines and patchy bilateral groundglass opacities with peribronchovascular thickening consistent with pulmonary edema.Predominantly dependent lower lobe patchy consolidation may represent dense edema and superimposed aspiration. MEDIASTINUM AND HILA: No mediastinal or hilar lymph node enlargement though the perihilar lymphatic tissue appears edematous.Normal heart size with a trace pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Refer to same day separately dictated CT abdomen/pelvis report. Abdominal ascites and question of right renal infarct. | 1. No evidence of pulmonary embolism.2. Large bilateral pleural effusions and pulmonary edema, possibly with superimposed aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 44-year-old female with bilateral biopsy proven fibroepithelial lesions presents for routine annual examination. No new breast complaints. Family history of breast carcinoma in her maternal aunt at age 31. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is redemonstration of a stable asymmetry within the upper outer right breast which contains a ribbon clip from prior benign biopsy. Additionally, a biopsy clip is present within the far posterior upper left breast, from prior benign biopsy. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral 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. | 32 year old with pelvic Ewing's sarcoma. LUNGS AND PLEURA: Scattered stable micronodules, most postinflammatory.Surgical sutures in the right upper and lower lobes.No suspicious nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of local recurrence or metastatic disease. |
Generate impression based on findings. | Male 69 years old; Reason: COLON CANCER S/P HEPATIC RESECTION JUNE 2014. EVALUATE FOR INTERVAL DISEASE History: COLON CANCER CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. Nodules in the right lower lung are calcified.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Extensive aortic calcifications with extensive plaque along the wall, especially ascending aorta (image 36; series 3) and descending thoracic aorta (image 64; series 3, appears stable.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post right hepatic lobectomy. Stable fluid collection adjacent to the surgical resection margin. The portal vein is patent. The hepatic vein is patent. Unchanged well marginated hypodense foci in the remainder left hepatic lobe are unchanged and may represent small cysts. No biliary ductal dilatation.SPLEEN: Multiple splenic granulomata, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: Small adrenal nodules bilaterally, unchanged.KIDNEYS, URETERS: Right kidney remains atrophic. No hydronephrosis of the left kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small presumed lymph node adjacent to bowel (image 123; series 3) is stablePELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Unchanged bladder wall thickening with mild pericystic infiltration of fat.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic changes in the sacrum which is symmetric and likely chronic.OTHER: No significant abnormality noted | Overall no substantial interval change compared to prior no definite evidence of metastatic disease.1.Stable postoperative appearance following right hepatic lobectomy. No definite evidence of disease in the liver.2.Residual bladder wall thickening without pelvic adenopathy. |
Generate impression based on findings. | 77 years, Female, Reason: 76 show female with history of radiofrequency ablation of left renal mass in 2009. History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Prominent pancreatic duct is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable postprocedural appearance of left kidney without evidence of recurrent disease.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branchesBOWEL, MESENTERY: Small gastric diverticulum (8/31). Large air-filled diverticulum arising from the third portion of the duodenum measuring 4.4 cm (80696/39).BONES, SOFT TISSUES: Right mastectomy.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Atrophic uterusBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes of the visualized spine.OTHER: No significant abnormality noted | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Severe constipation.VIEW: Abdomen AP (one view) 03/06/15 A moderate amount of feces is present at the hepatic flexure, a small amount in the transverse colon, and a moderate amount in the rectum. No significantly dilated bowel loops are present. | No significant change in stool burden in the interval. |
Generate impression based on findings. | Reason: Rule out pneumonitis. History: CMV infection/viremia, immunocompromised LUNGS AND PLEURA: Focal scarlike opacities are unchanged.No significant pulmonary or pleural abnormality, specifically no evidence of pneumonitis or viral infection. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Right jugular catheter tip in SVC.A very small pericardial effusion has accumulated since the prior study.No visible coronary calcifications. CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Benign-appearing hepatic cystlike hypodensities are stable. | No significant abnormality, except for a very small small pericardial fluid collection which may be physiologic in size but larger than before. |
Generate impression based on findings. | Testicular cancer orchiectomy on 3/6/15. Mildly enlarged retroperitoneal lymph node on imaging 3/5/15. LUNGS AND PLEURA: No suspicious pulmonary nodules or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Anterior triangular mediastinal soft tissue likely represents thymic hyperplasia.Normal heart size without a pericardial effusion.No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Refer to separately dictated CT abdomen/pelvis report. | No evidence of intrathoracic metastases. |
Generate impression based on findings. | 49 years, Female, Reason: dissection protocol History: chest pain. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Mild cardiomegaly with hypertrophy of the left ventricle. No aortic dissection or aneurysm.CHEST WALL: No significant abnormality notedABDOMEN: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: Mild atherosclerotic calcifications of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of dissection.2.Cardiomegaly. |
Generate impression based on findings. | Reason: urothelial cancer, s/p surgery and chemotherapy, needs surveillance History: urothelial cancer, s/p surgery and chemotherapy, needs surveillance LUNGS AND PLEURA: Calcified granulomata, but no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No visible coronary calcifications, and the heart and pericardium appear normal.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. The abdomen and pelvis will be reported separately. | No evidence of intrathoracic metastases or other chest abnormality. |
Generate impression based on findings. | HNC and CRT. CHEST:LUNGS AND PLEURA: Subcentimeter ground glass density micronodule in the superior segment of the left lower lobe decreased in density compared to the prior study, probably post inflammatory. No new or suspicious lesions.MEDIASTINUM AND HILA: Chest port tip at superior cavoatrial junction. No visible coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild intrahepatic and extrahepatic biliary ductal dilatation likely related to cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube retention in the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No signs of metastatic disease or other acute abnormality. |
Generate impression based on findings. | Male 15 years old Reason: eval fracture History: s/p ORIFVIEWS: Right hand AP, lateral and oblique on 3/6/15 (3 views) Interval open reduction and internal fixation with two K wires of the boxer's fracture of the right fifth metacarpal noted. Periosteal reaction and callus formation around the healing fracture is present. Alignment is anatomic. | Anatomic alignment of healing fracture as described after K wires placement. |
Generate impression based on findings. | Follow-up groundglass nodules. Dyspnea. LUNGS AND PLEURA: Mosaic attenuation of the lung parenchyma with background lung density chronically increased and areas of hypoperfusion. Additionally, there are probable areas of decreased ventilation in the lung bases within the subsegments affected by presumed metastatic calcification. Patchy peribronchovascular ground glass opacities some of which are static in distribution compared to previous examination while other areas are new (right lower lobe image 60).Scattered sub-solid nodules. Right middle lobe lesion better seen on the current study and is now suggestive of an evolving area of metastatic calcification. Assessment is somewhat limited due to motion artifact. Numerous dense micronodules in the lung bases, some of which appear calcified. Trace pleural fluid.MEDIASTINUM AND HILA: Main pulmonary artery appears mildly enlarged, consistent with pulmonary hypertension. Mild coronary artery calcifications are present. Upper normal heart size. Moderate pericardial effusion, similar in volume. No tracheobronchial nodules are appreciated. Moderate to severe mediastinal and hilar lymphadenopathy. The solid nodes retain their fatty hilum, however the periphery of the lymph nodes in many areas is increased in density suggestive of calcium deposition.Reference subcarinal region lymph node measures 22-mm, previously 20-mm (4/47). Unchanged calcification or high density material within the SVC.CHEST WALL: No significant change in chest wall lymphadenopathy and mild subcutaneous edema/skin thickening.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild ascites adjacent to the liver. The kidneys are atrophic. Indeterminate hypoattenuating lesion in the left kidney unchanged, incompletely characterized. Lymph nodes in the upper abdomen appear similar to previous.. | No significant change in lymphadenopathy. Signs of pulmonary hypertension with probable metastatic calcification in the lung parenchyma related to chronic renal disease. In addition to previously described differential considerations of multicentric Castleman's disease or less likely lymphoma, amyloidosis related to renal disease is also considered in the differential diagnosis of these abnormalities. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No sign metastases or other significant pulmonary/pleural abnormality.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Only mild coronary calcifications are present. The heart and pericardium otherwise appear normal.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign metastases, or other significant abnormality. |
Generate impression based on findings. | 66 year old female with right shoulder pain. Assess fracture healing. Four views of the right shoulder again show an impacted proximal humerus fracture with slight lateral angulation of the distal fracture fragment. Small amount of callus formation adjacent to the fracture indicates attempted healing. | Healing proximal humerus fracture. |
Generate impression based on findings. | 58-year-old female with bilateral hip pain with history of moderate OA but not responding to intra-articular injection. Right hip:Two views of the right hip are provided. Moderate to severe osteoarthritis affects the right hip, progressed compared to prior.Left hip:Two views of the left hip are provided. Moderate to severe osteoarthritis affects the left hip, slightly progressed compared to prior.Pelvis:One view of the pelvis again demonstrates the aforementioned bilateral hip osteoarthritis. Degenerative arthritic changes affect the visualized lower lumbar spine. Arterial calcifications. | Progression of bilateral hip osteoarthritis. |
Generate impression based on findings. | 30 year-old male with left ankle pain. Evaluate for fracture. Left ankle:Three views of the left ankle are provided. Oblique fracture through the distal fibula with slight posteromedial displacement of the distal fracture fragment. Vertical fracture through the "posterior malleolus" of the distal tibia with slight posterior displacement of the distal fracture fragment. Mildly displaced transverse fracture through the medial malleolus. Additional linear density situated medial to the medial malleolus may represent a retinacular avulsion fracture. Minimal posterior subluxation of the talar dome with respect to the center of the tibial plafond. Soft tissue swelling and joint effusion are present.Left foot:Three views of the left foot again demonstrate the aforementioned ankle fractures. We see no additional fractures. Dorsal soft tissue swelling.Left tibia/fibula:Two views of the left tibia/fibula again demonstrate the aforementioned ankle fractures. The proximal tibia and fibula are intact. | Trimalleolar ankle fractures as described above. |
Generate impression based on findings. | There is a stable right parietal approach ventriculostomy catheter with tip terminating near the right foramen of Monro.. There is no visualized discontinuity or kinking of the catheter/reservoir system. The ventricular caliber is stable on the left and further decreased on the right. The left frontal horn remains 3.8 cm in oblique measurement. There has been further reduction of prominence of extra-axial space. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | Stable dilatation of left lateral ventricle with further decreased size of right lateral ventricle. Stable ventriculostomy catheter with no evidence of discontinuity or kinking of the visualized segments. |
Generate impression based on findings. | Reason: r/o ich History: left arm weakness, numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a new 12mm hypodense focus present in the left inferior parietal lobule which was not present on the prior exam.There is an 11mm hypodense focus present along the lateral aspect of the left hand motor area at the precentral gyrus . There are subtle hyperdense nodules along the lateral walls of the lateral ventricles which have not changed since the prior exam.There are small foci of encephalomalacia in both cerebellar hemispheres. These are stable compared to the prior exam.A hypodense focus is present in the pons but obscured by artifact. It is unchanged since the prior exam.No 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 demonstrates mild prolapse of the right orbital floor into the maxillary sinus associated with fracture which is stable since the prior exam. The right eyeball lens is thin.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.There is a new subtle hypodense focus present along the lateral aspect of the left hand motor area at the precentral gyrus . The possibility that this represents acute infarction cannot be excluded. If clinically appropriate MRI of the brain may be helpful for further evaluation2.There is a new lesion present in at the left inferior parietal lobule which is nonspecific. If clinically appropriate MRI of the brain may be of further benefit in evaluating this.3. No evidence for acute intracranial hemorrhage or mass effect.4.There are subtle hypodense nodules present along the lateral walls of the lateral ventricles which are nonspecific and stable since the prior exam. If clinically possible and MRI of the brain may be helpful in further assessing these.5.There are small foci of encephalomalacia in both cerebellar hemispheres. These are stable compared to the prior exam.6.A pontine lesion is suspected to represent old lacunar infarct.7.Old right-sided orbital floor fracture. |
Generate impression based on findings. | History of lung cancer on observation, compare to prior scans CHEST:LUNGS AND PLEURA: Postsurgical changes reflect prior left upper lobectomy.Using similar measurement technique on 3 mm slice thickness, the previously referenced mixed solid and ground glass nodule at the left apex measures 9 x 15 mm (4/27) as compared to 8 x 13 millimeters. There is extension to the pleural surface which is slightly thickened, a new finding.The referenced right middle lobe nodule is also slightly increased, 8 mm short axis (4/66), previously 6 mm.Left apical ground glass nodule is not significantly changed (4/22).Apical scarring and mild centrilobular emphysema stable. Persistent left lower lobe pleural thickening, micronodules and atelectasis are unchanged. No new suspicious pulmonary nodule or interval pleural effusion.MEDIASTINUM AND HILA: The mid esophagus contains fluid with circumferential wall thickening. This is at the site of prior resection and may be related to postsurgical and radiation changes, stable.Severe calcification of the left anterior descending artery stable. No interval pericardial effusion.No interval mediastinal or hilar lymphadenopathy.CHEST WALL: There is mild pectus excavatum deformity which compresses and deviates the right atrium slightly right of midline.Microcalcifications both breasts.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is a cystic lesion at the anterior aspect of the medial segment of the left hepatic lobe suspicious for a celiated hepatic foregut cyst (3/111), not significantly changed. However, there is a new low density focus of the left hepatic lobe (3/105) which may represent early metastasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable nodular thickening of the left adrenal gland.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable degenerative changes.OTHER: Extensive atherosclerotic disease involving the thoracic and abdominal aorta. | Interval increased size of two reference pulmonary nodules: the solid right middle lobe nodule measures 8 mm in short axis, compared to 6 mm. Left upper lobe mixed groundglass and solid nodule is 9 x 15 mm, as compared to 8 x 13 mm. No new suspicious pulmonary nodules or pleural effusion. New low density focus of the left hepatic lobe (3/105) which may represent early metastasis.No interval mediastinal or hilar lymphadenopathy. |
Generate impression based on findings. | Lung mass with mets to the spine. Staging.RADIOPHARMACEUTICAL: 9.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates lower cervical spinal fixation hardware. There is a left upper lobe paramediastinal lung nodule. Bilateral lower lobe interstitial and airspace opacities are present. There are prominent to enlarged AP window and right paratracheal lymph nodes. There are multiple hypodense hepatic lesions in both lobes. A left adrenal nodule is noted. There is colonic diverticulosis. Today's PET examination demonstrates a markedly hypermetabolic left upper lobe pulmonary nodule (max SUV = 20.3). There are multiple significantly hypermetabolic AP window lymph nodes (max SUV = 9.0). Additional hypermetabolic activity is noted in a left infrahilar lymph node and a left internal mammary/pericardial lymph node, which are also consistent with tumor. A hypermetabolic right supraclavicular lymph node (max SUV = 4.4) is consistent with tumor.A focus of increased activity in the apical right chest wall may represent metastatic disease in a lymph node or chest wall. A focus of hypermetabolic activity in the right side of the T6 vertebral body without CT correlate is suspicious for tumor. Hypermetabolic activity at the surgical site from C4-C6 may represent post-surgical change or residual tumor. No suspicious FDG avid lesion is identified in the abdomen or pelvis. There is minimal activity in bilateral inguinal lymph nodes which is non-specific. | 1. Markedly hypermetabolic left upper lobe pulmonary nodule compatible with primary lung cancer.2. Ipsilateral mediastinal/hilar and contralateral supraclavicular hypermetabolic lymph nodes compatible with metastatic disease.3. Increased activity in T6 suspicious for tumor along hypermetabolic activity in the region of C4-C6 which may represent post-surgical change or residual tumor.4. No FDG avid tumor in the abdomen or pelvis. |
Generate impression based on findings. | History of left shoulder dislocation. Severe osteoarthritis affects the glenohumeral joint. There appears to be slight anterior subluxation of the humeral head on the Grashey view, although alignment on the axillary view is within normal limits. There is deformity of the humeral head that likely represents chronic posttraumatic/arthritic remodeling and prominent osteophyte formation. Mild deformity of the glenoid likely also reflects chronic arthritic remodeling. Ossicles measuring at least 2 cm overlying the scapula likely represent intra-articular loose bodies. There is foreshortening of the distal clavicle presumably due to prior surgery. | Severe osteoarthritis and other findings as above. |
Generate impression based on findings. | The patient submitted an additional outside study for review. Submitted for review is a standard screening mammogram with tomosynthesis (2/13/15). For comparison, followup diagnostic mammogram and ultrasound (2/10/15) are available. Two standard views of both breasts with tomosynthesis were obtained. The breast parenchyma is composed of scattered fibroglandular elements. There is a spiculated mass in the left breast at 12'o clock position at central depth. Inclusive of spiculation, this measures about 3 cm. There are a few calcifications within the area of the spiculation, especially medial and posterior to the center of the mass. There is a high density round circumscribed several millimeter lesion that is likely a calcifying oil cyst in the inferior right breast. Additional bilateral benign morphology calcifications including benign ductal calcifications are seen. No dominant mass, suspicious microcalcifications, or areas of architectural distortion are noted in the right breast. | Spiculated mass in the left breast for which further diagnostic imaging has been performed. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Pain. Rule out fracture. There is perhaps mild soft tissue swelling about the PIP joint, but I see no fracture or malalignment. | No fracture evident. |
Generate impression based on findings. | 76 years old, Male, Reason: PT with cholangio; needs surveillance scan in 2 months History: none CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules are roughly stable. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Severe coronary artery calcifications. Scattered mediastinal and hilar lymph nodes not meeting size criteria for lymphadenopathy.CHEST WALL: No significant abnormality noted. Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Three biliary stents are again seen with expected pneumobilia, not significantly changed. Intrahepatic biliary ductal dilatation is not significantly changed. Segment 5 lesion remains very difficult to measure although is approximately 1.7 x 2.6 cm (series 3, image 99) and not substantially changed compared to prior. There is a new 1.2 x 1.6 cm hypodense nodule of the liver (image 84; series 3) that is presumed to represent a metastasis. Adjacent capsular retraction is again noted. The anterior branch of the right portal vein remains occluded. There is differential enhancement of the liver parenchyma likely related to differential vascular flow as described previously. Trace perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: Scattered punctate parenchymal calcifications unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval enlargement of reference periportal lymph node now measuring 2.1 x 1.2 cm (image 97; series 3). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Progression of disease.1.Unchanged hepatic segment 5 mass compatible with patient's known cholangiocarcinoma with associated perfusion abnormalities and capsular retraction.2.New presumed liver metastasis.3.Interval enlargement of reference periportal lymph node. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1. No MR evidence of intracranial metastatic disease.2. Nonspecific punctate and confluent areas of T2/FLAIR hyperintensity within the supratentorial white matter, with differential diagnosis including chronic small vessel ischemic changes, demyelinating disease, as well as infectious/inflammatory processes. |
Generate impression based on findings. | Female, 42 years old, status post cardiac arrest with no brainstem reflexes. Since the prior examination, diffuse cerebral edema has progressed with further loss of gray-white distinction, sulcal effacement, effacement of the basilar cisterns and ventricles. No evidence to suggest intracranial hemorrhage is seen. | Progressive cerebral edema compatible with diffuse hypoxic ischemic injury. |
Generate impression based on findings. | Lower extremity weakness. Question of infection in the spinal canal around the tip of the intrathecal catheter. Physiologic activity is present in the liver, spleen, and bone marrow. No abnormal leukocyte accumulation is identified to indicate an active infectious or inflammatory process. | No scintigraphic evidence of active infection or inflammation. |
Generate impression based on findings. | 31 year old female who has a complaint of thickening along the lateral aspect of her left breast x 1 month. No family history of breast cancer. MAMMOGRAM: Three standard views of both breasts, and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. LEFT BREAST ULTRASOUND: On physical examination, no discrete palpable abnormality is identified.A targeted ultrasound was performed for the patient's area of concern. At the 3 o'clock position of the left breast, there is dense fibroglandular tissue with no discrete solid or cystic mass identified. No abnormal vascularity is identified. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, to begin at age 40. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Proximal second digit swelling and tenderness to palpation.VIEWS: Right hand PA, right index finger oblique/lateral (3 views) 03/06/15 Soft tissue swelling surrounds the proximal small phalanx of the index finger. The bones are normal. No fracture is identified. | Soft tissue swelling. |
Generate impression based on findings. | Middle finger swelling of tip.VIEWS: Left hand PA, left middle finger oblique/lateral (3 views) 03/06/15 Soft tissue swelling is present around the distal phalanx of the middle finger. The bones are normal in appearance. No fracture is identified. No bone destruction is present. | Soft tissue swelling around the distal phalanx of the middle finger. |
Generate impression based on findings. | Shortness of breath, tachycardia. Rule out leak after Whipple procedure. ABDOMEN:LUNG BASES: Bilateral small pleural effusions (left greater than right) with overlying compressive atelectasis.LIVER, BILIARY TRACT: Simple cyst is unchanged. Pneumobilia. Portal vein is patent.SPLEEN: No significant abnormality notedPANCREAS: Status post Whipple procedure. In the operative bed, there is an 8.3 x 5.3-cm poorly loculated fluid collection which contains foci of air, presumably this is postsurgical.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst, unchanged.RETROPERITONEUM, LYMPH NODES: Index mesenteric node now measures 1.7 x 1.4 cm (image 116; series 4), smaller compared to prior. Index aortocaval node measures 1.5 cm in diameter (image 110; series 4) not significantly changed from previous study. 2-cm peri-pancreatic lymph node is also noted (image 85; series 4).BOWEL, MESENTERY: Fat stranding in the mesentery is unchanged. J-tube terminates in bowel. Postsurgical changes in the upper abdomen with scattered foci of air, presumed to be post surgical but could be followed.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted. Air presumably from recent instrumentation is noted.LYMPH NODES: Index right external iliac lymph node has resolved.BOWEL, MESENTERY: Small amount pelvic ascites in the right hemipelvis.BONES, SOFT TISSUES: No significant abnormality noted | Status post Whipple procedure with new poorly defined fluid collection near the surgical bed; plan is for attempted percutaneous drainage. Small bilateral effusions. Postsurgical changes in the upper abdomen which could be followed. Small lymph nodes. Findings discussed with Dr. Matthews at the time of dictation. |
Generate impression based on findings. | There are several discrete oval and minimally irregular areas of T2/FLAIR hyperintensity within the left frontal lobe white matter, more confluent in the left superior frontal gyrus. Additional foci are seen in the left cerebral white matter, especially the left periatrial white matter where the abnormality is more confluent, with apparent subtle mass effect upon the adjacent ventricular margin on axial images although this is not confirmed on coronal imaging to the ventricular margin appears symmetric. The FLAIR abnormality delineates the normal prevascular spaces in this area, with sparing of the subcortical U-fibers. Abnormal signal extends along the lateral margin of the left occipital horn. The areas of abnormality are isointense to hypointense on diffusion weighted images and hyperintense on ADC. No definite right-sided abnormalities are seen.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the maxillary sinuses with trace mucosal thickening in the ethmoid air cells. There is minimal fluid in the right mastoid air cells. | Scattered areas of nonenhancing T2/FLAIR hyperintensity in the left cerebral white matter, most confluent in the left periatrial white matter with delineation of normal to somewhat prominent perivascular spaces. The findings are favored to represent areas of nonspecific gliosis which may in part simply relate to prominent perivascular spaces, although no significant left atrial ex vacuo dilatation or mass effect is appreciated at this time. Dilatation of perivascular spaces in the peritrigonal region is associated with mucopolysaccharidoses, although usually seen to a much greater degree. The imaging differential diagnosis would include demyelinating process such as ADEM or vasculitis if clinically appropriate, although atypical given unilaterally of findings. Follow-up exam may be helpful in 6-12 months to confirm stability, and can include MR spectroscopy if desired.Dr. Yang discussed these findings over the telephone with Dr. Gustavo Oroza-Henners on 3/6/2015 11:51 AM. |
Generate impression based on findings. | Abdominal pain and lactic acidosis. Assess for cause of acute abdominal pain and sepsis. ABDOMEN:LUNG BASES: Bilateral pleural effusions and patchy basilar pulmonary opacities are again partially visualized. Please refer to the CT of the chest that has since become available.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric enhancement of the kidneys without evidence of pyelonephritis or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Abdominal ascites is again noted, including around the kidneys, which is nonspecific. No free air.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The Foley catheter appears to take a convoluted course. The bladder itself is not directly visualized but could possibly be collapsed completely around the Foley catheter. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Pelvic ascites is noted. No free air. | 1.No evidence of pyelonephritis or hydronephrosis.2.Abdominal pelvic ascites without evidence of a loculated fluid collection, bowel obstruction or free air.3.Possible complete collapse of the bladder around the Foley catheter which takes an atypical course. Less likely is perforation of the Foley catheter. Correlate clinically.Findings were discussed with the primary service Dr. Ashley (pager 3674) such that at the time of this dictation by Dr. Michael Veronesi. |
Generate impression based on findings. | Male 15 months old Reason: cardiopulmonary assessment History: preop heart surgeryVIEWS: Chest AP/lateral (two views) 3/6/15 at 1146 hours Mediastinal clips are again noted. Cardiac silhouette size is enlarged but stable. Patchy opacity of the left lower lobe may represent pneumonia or atelectasis on a background of lung vascular engorgement. No effusions or pneumothorax | Left lower lobe opacity concerning for pneumonia or atelectasis as described. |
Generate impression based on findings. | 70 years, Male. Reason: 70M intubated in MICU with abdominal distension, low UOP History: 70M intubated in MICU with abdominal distension, low UOP Persistent retrocardiac opacity. NG tube tip projects over the gastric antrum. Vertebroplasty changes are again noted at L2. Scattered loops of air within the colon in a nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Pain Thumb: No radiographic abnormalityShoulder: Excessive calcific fragments and partially visualized deformity of the humoral head previously described on the recent CT. No change in fragment and gross anatomic alignment. The fragment donor site is not well visualized. Mild inferior displacement of the humeral head, suspected joint effusion and/or resolving hemarthrosis. | Unchanged Hill-Sachs fracture |
Generate impression based on findings. | Reason: r/o fracture History: fall, R facial trauma CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.CT maxillofacial bones:There are no fractures identified involving the maxillofacial bones.The skull base foramina are intact.There is a redemonstration of thinning of the skull are posteriorly of the right eyeball and status post silicone injection in the left eyeball.Visualized portions of the mastoid air cells and middle ears are clear. The visualized portions of the paranasal sinuses are clear. The posterior maxillary molars have significant dental caries.Atherosclerotic calcifications are present at the carotid bifurcations. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT of the maxillofacial bones is within normal limits.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Staphyloma of the right eye is stable.5.Dental caries |
Generate impression based on findings. | Right upper quadrant ultrasound. Evaluate for liver or biliary pathology. LIVER: The liver measures 14.7 cm in length. No intrahepatic biliary ductal dilatation or dominant masses. Liver echotexture is coarsened slightly. Portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common duct measures 5 mm which is the upper limits of normal in size.PANCREAS: Poorly visualized secondary overlying bowel gasRIGHT KIDNEY: No hydronephrosis. The right kidney measures 10.3cm in length and the left kidney measures 10.6cm in length.OTHER: No significant abnormalities noted. Spleen measures 7.2 cm in length | Status post cholecystectomy. No sonographic evidence of liver or biliary pathology. |
Generate impression based on findings. | Rule out PE, dyspnea on exertion, ILD, shortness of breath PULMONARY ARTERIES: The quality of this examination is diagnostic for pulmonary embolism. No pulmonary embolus is presentLUNGS AND PLEURA: Diffuse pulmonary fibrosis most concentrated at the bases with associated paraseptal emphysema. Peripheral honeycombing in the upper lobes with central spirits demonstrating dense groundglass opacification. Calcified granuloma right lower lobe. Loculated pleural effusions within both major fissures. The overall appearance is most consistent with a fibrosing NSIP pattern with diffuse edema in the spared lung parenchyma.MEDIASTINUM AND HILA: Diffuse dilatation of the esophagus with air-fluid level noted to the level of the aortic arch.Right central catheter terminates in the mid right atrium. There is right atrial and left ventricular enlargement with a concentric small pericardial effusion.Moderate aortopulmonary, subcarinal and right hilar lymphadenopathy with diffuse edema.CHEST WALL: Multiple cysts in the thyroid gland. No axillary lymphadenopathy. Minimal subcutaneous edema.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolus.Pulmonary fibrosis with overall appearance most consistent with a fibrosing NSIP pattern with diffuse edema in the spared lung parenchyma.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | DVT, chest pain with inspiration this morning. PULMONARY ARTERIES: Diagnostic quality study, no pulmonary embolus.LUNGS AND PLEURA: Small pleural effusions with associated atelectasis.MEDIASTINUM AND HILA: No visible coronary artery calcifications.CHEST WALL: Superior endplate deformity of L1 vertebral body unchanged and consistent with a compression fracture, incompletely included within the scanning range.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolus. L1 superior endplate compression fracture has been described previously.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male 67 years old; Reason: metastatic prostate cancer needs repeat exam for staging on treatment History: metastatic prsotate cancer CHEST:LUNGS AND PLEURA: No solid pulmonary lesion has developed. The pleural spaces remain clear. There is a new right sided pulmonary embolus (image 47; series 80264 and image 38; series 3).MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. New mediastinal lymph nodes. For reference purposes, a right paratracheal lymph node measures 1.1 x 1.5 cm (image 34; series 3).CHEST WALL: There are multiple bony metastases including thoracic spine and ribs.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. No suspicious hepatic lesions. The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable retroperitoneal lymphadenopathy. The reference left para-aortic lymph node measures 1.0 x 0.7 cm (image 104/series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic bony metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged. Fiducial markers are noted within the prostate.BLADDER: No significant abnormality notedLYMPH NODES: Small pelvic lymph nodes persist.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted | New right pulmonary embolus. New thoracic adenopathy. Stable abdominal adenopathy. Sclerotic bony metastases. Dr. Smulewitz notified at the time of dictation. |
Generate impression based on findings. | Female 9 years old Reason: rule out fracture/dislocation History: painVIEWS: Pelvis AP and frog leg 3/6/15 (two views) Mild bilateral coxa valga deformity. Both femoral heads are well directed into a normally developed acetabulum. No evidence of SCFE or AVN. No fractures. | Normal examination. |
Generate impression based on findings. | Rotator cuff tear and pain. Ankylosing spondylitis history Shoulders: Bilateral marked near severe osteoarthritic changes with near bone-on-bone narrowing, bulky osteophytes and sclerosis. In addition flattening is observed along both humeral heads in a somewhat symmetric appearance and with questionable underlying crescentic lucency. Bilateral early AVN cannot be excluded. No superimposed acute abnormalitiesL-spine: Diffuse effusions with relative preservation of disk spaces and vertebral body heights observed throughout the lumbar spine compatible with known ankylosis spondylitis.C-spine: Minimal anterior bridging osteophytes observed with otherwise mild straightening of the cervical spine. No distinct additional abnormalities identified in this limited two view exam | Anchylosis finalize observed involving the lumbar spine with more minimal degenerative changes in the upper cervical spine. Bilateral shoulder osteoarthritis with questionable early AVN. See detail provided |
Generate impression based on findings. | Reason: emesis, status SAH and hydrocephalus History: emesis, c/f increase hydrocephalus, status SAH There are foci of encephalomalacia present involving the left inferior frontal gyrus and part of the left superior temporal gyrus extending into the left supramarginal gyrus. There is associated enlargement of the left lateral ventricle. Foci of encephalomalacia is also present along the inferior medial aspects of the frontal lobes bilaterally. Biventricular diameter on coronal imaging at the level of the entry point of the ventriculostomy tube is currently 46 mm and previously was the same. The third and fourth ventricles are also enlarged but stable.There is a radiopaque stent present along the distal left internal carotid artery.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. | 1.The ventricles are enlarged but remain stable when compared to prior exam.2.Multiple foci of encephalomalacia are present in the left frontal lobes and to a lesser degree left temporal lobe, left parietal lobe and right frontal lobe as detailed above. Most likely these are related to prior ischemic cerebral infarctions.3.Status post distal left internal carotid artery stent placement. |
Generate impression based on findings. | Male 12 years old Reason: eval VP shunt History: HA, irritabilityVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 3/6/15 Bilateral intracranial VP shunt valves are unchanged. Left-sided Strata valve P/L is 1.0 and the right-sided P/L is1.5 (unchanged). No evidence of kinking or discontinuity of both VP shunt catheters. No evidence of CSF pseudocyst formation. Unchanged mild adenoid hypertrophy. No evidence of skull fractures or scalp edema. Normal pneumatization of visualized paranasal sinuses. Normal alignment of the cervical spine. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax. Normal abdominal gas pattern. | No evidence of VP shunt malfunction. |
Generate impression based on findings. | Female 32 years old Reason: cardiopulmonary assessment History: post op heart surgery, evaluate for effusionsVIEWS: Chest PA/lateral (two views) 3/6/15 at 1219 hrs. Sternal wire and pacemaker device with pacemaker leads as well cholecystectomy surgical clips are again noted. Cardiac silhouette size is enlarged but stable. No focal opacities, effusions or pneumothorax. | No effusions. |
Generate impression based on findings. | Pain Persistent Hill-Sachs fracture without evidence of interval change a new complication. Alignment preserved. Decreasing soft tissue swelling | Hill-Sachs fracture without evidence of interval change or new complication |
Generate impression based on findings. | Reason: eval for increasing hydrocephalus History: 12yo M with VP shunt presents with HA, irritability A left-sided and ventriculostomy catheter courses through the left parietal lobe into the trigone of left lateral ventricle remains in stable position. A right-sided ventricular catheter courses along the floor of the right middle cranial fossa and has its tip 5 remains in the quadrigeminal plate cistern and is associated no abscess small air bubble. There is encephalomalacia involving the posterior aspect of the corpus callosum. The lateral ventricles are larger on the current exam when compared to the prior exam where they were collapsed.Some encephalomalacia is present in the right temporal lobe and there is loss of volume along the cortical mantel of white matter.A cystic lesion in the pineal region remains stableThere is cortical dysplasia present in the left parietal lobe possibly representing schizencephaly.The cerebellar tonsils extend into the foramen magnum and are pointed inferiorly. The posterior fossa in general appears relatively small.The septum pellucidum is not identified. The corpus callosum appears very thin.There appears to be cortical dysplasia present a amount left upright lobe and not clear whether it is present on the right side as well.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. | 1.Since the prior exam the lateral ventricles are slightly larger, however, on the prior exam are collapsed. Please correlate with clinical symptoms and signs.2.Chiari malformation.3.Cortical dysplasia and multiple cerebral deformities are stable. An MRI may help further assess this and it has not been done already in the past.4.The pineal region cystic lesion remains stable.5.No evidence for acute intracranial hemorrhage mass or edema. |
Generate impression based on findings. | Male 63 years old; Reason: gastric cancer s/p resection 4/2012 (pT4N3R1) s/p CRT adjuvant therapy done 12/2012. Now on surveillance. CT 1/2015 showed new subcentimeter liver lesions. Please evaluate interval change. History: none CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Mild ductal dilatation. The prior noted right hepatic lobe lesion is not evident on the current exam. There is a smaller hypodense lesion in segment 8 (image 93 study series 3). The portal vein is patent.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: Postsurgical changes in the stomach.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 | 1.Resolution of the right hepatic lobe lesion with new nonspecific subcentimeter hypodense segment 8 lesion. |
Generate impression based on findings. | Pain Interval continued healing of the distal tibial fracture without evidence of new complication. Superimposed mild degenerative changes. Decreased soft tissue swelling. | Healing distal tibial fracture |
Generate impression based on findings. | Reason: Fall with head strike History: Headache The CSF spaces are appropriate for the patient's stated age with no midline shift. A partially healed burr hole is present along the left frontal bone and is not substantially changed since the prior exam.No 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 demonstrate opacification of the right posterior ethmoid air cells which is stable. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | CLL. There has been overall interval increase in size of the extensive diffuse cervical, upper mediastinal, and bilateral axillary lymphadenopathy. For example, a right level 5A lymph node measures 11 mm in short axis, previously 5 mm, and a level 1B lymph node measures 14 mm in short axis, previously 9 mm. The partially imaged axillary and upper mediastinal lymphadenopathy also appear to have increased in size. The thyroid and major salivary glands are unremarkable. The osseous structures are unchanged. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Overall interval increase in size of the extensive diffuse cervical, upper mediastinal, and bilateral axillary lymphadenopathy. |
Generate impression based on findings. | Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There are two new masses in the LEFT breast; one at upper outer quadrant and the other at upper inner quadrant. No suspicious microcalcifications or areas of architectural distortion are present. | Two new masses in the LEFT breast; one at upper outer quadrant and the other at upper inner quadrant, for which spot compression views and possible ultrasound study are recommended. |
Generate impression based on findings. | Knee pain The oblique proximal fibular fracture appears mildly more prominent compatible with subacute timing and resorption along the fracture edges. Overall no significant change in alignment.Minimal osteoarthritic changes of the knee | Subacute proximal oblique right fibular fracture in near-anatomic alignment |
Generate impression based on findings. | Distal fibular fracture Moderate callus formation without significant change in alignment of the distal fibular fracture. Decreased soft tissue swelling. Persistent mild lateral displacement similar to prior study again observed. Overlying moderate degenerative ankle changes. Ankle mortise intact | Healing left distal fibular fracture |
Generate impression based on findings. | Male 75 years old; Reason: CLL History: Compare with prior scans CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Coronary calcifications.right paratracheal lymph node measures 1.9 x 0.9 cm (image 11/series 3) previously, 1.4 x 0.9 cm.Right subcarinal lymph node measures 2.7 x 1.7 cm (image 48/series 3) previously, 2.1 x 1.0 cm.CHEST WALL: Left axillary lymph node measures 3.1 x 2.6 cm (image 11/series 3) previously, 2.3 x 1.8 cm.OTHER: ABDOMEN: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: Left para-aortic lymph node measures 3.9 x 3.6 cm (image 110/series 3) previously, 2.7 x 2.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcificationsBLADDER: No significant abnormality notedLYMPH NODES: Right pelvic lymph node measures 4.3 x 1.8 cm (image 177/series 3) previously, 3.0 x 1.1 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Increase in lymphadenopathy. |
Generate impression based on findings. | Male 48 years old; Reason: hx of Gleason 4+3 prostate cancer, evaluate for metastatic disease History: see above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No lymphadenopathy in the abdomen or pelvis. |
Generate impression based on findings. | Female 70 years old; Reason: 70 yr old patient with hx of ovarian cancer with rise in CA-125 had complained on SOB in the past but improving somewhat compare to 1-27-15 scan eval disease process History: SOB CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy. Reference lymph node measures 1.0 x 0.8 cm (image 16/series 3) previously, 0.9 x 0.7 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Reference left hepatic lobe liver lesion measures 3.3 x 2.6 cm (image 79/series 3) previously, 3.5 x 3.4 cm.Gastrohepatic lymph node mass measures 4.5 x 4.0 cm (image 82/series 3) previously, 4.3 x 3.6 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Omental mass measures 8.8 x 2.0 cm (image 95/series 3) previously, 8.4 x 2.3 cm.Left upper abdominal mesenteric mass measures 4.9 x 2.4 cm (image 102/series 3) previously, 3.6 x 2.5 cm.Multiple other mesenteric masses and mesenteric ascites remain.BONES, SOFT TISSUES: Compression deformity of the L1 and L2 vertebral bodies.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large cul-de-sac mass adjacent to the rectum and possibly invades it.BLADDER: No significant abnormality noted.LYMPH NODES: Left pelvic lymph node measures 1.7 x 1.3 cm (image 156/series 3) previously, 1.9 x 1.2 cm.Right pelvic lymph node measures 2.1 x 1.2 cm (image 155/series 3) previously, 2.1 x 1.2 cm.BOWEL, MESENTERY: Extensive mesenteric nodal masses remain especially around the small bowel mesentery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Scattered ascites in the pelvis. | 1.Slight increase in the size of the mesenteric nodal targets. |
Generate impression based on findings. | 36-year-old female with history of ITP and hypertension with possible sarcoidosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 12 cm in length. Echotexture appears normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 12 cm in length. Echotexture appears normal. No hydronephrosis, shadowing calculus or mass.OTHER:No significant abnormalities noted. | Normal examination. No evidence for renal artery stenosis. |
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. Benign-appearing lymph nodes project over the axillae.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. | Lung cancer chemotherapy follow-up examination. CHEST:LUNGS AND PLEURA: Loculated right pleural fluid collection with thickening of both the parietal and visceral pleural surfaces minimally smaller.Right paramediastinal consolidation, presumably post-therapeutic. The majority of right lower and middle lobes are collapsed. Consolidation in the anterior and posterior paramediastinal right lung has decreased in the interim. Persistent septal thickening. Previously seen solid micronodules in the lung periphery are no longer identified where the lung is aerated, partially unable to assess due to consolidation in lung periphery Index lesions has decreased in size, 16 x 21 mm (3/60), previously 29 x 30 mm, the necrotic component is no longer reliably measurable.Left upper lobe nodule measures 3 mm, previously 5-mm 4/40).MEDIASTINUM AND HILA: Discrete lymph node enlargement has resolved resolved. Previously measured left hilar lymph node measures 3 mm, previously 9-mm (3/40). The mediastinum is shifted to the right. Soft tissue density surrounding the right mainstem bronchus and the right lower trachea about the same. Mild esophageal wall thickening unchanged distally, suggestive of esophagitis.One normal heart size. Physiologic volume of pericardial fluid. No measurable lymphadenopathy. Of a significant coronary artery calcifications.CHEST WALL: No suspicious lesions. Previously seen lymph nodes are no longer enlarged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips. New indeterminant subcentimeter hypoattenuating lesion near the hepatic dome (3/80 2) which does not meet the criteria for a cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Lymphadenopathy has resolved, no measurable lesions.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Nonspecific mild thickening of the gastric antrum present previously..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Improvement in lymphadenopathy, size of right lung mass and size and number of pulmonary nodules. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are bilateral mammogram in ultrasound dated January 28, 2015 performed at Silver Cross Hospital. No studies were submitted for comparison. Per outside report, the patient has known bilateral breast carcinoma and has received 4 rounds of neoadjuvant chemotherapy. The submitted studies were performed to assess tumor response. MAMMOGRAM: Two standard views of both breasts were obtained. The breast parenchyma is composed of scattered fibroglandular elements. Within the right breast, a cylinder shaped biopsy marking clip is present within the upper outer quadrant, posteriorly. A 0.4-cm cluster of calcifications is present approximately 1.2 cm posterior, inferior, and lateral to the clip. Elsewhere in the right breast, scattered benign calcifications are present. No mass is identified within the right breast. Within the upper, slightly outer left breast, a coil-shaped clip is present centrally within an irregular asymmetry which measures 8.0 x 4.9 x 2.6 cm. Scattered benign calcifications are present throughout the left breast. The degree to which this represents residual tumor versus her background parenchymal pattern cannot be assessed based solely on these studies. Response to treatment cannot be assessed, as pre-treatment imaging was not submitted.ULTRASOUND: Sonographic images labeled "left breast, 12 o'clock position, 8 cm from the nipple", demonstrate a conglomerate of multiple irregular hypoechoic masses with areas of shadowing measuring 4.5 x 2.2 x 2.3 cm.Sonographic images of the right breast from the 6 o'clock to 12 o'clock positions were submitted. No discrete solid or cystic mass is present on the submitted images. The known biopsy marking clip within the right breast is not documented on the submitted images. Images labeled "right breast axilla" demonstrate a benign morphology lymph node.PATHOLOGY: Outside pathology reports were submitted. Core needle biopsy of the left breast resulted infiltrating ductal carcinoma, grade 3, ER/PR positive, HER-2 negative.Core needle biopsy of the right breast resulted infiltrating ductal carcinoma, grade 2, ER/PR positive, HER-2 negative. | Known bilateral breast malignancies. Biopsy marking clip noted centrally within a large asymmetry within the upper central left breast. Biopsy marking clip present within the upper outer, posterior right breast without significant mass identified. Per report the patient has received neoadjuvant chemotherapy. Treatment response cannot be assessed, as no pre-treatment imaging was submitted for interpretation. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
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. Small mass in the left upper outer breast may represent an intramammary lymph node.No suspicious morphology masses, microcalcifications or areas of architectural distortion are present. | Small mass in the left upper outer breast may represent an intramammary lymph node. Comparison to prior studies is recommended and otherwise additional compression views/ultrasound may be needed.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | 70 year-old with nausea and vomiting. Hepatitis C cirrhosis. ABDOMENLUNG BASES: There is linear atelectasis at the lung bases. Tiny micronodules.LIVER, BILIARY TRACT: Cirrhotic appearing liver again noted. No focal enhancing lesions. There is no intrahepatic or extrahepatic biliary duct dilatation. SPLEEN: There is an accessory splenule, otherwise the spleen is unremarkable.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a punctate nonobstructing right renal stone in the collecting system. There is a left superior pole cyst which is unchanged from prior examination.RETROPERITONEUM, LYMPH NODES: First small retroperitoneal lymph nodes with fatty hila. There is moderate calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: There is sigmoid diverticulosis without evidence of diverticulitis. Otherwise the stomach, small bowel, and colon are unremarkable. The appendix is well visualized and unremarkable. There is no significant mesenteric lymphadenopathy.BONES, SOFT TISSUES: T11 -- 12 disk bulge.PELVISUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There are bilateral non-pathologically enlarged iliac lymph nodes as noted previously. BONES, SOFT TISSUES: There is degenerative disease of the thoracic and lumbar spine. There is a small fat containing ventral hernia without evidence of complication.OTHER: No significant abnormality noted | 1. No significant abnormality to explain nausea and vomiting.2. Cirrhotic liver morphology. |
Generate impression based on findings. | Invasive squamous cell carcinoma of the scalp status post excision on June 9, 2014. Neck: There are several subcentimeter nodules throughout the thyroid lobes bilaterally. There is no significant lymphadenopathy in the neck. There is multilevel degenerative spondylosis. There is a 6 mm calcified nodule in the right lung apex. There is an unchanged micronodule in the left lung apex. The carotid arteries and jugular veins are patent. There is a two vessel aortic arch. The salivary glands are unremarkable.Head: There are postoperative findings related to interval posterior scalp mass resection without discernible evidence of tumor in the treatment bed. The underlying calvarium appears to be intact. The intracranial contents are unremarkable without evidence of mass lesions. The ventricles are unchanged in size. The imaged paranasal sinuses and mastoid air cells are clear. | 1.Postoperative findings related to interval posterior scalp mass resection without discernible evidence of tumor in the treatment bed. 2.No significant lymphadenopathy in the neck.3.Unchanged thyroid nodules. |
Generate impression based on findings. | Female 48 years old; Reason: progression of disease History: abd pain, bladder symptoms CHEST:LUNGS AND PLEURA: Scattered pulmonary micro-nodules. The pleural spaces are clear.MEDIASTINUM AND HILA: Right chest wall port terminates at the cavoatrial junction.There is a small pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Persistent mild collecting system dilatation of the kidneys with bilateral nephroureteral stents.Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Few scattered retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes from hysterectomy. There is a soft tissue mass at the apex of the vagina that likely invades into the bladder anteriorly and the rectum posteriorly. It measures 2.8 x 2.3 cm (image 172/series 5) previously, 3.8 x 3.8 cm.BLADDER: No significant abnormality noted.LYMPH NODES: Small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Decrease in the size of the pelvic mass. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Benign left breast biopsy in 1997. Family history of breast cancer in mother. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign biopsy in right breast. 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. Postsurgical changes with architectural distortion are present in the right breast. Benign calcifications are present bilaterally.No suspicious masses or microcalcifications 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. | 45-year-old male with left lower quadrant pain and diarrhea. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy.SPLEEN: No significant abnormality noted. Focus of accessory splenic tissue.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is extensive diverticula formation throughout colon without wall thickening or pericolonic fat infiltration suggest acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Dense prostate calcifications. Mild cystic change left seminal vesicle.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is extensive diverticula formation throughout colon without wall thickening or pericolonic fat infiltration suggest acute diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No interval change. No bowel wall abnormality. |
Generate impression based on findings. | Lung cancer. One year after RLL for stage IA NSCLC. LUNGS AND PLEURA: Postsurgical finding of a right lower lobectomy.No suspicious pulmonary nodules.No pleural effusion with interval resolution of very small loculated pleural fluid at the right base.MEDIASTINUM AND HILA: Borderline enlarged subcarinal lymph node is unchanged at 10 mm. No new lymphadenopathy.Moderate coronary artery calcification.Moderate cardiomegaly without pericardial effusionMain pulmonary artery dilatation suggestive of pulmonary artery hypertension, unchanged.Diffuse circumferential mild esophageal wall thickening suggestive of esophagitis.CHEST WALL: Minimal degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. | No evidence of recurrent or metastatic disease. Findings suggestive of esophagitis. |
Generate impression based on findings. | There has been interval expected evolution of multiple variably sized hypodense infarcts, with mild localized mass effect especially upon the right atrium.The ventricles and sulci are stable. There is no midline shift. There is no intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | Interval expected evolution of multiple scattered bilateral cerebral infarctions, without hemorrhagic transformation. |
Generate impression based on findings. | Determine etiology of abdominal pain after ventral hernia repair with mesh. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: No significant abnormality noted. Tiny bulla at the left lung base.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: Status post ventral hernia repair. No evidence of recurrent or any identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Moderately enlarged uterus; query fibroids. Correlate with gynecologic ultrasound as clinically indicated.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Status post hernia repair with no evidence of recurrent hernia. No CT findings to explain abdominal pain. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast cancer in maternal aunt. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. An 8mm left retroareolar mass corresponding with a cyst seen on prior ultrasound is stable. An additional circumscribed mass in the left medial left breast representing a fibroadenoma seen on prior ultrasound is also unchanged.No suspicious morphology masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 77 year old female status post right mastectomy in 1994 for breast cancer, presents today for routine follow up. No current breast complaints. No family history of breast cancer. 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. Scattered benign calcifications are present. A stable intramammary lymph node is present in left upper outer breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 57 years old; Reason: metastatic breast cancer on Xeloda please assess response to treatment and compare to previous imaging History: metastatic breast CHEST:LUNGS AND PLEURA: Radiation changes in the left upper lobe. Ground glass nodule adjacent to left major fissure measuring 6 x 5 mm on image 27/series 5, unchanged.The pleural spaces are clear.MEDIASTINUM AND HILA: Prevascular lymph node measures 1.0 x 0.8 cm (image 25/series 3) previously, 1.3 x 1.0 cm.CHEST WALL: Reference left axillary lymph node measures 3.1 x 2.6 cm (image 28/series 3) previously, 3.3 x 2.8 cm.Left breast lesion measures 1.6 x 1.4 cm (image 33/series 3) previously, 2.0 x 1.6 cm.Extensive osseous metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Hepatic metastases measures 1.2 x 1.2 cm (image 80/series 3) previously, 1.3 x 1.1 cm. Other lesions remain.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive osseous metastatic disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant change in the left ovarian or adnexal massBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosisBONES, SOFT TISSUES: Sclerotic osseous metastatic diseaseOTHER: No significant abnormality noted. | 1.No stable size measurements of the reference lesions.2.Extensive osseous metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast needle aspiration in 2005. Two standard digital views of both breasts were performed with tomosynthesis and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. There is a stable intramammary lymph node in the upper outer right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable intramammary lymph node in the right breast. 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. | Generalized abdominal pain and tympanic abdomen. Obstipation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Ill-defined hypodense lesions in the right lobe liver probably represent metastases. For reference purposes, a segment 6 lesion measures 2.5 x 3.1 cm (image 56; series 3). No intrahepatic ductal dilatation.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: Colon is dilated with air-fluid levels and measures up to 7.4 cm in diameter. There is a concentric, obstructing mass in the sigmoid colon measuring 3.9 cm in diameter (image 146; series 3) which is presumed to represent adenocarcinoma. Colon distal to this point is decompressed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount abdominal ascitesPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Multiple small pelvic lymph nodes. For reference purposes, a left hypogastric lymph node (image 140; series 3) measures 1.5 x 1.0 cm.BOWEL, MESENTERY: Colon is dilated with air-fluid levels and measures up to 7.4 cm in diameter. There is a concentric, obstructing mass in the sigmoid colon measuring 3.9 cm in diameter (image 146; series 3) which is presumed to represent primary colon carcinoma. Colon distal to this point is decompressed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites | Obstructing sigmoid mass presumably representing primary colon carcinoma. Liver metastases. Small pelvic lymph nodes. ER notified of these findings at the time of dictation (#45657). |
Generate impression based on findings. | Metastatic prostate cancer to the bones. Restaging evaluation. Again seen is multiple foci of osseous uptake with new lesions and increased uptake in others. There are new calvarial, sternal, right mid-femoral, and proximal left tibial lesions. Existing calvarial lesions appear more confluent with increased uptake. Additionally, numerous other areas of uptake within the right femur, spine, ribs, and right proximal humerus are again demonstrated. | Progression of bone metastases. |
Generate impression based on findings. | Esophageal adenocarcinoma stage IV. Please assess and make direct comparison to OSH imaging on 2/3/15 and provide index lesion measurements for both scans for comparison. CHEST:LUNGS AND PLEURA: Mild apical predominant emphysema. Mild bronchial wall thickening. Scattered multiple bilateral micronodules/nodules suspicious for pulmonary metastases, are smaller in number and size compared to the previous exam. MEDIASTINUM AND HILA: Severe coronary artery calcifications. Left-sided central venous catheter terminates in the distal SVC. No significant lymphadenopathy. The distal esophagus is thickened and presumably represents the site of primary malignancy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The extension of metastases into the right liver lobe from the adjacent adrenal metastases appears less pronounced on today's exam. Bulky gastrohepatic lymphadenopathy is noted but appears less pronounced compared to prior exam. The porta hepatis reference lymph node measures 1.3 x 3.1 cm compared to 2.7 x 5.7 cm previously. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The large right-sided adrenal metastasis is similar in size measuring 5.1 x 7.4 cm (series 5, image 111), previously measured 5.3 x 7.3. The left adrenal mass measures 3.3 x 2.2 cm (series 5, image 115), previously measured 3.4 x 4.0 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 1.2 x 1.3 cm (series 5, image 122), previously measured 1.6 x 2.2 cm. severe atherosclerotic plaque and calcifications are noted about the abdominal aorta and its proximal branches.BOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: Mild degenerative changes are noted about the thoracic spine.OTHER: Small foci of increased soft tissue attenuation along the anterior abdominal wall likely represent subcutaneous injection of medication.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Nonobstructive bowel pattern.BONES, SOFT TISSUES: Degenerative changes are noted about the thoracolumbar spine most severe at L1-L2 level with loss of disk height and endplate sclerosis.OTHER: No significant abnormality noted | Distant metastases with overall improvement. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Benign intramammary lymph nodes are present in the outer upper quadrants of both breasts. Bilateral arterial calcifications are noted.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. | Persistent bacteremia. Evaluate for sources of infection. Physiologic activity is present in the liver, spleen, and bone marrow. An accumulation of radiotracer in the left forearm correlates to the injection site and is presumably infiltrated radiotracer. There is faint, minimal uptake within the right iliac fossa which likely represents inflammatory change. | Minimal uptake within the right iliac fossa which is likely inflammatory without definite evidence of infection. |
Generate impression based on findings. | 19 year-old female with right R3 pain for one month in a rower. Evaluate for compression fracture. No acute fracture or malalignment. | Normal examination. |
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.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. | There is prominent hyperdensity along the right left tentorium with only very minimally hyperdense extra-axial material along the dorsal posterior fossa. Additional extra-axial hyperdensity is seen along the right aspect of the falx posteriorly and extending along the right parietal and temporal lobes, into the right middle cranial fossa. The subdural blood products have a more globular appearance along the anterior aspect of the right tentorium measuring 9 x 12 mm on 2/14. There has been expected evolution of likely previous hyperacute blood products in the subgaleal space which are now increased in density with a more heterogeneous appearance, right greater left side and predominately along the parietal bones. These measure up to 2.5 cm in greatest thickness on today's exam, previously measuring up to 2.1 cm. There is slight inward displacement of the occipital bones. Incidental note is also made of slight focal prominence of the extra-axial space anterior and inferior to the temporal poles, with the possibility of small arachnoid cysts in this location not entirely excluded at this time.There is suggestion of slight decreased prominence of the subarachnoid space diffusely. Addition, the deep gray nuclei less hypoattenuating than on the prior exam, not readily delineated from the surrounding white matter.The ventricles are within normal limits. There is no midline shift or mass effect. There is diffuse edema extending into the facial soft tissues, right greater than left side. There is opacification of bilateral mastoid air cells and middle ear is. There is a partially visualized nasogastric tube which at the time of the exam may have been coiled within the visualized nasopharynx, although subsequent chest x-ray imaging demonstrates normal course. | 1. Right greater than left acute subdural hemorrhage.2. Slight interval decreased prominence of the subarachnoid space is suggested although ventricles and sulci remain visualized. Decreasing attenuation of the deep gray nuclei suggestive of global hypoxic ischemic injury. Given clinical concern for HIE, close monitoring is recommended for developing cerebral edema.3. Interval expected evolution and increased size of right greater than left subgaleal hematomas.4. Partially visualized but probably coiled nasogastric tube in the nasopharynx.Dr. Yang discussed these findings over the telephone with NP Amy Noetzli on 3/6/2015 1:53 PM. |
Generate impression based on findings. | 52 year old woman with history of right breast IDC s/p lumpectomy 2010. No current breast complaints. 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. Postsurgical changes of right lumpectomy appear stable with local volume loss, architectural distortion, dystrophic calcifications, and surgical clips. Skin thickening over the right breast also appears stable. No dominant mass or suspicious microcalcifications are seen in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral 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. | Esophageal cancer. Restaging.RADIOPHARMACEUTICAL: 15 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 95 mg/dL. Today's CT portion grossly demonstrates prominent gastrohepatic lymph nodes. There are severe coronary artery calcifications. Today's PET examination demonstrates decreased size and metabolic activity of an esophageal lesion (max SUV = 6.8, previously 14.0). There is also a decrease in size and metabolic activity of two gastrohepatic lymph nodes (max SUV = 4.2, previously 5.4). There is hypermetabolic activity within the left frontal lobe which correlates to an enhancing lesion when compared to recent MRI.Hypermetabolic activity within previously noted left periaortic/paraspinal lymph nodes is no longer identified. No significant hypermetabolic activity is seen in the right paratracheal region. Minimal activity in the right hilar and subcarinal lymph nodes has not significantly changed. There is no significant change in hypermetabolic activity in a left retroperitoneal lymph node. There is decreased activity posterior to the right sacrum (max SUV = 1.6, previously 2.3). | 1.Overall, improvement in the primary esophageal lesion and regional lymph node metastases. No new lesions are identified.2.Hypermetabolic lesion in the left frontal lobe corresponding to known left precentral gyrus metastasis. |
Generate impression based on findings. | 19 year-old female with right knee pain. No acute fracture or malalignment. No joint effusion. | Normal right knee. |
Generate impression based on findings. | Reason: GIST restaging on chemo CHEST:LUNGS AND PLEURA: Interval resolution of left pleural effusion. Stable lung base scarring and band-like atelectasis.MEDIASTINUM AND HILA: Mild coronary artery calcification. Cardiac size is unremarkable. Previously described subcentimeter precarinal lymph node is smaller (image 40; series 3). Trace pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Perihepatic fluid has resolved. There is also mild decrease in the size of the two liver lesions. Left liver lobe lesion measures 2.0 x 1.7 cm (image 103; series 3), smaller. Right hepatic lobe lesion measures 2.3 x 1.7 cm (image 94; series 3), smaller. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Regression of sigmoid colon masses. Largest lesion is decreased in size measuring 3.3 x 3.7 cm (image 164; series 3). Smaller lesion is also decreased in size measuring 2.2 x 2.0 cm (image 170; series 3).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Pelvic ascites has resolved. | Interval regression of disease with measurements given above. |
Generate impression based on findings. | Thyroid cancer, evaluate for recurrence. Tg not suppressed. There are postoperative changes related to total thyroidectomy and neck dissection. There is no discernible mass lesion in the thyroidectomy bed. There are scattered subcentimeter cervical lymph nodes that are not significantly enlarged. The salivary glands are unremarkable. The major cervical vessels are patent. There is mild cervical spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. Stable post-treatment findings in the neck without evidence of measurable locoregional tumor recurrence. 2. Scattered nonspecific lymph nodes in the neck, which are otherwise not particular enlarged. |
Generate impression based on findings. | Soft Tissues: Right lower limb soft tissue wound/ulceration and subcutaneous edema extending from the mid tibia through the ankle joint. Some areas of the ulcer appear to extend to the deeper soft tissues of the leg, approaching the bone (series 5, image 114). There is abnormal signal intensity within the distal right tibial metaphysis, extending through the right tibial epiphysis, which measures approximately 14 x 3 cm and has what appears to be a sinus tract extending through the medial cortex of the bone (series 5, image 108).Abnormal high T2 signal intensity within the left lower extremity soft tissues, consistent with edema, however the underlying deeper tissues remain relatively normal in appearance.Vasculature: RIGHT LEG: The popliteal artery is almost completely occluded at the level of the popliteal fossa, with contrast opacification only of the anterior tibial artery (one vessel runoff). No appreciable reconstitution of the peroneal or posterior tibial arteries more distally.LEFT LEG: The popliteal artery is patent, with a two vessel runoff including patent anterior tibial artery and peroneal artery. Posterior tibial artery is not visualized. | 1) Findings suggestive of osteomyelitis of the distal right tibia, with overlying deep soft tissue ulcerations as above.2) Left calf subcutaneous edema that may represent cellulitis although this is nonspecific, correlate with physical exam. 3) Right popliteal artery near complete occlusion, with opacification of only the anterior tibial artery distally in a 1-vessel runoff.4) Left popliteal artery is patent, with a 2-vessel runoff including opacification of only the anterior tibial artery and peroneal artery. |
Generate impression based on findings. | 48-year-old female with back pain. Evaluate for DDD. Lumbar spine: Vertebral heights and intervertebral disk spaces are preserved. Alignment is anatomic. Multilevel small anterior osteophytes. Mild facet joint osteoarthropathy affects the lower lumber spine. Cholecystectomy clips. Incompletely visualized loops of bowel appear slightly dilated. If clinically indicated, dedicated abdominal imaging is recommended.Thoracic spine:No acute fracture or malalignment. Vertebral body heights and intervertebral disk spaces are preserved. Alignment is anatomic. Lower cervical spine anterior fixation device is partially visualized | Mild degenerative arthritic changes of the lumbar spine. |
Generate impression based on findings. | Esophageal cancer. Please compare to prior PET per CALGB 80803 requirements.RADIOPHARMACEUTICAL: 13.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates interval decrease in thickening of the distal esophageal wall. A prominent right paratracheal lymph node is unchanged. A right chest port catheter terminates near the superior atriocaval junction. Left lower lobe atelectasis/scarring is noted. A hypodense right renal lesion likely represents a cyst. Lower cervical spinal fixation hardware is noted.Today's PET examination demonstrates interval decrease in size and metabolic activity within the distal esophagus (max SUV 9.6, previously 17.6). There is also decrease in size and metabolic activity of a right paratracheal lymph node (max SUV 3.3, previously 5.6). No new suspicious FDG avid lesion is identified.No FDG avid tumor is identified in the neck or pelvis. | Interval decrease in size and metabolic activity of the distal esophageal tumor and regional lymph node metastases. No new FDG avid lesion is identified. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Stable left axillary lymph node.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. | History of smoking prior right lower lobe nodule on 12/26/2011 chest CT. Shortness of breath. Weight loss. LUNGS AND PLEURA: The previously described well circumscribed right lower lobe nodule appears to contain punctate internal lipid attenuation, suggestive of but not pathognomonic for a hamartoma, and slightly increased in size measuring 14 x 13 mm (4/74), previously 10 x 10 mm. The slow growth rate also favors benignity.Interval development of right inferior interlobar lymphadenopathy which causes slight compression upon the proximal aspect of the right middle lobe and right lower lobe airways though they remain patent.Interval development of a lobular branching opacity in the anterolateral aspect of the right lower lobe superior segment. The largest solid component measures 2.8-cm in length (4/49). mild interstitial lung disease with subpleural reticulation, bronchiolectasis and honeycombing suggestive of UIP. Trace pleural fluid or thickening on the left..MEDIASTINUM AND HILA: Interval development of right inferior interlobar lymphadenopathy measuring approximately 21 (3/50) and 24-mm (3/56) in short axis. Chronic mild enlargement of hilar and subcarinal lymph nodes not significantly changed.Atherosclerotic calcification of the aorta and its branches. Main pulmonary artery normal in size. Severe coronary artery calcifications. Mild cardiomegaly with left atrial enlargement.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Vascular calcifications. Unchanged benign appearing left adrenal gland lesion. | 1. Interval development of an expansile endobronchial lesion and within the in the right lower lobe and ipsilateral inferior interlobar lymphadenopathy which causes slight compression of the airways. Differential considerations include malignancy such as mucinous adenocarcinoma or or an infectious process such as allergic bronchopulmonary aspergillosis or atypical mycobacterial infection. Infections do not typically result in this degree of lymphadenopathy in a patient of this age and are therefore considered less likely than malignancy but should be ruled out clinically. 2. Mild interstitial lung disease in a pattern consistent with UIP. 3. Growth rate and characteristics of the right lower lobe nodules seen previously in 2011 favor a benign lesion such as a hamartoma.4. Mild cardiomegaly with enlargement of the left atrium and coronary artery calcifications. |
Generate impression based on findings. | History of Gleason 4+3, evaluate for metastatic disease. No abnormal osseous foci are identified to indicate metastatic disease. Degenerative uptake is noted in the right acromioclavicular joint and ankles. | No evidence of bone metastases. |
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 with confluent surrounding hypoattenuation suggestive of edema. The grey-white matter differentiation otherwise 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 to suggest hepatic encephalopathy. However, CT is insensitive for evaluation of hepatic encephalopathy and further evaluation with MRI may be considered. |
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