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Generate impression based on findings. | Patient with esophageal cancer status post resection. Chemoradiation. CHEST:LUNGS AND PLEURA: Dense right upper lobe paramediastinal radiation reaction, unchanged.Stable scattered bilateral micronodules, unchanged and likely post-inflammatory.No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Reference low right cervical lymph node is 7 mm, previously 6 mm (series 3, image 16).Reference right paratracheal lymph node is 11 x 7 mm (series 3, image 30), unchanged. Scattered small mediastinal lymph nodes, unchanged.Normal heart size with an unchanged small pericardial effusion.Moderate coronary artery calcification.Post-surgical findings of esophagectomy and gastric pull up.Fluid collection anterior to the gastric interposition adjacent to the left atrium consistent with a loculated pericardial effusion, unchanged.CHEST WALL: Postoperative abnormalities in the right chest wall, unchanged.Mild degenerative changes of the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomy with multiple small splenules, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter renal hypodensities are unchanged, too small to characterize, likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Calcified atherosclerotic disease of the aorta and branch vessels.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Interval resolution of previously seen small bowel obstruction.Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease. Interval resolution of small bowel obstruction. |
Generate impression based on findings. | Primary hyperparathyroidism. There is physiologic distribution of the radiopharmaceutical. A subtle focus of radiotracer uptake inferior and posterior to right lower pole is suspicious for a parathyroid adenoma.The right thyroid lobe appears to measure 6.3 cm and the left lobe 5.8 cm in length. | Focus of uptake posteroinferior to the right lower pole is suspicious for a parathyroid adenoma. |
Generate impression based on findings. | Female 79 years old; Reason: Metastatic breast cancer on endocrine therapy, eval for progression. History: Metastatic breast cancer on endocrine therapy, eval for progression. CHEST:LUNGS AND PLEURA: Emphysematous changes in the upper lobes with volume loss and fibrosis in the right apex.Reference a nodule in the right lower lobe medially measures 6 mm on image 47/series 5, unchanged. No pleural effusionsMEDIASTINUM AND HILA: Displacement of the heart to the left.Trace pericardial effusion.CHEST WALL: Left breast mass decreased in size measuring 2.9 x 2.6 cm (image 44/series 3) previously, 3.7 x 3.6 cm.Left axillary lymph node measures 1.0 x 0.8 cm (image 28/series 3) previously, 2.0 x 1.8 cm.ABDOMEN:LIVER, BILIARY TRACT: Reference left hepatic lobe lesion measures 2.0 x 1.8 cm (image 86/series 3) previously, 1.7 x 1.7 cm. There are scattered other small hypodense foci in the liver that is too small to characterize.Right hepatic lobe lesion measures 4.2 x 3.9 cm (image 113/series 3) previously, 4.2 x 3.8 cm.Portal vein is patent. 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: The abdominal aortic aneurysm measures 7.2 x 6.8 cm previously, 6.8 x 6.6 cmBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small focus of gas within the uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: Aneurysm dilatation of the iliac vessels.OTHER: No significant abnormality noted. | 1.Decrease in the size of the left breast lesion. The reference measurements are provided above.2.Increase in the size of abdominal aortic aneurysm.. |
Generate impression based on findings. | Male 74 years old; Reason: rule out rectal cancer recurrence, metastases History: Rectal cancer s/p resection ABDOMEN:LUNG BASES: Minimal scarring at the lung bases.LIVER, BILIARY TRACT: Bilateral hepatic cysts. Previously described hyperdense lesion in segment 4 is not identified on today's exam. Cholelithiasis. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst with small calcification is unchanged compared to prior. No hydronephrosis of either kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aortaBOWEL, MESENTERY: Status post ostomy takedown. Colonic diverticulosis.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: Postoperative changes in the anorectal region. Mild soft tissue thickening in the rectum represent postsurgical changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable exam with no definite metastatic disease. |
Generate impression based on findings. | 40 year-old female with right knee pain status post fall. Minimal osteoarthritis affects the right knee, unchanged compared to prior. No acute fracture or malalignment. | Minimal osteoarthritis with no acute fracture or malalignment. |
Generate impression based on findings. | 55 year-old female with SLE with severe stabbing pain in first and second toes of the left foot, numbness lateral left calf. Moderate osteoarthritis affects the first MTP joint, progressed compared to prior. Previously seen second distal phalangeal fracture has healed in the interval. No acute fracture or malalignment. Increased arterial calcifications are seen in the soft tissues. | Progressed moderate first MTP joint osteoarthritis. |
Generate impression based on findings. | 30 year-old male status post reduction left ankle fracture. Mortise and lateral only. Interval reduction and casting of the left ankle. Limited evaluation of fine bone detail due to overlying casting material. Again seen are trimalleolar fractures, now reduced to gross anatomic alignment. Soft tissue swelling. | Interval reduction and casting of the left ankle trimalleolar fractures as described above. |
Generate impression based on findings. | Status post robotic pyeloplasty of left horseshoe kidney, with bilateral grade I hydronephrosis. Evaluate for obstruction. The posterior abdominal radionuclide angiogram demonstrates prompt, symmetrical perfusion of the kidneys. Sequential renal images show a horseshoe kidney with the left kidney moiety larger than the right. There is prompt uptake and excretion of the radiopharmaceutical by both moieties. The estimated contribution of the right kidney moiety to total renal function is 42% and that of the left kidney moiety is 58%. There are no abnormalities of the ureters or bladder.Following administration of the diuretic, there was prompt washout of collecting system radiotracer into the bladder without evidence of current obstruction. The T1/2 washout from the left collecting system was 5.5 minutes. The T1/2 washout from the right collecting system was 4 minutes. | Normal functioning horseshoe kidney without evidence of obstruction. |
Generate impression based on findings. | 45-year-old male with knee pain. Normal appearing right knee. No acute fracture or malalignment. | Normal right knee. |
Generate impression based on findings. | Male 2 days old Reason: evaluate lung fields, ett placement History: respiratory decompensationVIEW: Chest AP (one view) 3/6/15 at 1343 hrs. Esophageal temperature probe has been retracted or removed. Left humeral transverse fracture again noted. ET tube terminates below thoracic inlet. NG tube is in the stomach. The umbilical lines unchanged.Cardiac silhouette size is normal. Small lung volumes with no focal opacities, effusions or pneumothorax. Persistent soft tissue edema | Interval removal of esophageal temperature probe.No change in small lung volumes. |
Generate impression based on findings. | 63 year old female who has a complaint of palpable mass of the right upper outer quadrant. Patient had an FNA of this area last year resulting benign cells. Prior mammographic and sonographic workup showed normal dense parenchymal tissue without suspicious findings. No family history of breast cancer. MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A triangular marker has been placed overlying the upper outer posterior right breast, denoting area of palpable finding. The area noted immediately subjacent to the palpable marker demonstrates dense parenchymal breast tissue. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.RIGHT BREAST ULTRASOUND: A targeted right ultrasound was performed for the palpable area of concern. At the 10 o'clock position of the right breast, there is prominent dense parenchymal tissue. No abnormal vascularity is associated with this region. There is no solid or cystic mass identified. | Dense parenchymal breast tissue subjacent to the area of palpable concern in the upper outer right breast. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains benign, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 62-year-old male with prior embolization of left renal cell carcinoma, now with elevated creatinine. RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Echotexture is within normal limits. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 12.2 cm in length. There is a lobulated, solid mass extending from the lower pole measuring approximately 2.1 x 2.4 x 3.3 cm. There is some degree of cortical atrophy likely due to embolization with increase in renal sinus echoes. No gross hydronephrosis.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted. | No hydronephrosis. Post-embolization changes left kidney with solid mass. |
Generate impression based on findings. | RFO trigger for BMI over 40. Thoracotomy.VIEW: Chest right lateral decubitus (one view) 03/06/15, 1324, 1326, 1320 A left chest tube is present. Multiple surgical clips are noted. There is a left pneumothorax. Partial resection of the left sixth rib is again seen. Mediastinum is shifted to the right. No unexpected foreign body is present. | No unexpected foreign body. These findings were discussed by telephone with Dr. Mark Slidell on 03/06/15, at 1340. |
Generate impression based on findings. | Female 15 days old Reason: Term infant now nasally intubated, please assess tube placement History: Tube placementVIEW: Chest AP (one view) 3/6/15 at 1348 hrs. Hardware of the mandible noted. Right mainstem bronchus intubation. NG tube terminates in the GE junction. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Right mainstem bronchus intubation. |
Generate impression based on findings. | Idiopathic peripheral neuropathy with abdominal pain. Assess for tumor. Right leg weakness. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Tiny calcifications in the liver are nonspecific. Rectal abnormalities cannot be evaluated in the absence of intravenous contrast.SPLEEN: Probable calcified splenic granulomas.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Atherosclerotic aortic calcifications.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Given the limitations of an unenhanced study, no evidence of primary tumor in the abdomen or pelvis. |
Generate impression based on findings. | There is mild left posterior scalp stranding. The calvarium is unremarkable without fracture. There is no acute intracranial hemorrhage, mass effect, or midline shift. There are patchy areas of low attenuation in the cerebral hemispheres. There is mild diffuse cerebral volume loss. There is a small left maxillary retention cyst. Otherwise, the imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | 1. Small left posterior scalp contusion without evidence of acute intracranial hemorrhage or skull fracture. 2. Patchy areas of low attenuation in the cerebral hemispheres are nonspecific, but most likely represent age-indeterminate small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 51-year-old female with pain. Postsurgical changes of an ACL repair. No specific radiographic evidence of hardware complication. No acute fracture or malalignment. No joint effusion. The bones appear demineralized, likely related to disuse. | Postsurgical changes of an ACL repair without radiographic evidence of hardware complication. |
Generate impression based on findings. | There is diffuse cerebral parenchymal volume loss with particular prominent sulci in the bilateral parieto-occipital regions, similar to the appearance on MRI from 2010. There is no acute intracranial hemorrhage, mass effect, or midline shift. There are patchy areas of low attenuation in the cerebral hemispheres. The ventricles, sulci, and cisterns are otherwise normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. The are bilateral lens implants. Amorphous hyperattenuating material in the bilateral cheek subcutaneous tissues likely represents cosmetic filler material. The paranasal sinuses and mastoid air cells are otherwise unremarkable. | 1. Diffuse cerebral parenchymal volume loss with particular prominent sulci in the bilateral parieto-occipital regions, which may indicate Lewy body dementia versus a variant of normal pressure hydrocephalus. A brain PET may be useful for further characterization.2. Patchy areas of low attenuation in the cerebral hemispheres are nonspecific, but most likely represent age-indeterminate small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.3. No acute intracranial hemorrhage or mass effect. |
Generate impression based on findings. | Breast cancer (left) initial metastatic evaluation. Additional remote history of endometrial cancer. CHEST:LUNGS AND PLEURA: 6-mm subpleural nodule with internal lipid attenuation and angulated margins, most compatible with a subpleural lymph node (4/49). These are typically benign but should continue to be monitored.A small area of rounded subpleural consolidation is seen in the nearby lung, posterior right lower lobe abutting the fissure (4/48-49). Dependent subpleural opacities, most likely atelectasis noted bilaterally. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Upper normal heart size. Faint coronary artery calcification. Mildly patulous thoracic esophagus. Mildly prominent 11-mm right hilar lymph node, nonspecific (3/39). No mediastinal lymphadenopathy or pericardial fluid.CHEST WALL: Metallic marker in the left breast with surrounding asymmetric soft tissue density in addition to scattered solid and nodular densities, nonspecific by CT but may represent the patient's known malignancy. Mild left breast skin thickening. No axillary, subpectoral or internal mammary chain lymph node enlargement however mild asymmetry is present, with a subcentimeter high left subpectoral lymph node seen near the shoulder (3/2) and a poorly marginated but small 8mm left axillary lymph node occurring next to a calcification or marker (3/26).Hemangioma in the lower thoracic spine. No skeletal metastases are appreciated.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: Unchanged left adrenal gland nodularity.KIDNEYS, URETERS: Probable subcentimeter cyst inferior pole right kidney, incompletely characterized. Other punctate cortical lesion is too small to be accurately characterized.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. | 1. No conclusive evidence of pulmonary metastases. 2. Small (subcentimeter) but asymmetric lymph nodes in the left axilla and high subpectoral regions are of unclear clinical significance, consider assessment with PET scan or short-term follow-up in 3 months. 3. Peripheral subsegmental air space opacity in the right upper lobe indeterminate in etiology but suspicious for a small pulmonary infarction, less likely pneumonia. Suggest short-term plain film follow-up in 6 weeks. Finding discussed with endocrinology by Stephen Maron (3828) on 3/6/2015 at 2:46 p.m.4. Left breast nodules are nonspecific by CT and may be followed by dedicated imaging.5. No visible skeletal or solid organ metastases. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts (8 images) were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. 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: NSA - Screening Mammogram. |
Generate impression based on findings. | Evaluate right middle lobe lung lesion. Wedge excision of T1aN0M0 stage IA adenocarcinoma. Compare to previous. LUNGS AND PLEURA: New trace left pleural effusion.Post surgical findings of right middle lobe wedge resection. A nodule at the proximal end of the surgical suture is 14 x 9 mm, unchanged from immediate prior study but slowly enlarging from 2013. This is suspicious for local recurrence.Subpleural right upper lobe nodule, not significantly changed from immediate prior, but progressively increased in solid component (series 4, image 41) over the past two years, remains suspicious for a primary lung carcinoma. Diffuse reticulonodular interstitial opacities with traction bronchiectasis throughout the lungs, consistent with drug induced interstitial fibrosis, not significantly changed.MEDIASTINUM AND HILA: Mild enlarged nonspecific mediastinal lymph nodes, not significantly changed. The reference right lower paratracheal node is 10 mm (series 3, image 32), unchanged.Right lower paraesophageal node is 11 mm in short axis (series 3, image 77), previously 13 mm.Calcified mediastinal nodes consistent with prior healed infection.Severe coronary artery calcification.Normal heart size.CHEST WALL: Median sternotomy. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Calcified splenic and hepatic granulomas.Cholecystectomy clips. | 1. Nodule along the right middle lobe surgical suture, unchanged from immediate prior study, but slowly enlarging over the past two years, suspicious for local recurrence.2. Right upper lobe subpleural nodule, similar to prior, but with increased solid component over the past few years, suspicious for a primary lung carcinoma.3. New trace left pleural effusion. |
Generate impression based on findings. | Pancreatic cancer. Evaluate for progression of metastatic disease; compare to previous scan. CHEST:LUNGS AND PLEURA: Bibasilar dependent atelectasis. No mediastinal lymphadenopathy. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Right-sided central venous catheter terminates in the proximal right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A segment VII hypoattenuating liver lesion measuring 0.8 x 0.9 cm (series 7, image 93) is not definitely seen on the prior exam and likely represents a new hepatic metastasis. Additional tiny scattered hepatic hypodensities are too small to characterize.The gallbladder is again distended and is surrounded by ascitic fluid. Portions of the gall bladder wall are devoid of enhancement. These findings remain suspicious for possible cholecystitis. There is mild intra-hepatic biliary ductal dilatation as well as mild common bile duct dilation, similar to prior exam and likely related to patient's pancreatic mass.SPLEEN: Small splenic infarcts are redemonstrated and not significantly changed.PANCREAS: Again visualized a large mass in the region of the head/body of the pancreas extending into the uncinate process. This lesion measures approximately 3.5 x 5.2 cm and is unchanged in size. There is encasement of the celiac, hepatic, splenic and superior mesenteric arteries. The portal vein is occluded, with cavernous transformation of portal vein evident. There is attenuation of the SMV near the confluence. The splenic vein is occluded, with numerous perigastric varices evident.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BOWEL, MESENTERY: Nonspecific colonic bowel wall thickening may be from the ascites.BONES, SOFT TISSUES: Unchanged sclerotic focus in the L4 vertebral body.OTHER: Interval increase in the abdominal pelvic ascites and peritoneal/omental carcinomatosis.PELVIS:UTERUS, ADNEXA: Intrauterine device is noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction or perforation.BONES, SOFT TISSUES: Unchanged sclerotic focus in the L4 vertebral body.OTHER: Interval increase in the abdominal pelvic ascites and peritoneal/omental carcinomatosis. | 1.Pancreatic head/body mass with extensive vascular encasement is not significantly changed.2.Interval increase in the abdominopelvic ascites and increase in the peritoneal/omental carcinomatosis.3.Likely new small segment VII liver metastatic lesion.4.Persistent gall bladder dilatation with portions of the gall bladder wall lacking enhancement. These findings remain suspicious for possible cholecystitis. |
Generate impression based on findings. | Reversal of the normal cervical lordosis. No evidence of acute fracture or traumatic subluxation. Vertebral body heights are well-maintained.Postoperative changes of laminectomy with lateral mass screws bilaterally from C3 through C6 and a left pedicle screw at C7. There are disk osteophyte complexes at most levels with the largest at C4/5 and C6/7; the spinal canal has been decompressed posteriorly at these levels.Multilevel degenerative changes as follows:Mild left neural foraminal narrowing at C2/3Mild right neural foraminal narrowing at C4/5Moderate bilateral neural foraminal narrowing at C5/6Mild bilateral neural foraminal narrowing at C6/7Mild left neural foraminal narrowing at C7/1There is an incidental cystic lesion in the right parotid gland measuring up to 1.1 cm which was present on the previous MRI examination. | 1.Postoperative changes without evidence of surgical hardware complications.2.Multilevel degenerative changes with multilevel neural foraminal narrowing as detailed above.3.Incidental cystic lesion in the right parotid gland measuring up to 1.1 cm which was seen on the previous MRI examination. Further evaluation with dedicated imaging may be considered as clinically indicated. |
Generate impression based on findings. | Headache. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration. There is no midline shift. There are unchanged mildly low-lying cerebellar tonsils. There is a partially empty sella. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. A partially empty sella and mildly low-lying cerebellar tonsils may be a manifestation of pseudotumor cerebri.2. No evidence of acute intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | Cholangiocarcinoma. Recent ERCP. Rule-out retroperitoneal perforation, abscess, or fluid collection The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: Bilateral small pleural effusions with overlying compressive-type atelectasis.LIVER, BILIARY TRACT: Pneumobilia. No dominant liver lesions identified. Gallbladder is somewhat distended but there is no evidence of wall thickening. Common duct stent appears widely patent. Perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct stent is difficult to evaluate given lack of intravenous contrast; I cannot follow the pancreatic duct. Pigtail terminates in small bowel; the other end terminates in the region of the mid pancreas. No pancreatic ductal dilatation identified.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Probable right intrapelvic lipoma.OTHER: Trace ascites. | Within the limitations of an unenhanced study, no evidence of abscess or free air. Perihepatic and pelvic ascites. Bilateral pleural effusions. |
Generate impression based on findings. | 49 years, Female. Reason: Locate NJT position History: as above Central venous catheter tip in the suprahepatic IVC. NJ tube tip is past the ligament of Treitz within the jejunum. Right upper quadrant pigtail biliary drain. Retrocardiac opacity and left pleural effusion is similar compared to the prior exam. Residual enteric contrast throughout the colon. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NJ tube tip is past the ligament of Treitz within the jejunum. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two paternal aunts with breast cancer. 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. 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. Paternal grandmother with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. 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. | 67 years, Female. Reason: evaluate for ileus, obstruction, gaseous distension History: diffuse abdominal pain Dobbhoff tube tip projects over the gastric body. Surgical clips project over the mid abdomen. No pneumoperitoneum. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male; 26 days old. Reason: evaluate lungs and ETT placement History: RDS, premie on vent.VIEW: Chest AP (one view) 3/6/2015 1255 ET tube tip between the thoracic inlet and carina. Feeding tube side port at GE junction. Right jugular catheter tip in SVC. Unchanged mediastinal clip. Normal cardiothymic silhouette. Large lung volumes and multifocal coarse lung opacities are not significantly changed. No pleural effusion or pneumothorax. | Persistent multifocal pulmonary opacities compatible with RDS. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of fibrocystic disease. Family history of breast cancer in her mother. Two standard digital views of both breasts (8 images) with tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Multiple scattered focal asymmetries do not appear significantly changed, and likely represent a combination of nodular breast parenchyma and small cysts. Stable calcified cyst in the left retroareolar region. Benign lymph nodes project over both 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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Benign right breast biopsy in 2004. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. New linear morphology right inner lower breast calcifications are seen. Additionally, there is a focal asymmetry anterior to this area of calcifications in the right lower inner breast. No areas of architectural distortion are present. | Focal asymmetry and calcifications in the right lower inner breast which should be further evaluated with spot compression and magnification views with possible ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female; 9 months old. Reason: please evaluate NJ placement as well as possible cause for abdominal distension and desaturations History: abdominal distention, emesis, hypoxia. VIEW: Chest and abdomen AP (two views) 3/6/2015 at 1319 Chest: Left central venous catheter tip in left atrium. Normal cardiothymic silhouette. Persistent low lung volumes without focal airspace opacity, pleural effusion, or pneumothorax.Abdomen: Enteric tube tip in the third portion of the duodenum. Biliary drain terminates in the right upper quadrant. IVC stent is in expected position. Postoperative changes in the right upper quadrant are again noted. Disorganized but nonobstructive bowel gas pattern. No pneumatosis, pneumoperitoneum, or portal venous gas. | 1.NJ tube tip in the third portion of the duodenum.2.Disorganized, nonobstructive bowel gas pattern.3.Persistent low lung volumes without acute abnormality identified in the chest. |
Generate impression based on findings. | Hip pain Diffuse demineralization limits sensitivity. Superimposed mild osteoarthritic is with extensive surgical vascular clips project over the upper thigh, incompletely visualized. Moderate atherosclerotic disease. Preservation of femoral head shape and alignment. | Mild osteoarthritis |
Generate impression based on findings. | 74 year old with rheumatoid arthritis. Complaining of dyspnea. PFTs? Restriction. Evaluate for ILD. LUNGS AND PLEURA: Scattered stable noncalcified and calcified micronodules, most likely postinflammatory.Few scattered small pulmonary cysts, unchanged.No evidence of interstitial lung disease, airtrapping, or bronchiectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Scattered unchanged small mediastinal lymph nodes.Normal heart size without a pericardial effusion.Mild coronary artery and thoracic aorta calcification.CHEST WALL: Stable sclerotic focus in T7, most likely a benign bone island.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Left upper pole renal cyst. Additional subcentimeter left renal hypodensities are too small to characterize. | No evidence of interstitial lung disease or other significant acute abnormality. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast benign biopsy. 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. A linear scar marker overlies the right breast scar. Stable circumscribed mass in the right upper outer quadrant, likely benign intramammary lymph node. Stable scattered benign appearing calcifications bilaterally.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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 68 years old male. Reason: initial staging non-small cell lung cancer. History: newly diagnosed adenocarcinoma with metastasis to left femur. Also he has diffuse low grade lymphoma. Initial staging scan for non-small cell lung cancer. RADIOPHARMACEUTICAL: 14.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 105 mg/dL. Today's CT portion grossly demonstrates a stable nodular density in the left upper lobe. There is new patchy opacity in the right upper lobe with adjacent pleural thickening. Stable lymphadenopathy is noted in the neck, bilateral axillary regions and mediastinum. Extensive lymphadenopathy is also seen in the retroperitoneal cavity. Both internal fixation is noted in the left proximal femur. The soft tissue densities seen in the left hip subcutaneous tissue.Today's PET examination demonstrates interval increased metabolic activity in the left upper lobe nodular density with SUVmax of 9.0 (it was 6.7 on prior study). There is interval increased size and metabolic activity in the left proximal femoral lesion with SUVmax of 14.7 (it was 9.7 on prior study). There is a peripheral increase of metabolic activity in the soft tissue density in the left hip subcutaneous tissue.There is an interval decreased metabolic activity in the in the right thyroid lobe. Diffuse FDG uptake is seen in the post surgical site of the left upper thigh, which is consistent with post surgical change.Mild FDG uptake is seen in the extensive lymphadenopathy in the neck, bilateral axillary regions, mediastinum, retroperitoneal cavity and left inguinal region. The SUVmax in the right axillary lymph nodes is 2.0 (it was 1.6 on prior study). Minimal FDG uptake is seen in the right upper lobe opacities with thickening, consistent with an inflammatory change. | 1.Interval increased metabolic activity in the left upper lobe lung nodule.2.Interval progression of metastatic disease in the left proximal femur.3.Stable extensive lymphadenopathy with mild metabolic activity in the neck, chest, abdomen and left inguinal region, consistent with the patient's diagnosis of CLL.4. Stable hypermetabolic nodule in the right lobe of thyroid, which can be due to thyroid adenoma or carcinoma. |
Generate impression based on findings. | 18 year-old male with history of MS type I who presents with vomiting and headache. Evaluate for mass. Please note CT is insensitive for evaluation of previously noted stigmata of NF1. There is symmetric abnormal low-attenuation, primarily affecting the bilateral occipital cortices which in retrospect appears to correspond to abnormalities of the cortex present on the prior MRI examination suggestive of microgyria/migrational anomaly. There is no evidence of acute intracranial hemorrhage or mass. 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. | 1.No evidence of acute intracranial hemorrhage or mass. 2.Symmetric abnormal low-attenuation, primarily affecting bilateral occipital lobes which in retrospect appears to correspond to abnormalities of the cortex seen on the prior MRI examination suggestive of microgyria/migrational anomaly. It is unclear whether the findings are related to the current symptoms and they may be incidental; however further evaluation with dedicated MRI examination with seizure protocol with images extended to include the occipital lobe may be helpful.3.CT is insensitive for evaluation of previously noted stigmata of NF1. |
Generate impression based on findings. | 54 year old woman with history of thickening of the left breast at 6'o clock for a few months. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Specifically, no suspicious mammographic finding to correlate to the patient's palpable area of concern.SONOGRAPHIC | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 17 year-old male with history of abdominal abscess.EXAMINATION: MR enterography without and with IV contrast 3/6/2015 ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No focal renal lesions or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Borderline left para-aortic lymph node measures 10 mm (series 1601, image 69).BOWEL, MESENTERY: No bowel wall thickening, strictures, fistulous tracts, or other evidence of active inflammation. Right lower quadrant fluid collection seen on prior CT has resolved. No new fluid collections are identified to suggest abscess formation.BONES, SOFT TISSUES: The osseous structures are within normal limits.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No bowel wall thickening, strictures, fistulous tracts, or other evidence of active inflammation. Right lower quadrant fluid collection seen on prior CT has resolved. No new fluid collections are identified to suggest abscess formation.BONES, SOFT TISSUES: The osseous structures are within normal limits.OTHER: Small amount of pelvic free fluid. | Normal examination, without evidence of active small bowel inflammation or abscess as clinically questioned. |
Generate impression based on findings. | NSCLC evaluation. CHEST:LUNGS AND PLEURA: Reference right upper lobe 6-mm nodule (series 5 image 34) is unchanged from 9/2013, most likely benign.Postsurgical findings of left lower lobe wedge resection. Previously seen mild soft tissue thickening adjacent to a cyst in the left lower lobe has resolved.No suspicious pulmonary nodules.Subpleural mild groundglass opacity in the right lung base likely represents aspiration and atelectasis.Mild centrilobular and paraseptal emphysema with a right paramediastinal bulla.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No pericardial effusion.Mild coronary and thoracic aorta calcification.CHEST WALL: Mild degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Fatty infiltration of the liver with hepatomegaly. No suspicious hepatic mass.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Bilateral diffuse adrenal thickening with no discrete mass, unchanged.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.Submucosal fat deposition in the right colon, which may be sequela of prior colitisSevere calcified atherosclerotic disease of the abdominal aorta and left renal artery without aneurysm.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease. Previously seen mild soft tissue thickening adjacent to a cyst in the left lower lobe has resolved. |
Generate impression based on findings. | 2-year-old male with syncope who hit his head. Evaluate for intracranial hemorrhage. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. Left maxillary mucous retention cyst; otherwise, the visualized paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. |
Generate impression based on findings. | There are stable post-treatment changes in the region of the oral tongue with mild asymmetric ill-defined enhancement of the right hemitongue, but no evidence of a discrete mass. PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The submandibular glands are small in size with hyperenhancement, likely post treatment related. The right parotid gland is also somewhat heterogeneously enhancing with decreased decreased volume. The postcontrast appearance of the salivary glands is otherwise unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The floor of mouth is unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: The enteric tube has been removed. There is a persistent right internal jugular central venous catheter. Degenerative changes are noted involving the temporomandibular joints. | Stable posttreatment changes without evidence of cervical lymphadenopathy or locoregional tumor recurrence. |
Generate impression based on findings. | Evaluate bilateral lower extremities with frost bite. Cold feet, dopplerable PT signal, no palpable pulses in feet. Right foot: There is minimal uptake of radiotracer below the level of the right ankle. There is minimal soft tissue uptake within the proximal dorsum of the right foot but no appreciable uptake within the calcaneus, tarsal bones, metatarsals, or phalanges. Left foot: There is minimal uptake of radiotracer below the level of the left ankle. There is mild uptake of radiotracer within the talus. However, there is no appreciable uptake within the calcaneus, tarsal bones, metatarsals, or phalanges. | Overall, no appreciable uptake of radiotracer below the level of the bilateral ankles except for mild uptake within the left talus. |
Generate impression based on findings. | Chronic cough rule out interstitial lung disease. LUNGS AND PLEURA: Lobular and peribronchial air space opacities associated with very mild bronchial wall thickening in the left upper lobe apicoposterior segment. No proximal endobronchial mass is identified. Minimal bronchial wall thickening elsewhere with scattered areas of endobronchial debris such as in the left lower lobe series 4 image 53. The trachea and mainstem bronchi are patent. No pleural fluid or pneumothorax. Punctate calcified nodule in the left lower lobe, consistent with a granuloma.MEDIASTINUM AND HILA: Mild to moderate left hilar and interlobar lymphadenopathy. The left ventricle appears somewhat prominent for the patient's age, elongated but unchanged. Normal caliber of the aorta and main pulmonary artery.CHEST WALL: Symmetric appearing clips or calcifications in the deep soft tissues of the breasts bilaterally (3/46).6-mm soft tissue density nodule or lymph node right inferior deep breast present previously and unchanged, nonspecific by CT.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small posterior gastric diverticulum. | 1. Left upper lobe air space opacities. Given the patient's age this is statistically most likely a bronchopneumonia and could be bacterial, viral or fungal in etiology. Additional differential considerations are much less likely but cannot be excluded given the protracted course of patient symptoms include endobronchial spread of mucinous adenocarcinoma or other cellular products including cellular or follicular bronchiolitis if the patient had a history of autoimmune disease. As this process is not visible on conventional radiographs even in retrospect, a follow-up CT is recommended in 6 weeks to assess for resolution of the findings.2. Elongated left ventricle, correlate for systemic hypertension.3. Mild to moderate left hilar and or lymphadenopathy. |
Generate impression based on findings. | Heparin-induced thrombocytopenia. Altered mental status. Status post left nephrectomy competition by infected left retroperitoneal hematoma, now with dilated bowel loops. ABDOMEN:LUNG BASES: Large right sided pleural effusion with associated compressive atelectasis and smaller left pleural effusion with overlying atelectasis. LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. Ventriculocholecystic shunt terminates in the gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged nonspecific nodularity of the left adrenal gland.KIDNEYS, URETERS: The patient is status post left nephrectomy. There is a right nephroureterostomy catheter in unchanged position. Poorly defined areas of hypoattenuation in the renal parenchyma are unchanged. Nonobstructing renal stones again seen. Embolization coils.RETROPERITONEUM, LYMPH NODES: Interval decrease in size left retroperitoneal fluid collection now measuring approximately 6.4 x 2.6 cm (image 62; series 10224). Pigtail catheter terminates in the collection. Numerous prominent retroperitoneal lymph nodes again identified. IVC filter.BOWEL, MESENTERY: Gastrostomy tubes in place, unchanged. Multiple mildly dilated loops of small bowel again seen, consistent with chronic ileus.BONES, SOFT TISSUES: Bilateral hip dysplasia and multilevel fusions of the thoracolumbar spine. Unchanged mild/moderate body wall edema.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: Bilateral hip dysplasia and multilevel fusions of the thoracolumbar spine. Unchanged mild/moderate body wall edema.OTHER: Bilateral femoral vascular catheters; arterial on the right side and venous on the left side. | 1.Slight interval decrease in size of left retroperitoneal hematoma after interval insertion of a pigtail drainage catheter.2.Dilated loops thought to represent chronic ileus; these are not changed substantially compared to prior.3.Bilateral effusions with overlying atelectasis. |
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 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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 44-year-old female patient with globus sensation x 1 year. Evaluate for esophageal abnormality or diverticulum. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, trace provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the aortic arch with proximal escape and delayed secondary wave and occasional tertiary waves. Dysphasia protocol imaging revealed a small nonobstructive anterior esophageal web at the C5/C6 level (cine series 11). There was silent penetration that was cleared with cough.After administration of a 13-mm barium pill, there was hang up at the level of the aortic arch with reproduction of patient's globus/sticking sensation in the cervical esophagus (series 21).TOTAL FLUOROSCOPY TIME: 7:07 minutes | 1.Minor esophageal motility abnormality.2.Small nonobstructive anterior cervical esophageal web. |
Generate impression based on findings. | Non-Hodgkin's lymphoma. CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions. The pleural spaces are clear. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. There are multiple small mediastinal lymph nodes.CHEST WALL: Large axillary and sub-pectoral lymphadenopathy which has decreased in size in the interim. Reference left axillary lymph node measures 0.7 x 0.9 cm (series 4, image 20), previously 3.0 x 1.7 cm. Extensive lower neck and supraclavicular lymphadenopathy will be reported on the neck portion of the study.ABDOMEN:LIVER, BILIARY TRACT: The liver has a smooth contour. Scattered well marginated fluid attenuating right hepatic lobe lesions most likely represent small cysts.No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: Spleen is normal in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal and and mesenteric lymphadenopathy. Reference left para-aortic lymph node has decreased in size and measures 0.8 x 1.4 cm (series 4, image 12), previously measured 1.7 x 1.0 cm. Reference mesentery lymph node measures 1.4 x 1.9 (series 4, image 113), previously measured 2.4 x 1.8 cm. BOWEL, MESENTERY: Enlarged mesenteric lymph nodes with measurements provided above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Bulky pelvic lymphadenopathy. Left external iliac nodal chain node measures 2.1 x 3.9 cm (series 4, image 179), previously measured 2.0 x 3.5 cm.BOWEL, MESENTERY: Enlarged pelvic mesentery lymphadenopathy.BONES, SOFT TISSUES: Degenerative changes affect the lumbar spine, worst at L5-S1.OTHER: No significant abnormality noted. | Decreased size of the reference lymph nodes in the left axillary region, mesentery, and retroperitoneum. However, significant disease remains in the abdomen and pelvis, especially along the external iliac regions. |
Generate impression based on findings. | 7-month-old male status post IR and surgical treatment of an AVM. Reason: Follow up previous left arm AVM after IR gluing and debulking. Color and spectral Doppler were performed on inflow and outflow vessels. The left upper extremity AVM is no longer visualized, nor are any feeding or branch vessels.The subclavian, axillary, and brachial arteries exhibit normal high resistance spectral waveforms. The interrogated veins also demonstrate normal waveforms without evidence of residual arterialization or shunting. | Normal examination, without residual AVM or arteriovenous shunting. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of left breast abscess surgery in 1972. Family history of breast cancer in sister diagnosed at age 55 and breast cancer in paternal 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. Arterial and benign calcifications are present bilaterally.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. | A patient submitted outside study for review. Submitted for review are mammogram and ultrasound dated 2/20/2015, images from left breast biopsy and post-procedural mammogram dated 2/24/2015 performed at Presence St. Joseph's Hopsital. For comparison, mammograms dating back to January 18, 2012 are available. DIAGNOSTIC MAMMOGRAM (2/20/2015): Two standard views of both breasts, 1 spot compression view of the right breast, and 2 spot compression views of the left breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker has been placed overlying the upper outer left breast denoting the site of palpable abnormality. Subjacent to the marker is a partially obscured, spiculated mass measuring 2.6 x 1.7 x 1.8 cm. Immediately anterior and slightly inferomedial to the aforementioned mass is a second spiculated mass measuring 1.6 x 1.1 x 1.6 cm. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over both axillae.LEFT BREAST ULTRASOUND (2/20/2015): Images from targeted left ultrasound were submitted. At the 1:00 position of the left breast, 5 cm from the nipple, denoted on the images as "palp", there is a 1.6 x 1.5 x 1.0 cm irregular, hypoechoic mass with posterior acoustic shadowing and echogenic halo. No significant increased vascularity is noted. This lesion corresponds to the larger mass visualized on mammogram.At the 12:00 position of the left breast, 1 cm from the nipple, there is a second irregular, hypoechoic mass with echogenic halo and shadowing measuring 1.1 x 1.0 x 1.0 cm. Peripheral vascularity is noted on Doppler imaging. This may represent the second, smaller mass on mammogram, however the labeled position is somewhat discrepant from the expected location on mammography.A single image labeled "left axilla" was submitted. No sonographic abnormality is present on this image.ULTRASOUND-GUIDED LEFT BREAST BIOPSY (2/24/2015): Images from ultrasound-guided left breast biopsy were submitted of the aforementioned 12:00 and 1:00 masses. Targeting appears appropriate for both sites. Clips are noted on post-biopsy images.POST-PROCEDURAL LEFT MAMMOGRAM (2/24/2015): Two views of the left breast were performed following ultrasound-guided biopsy. Twist-shaped clips are noted along the posterior superior margin of the 1:00 mass, and along the medial superior margin of the 12:00 mass. PATHOLOGY: Per outside reports, pathology is as follows:12:00 mass: Infiltrating ductal carcinoma, grade 2. 1:00 mass: Infiltrating ductal carcinoma, grade 2. | 1. Two irregular hypoechoic masses at the 12:00 and 1:00 positions of the left breast status post biopsy, with both biopsies resulting in infiltrating ductal carcinoma. 2. Consider MRI given breast density and young age at cancer diagnosis.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | History of invasive SCCA of posterior scalp status post resection with negative sentinel lymph node biopsy. Evaluate for metastatic disease. LUNGS AND PLEURA: Mild dependent atelectasis and evidence of prior healed granulomatous disease.No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes consistent with prior healed infection.No intrathoracic lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Mild to moderate degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Calcified splenic granuloma.Large renal cysts.Severe abdominal aorta calcified atherosclerotic disease. | No evidence of intrathoracic metastases. |
Generate impression based on findings. | Metastatic prostate cancer needs staging. Multiple new osseous metastatic lesions are noted in the ribs, spine, calvarium, and pelvis. There are two new rib lesions in the left 9th rib and right 7th rib. An existing right 5th rib lesion is larger in size. There are at least two new lesions in the pelvis in the left ilium and right acetabulum. There are multiple new spine lesions. | Progression of osseous metastatic disease. |
Generate impression based on findings. | 44-year-old male with cellulitis, induration over right leg, sepsis. Evaluate for abscess. Moderate generalized subcutaneous soft tissue edema involving the entire right lower extremity, especially the dependent portions, posterolaterally. No discrete loculated fluid collection to suggest abscess formation.Generalized muscle atrophy and bone demineralization. Differentiating planes between musculature are unremarkable.Arterial calcifications. Stranding along the right inguinal region likely related to recent instrumentation. No lymphadenopathy. Note evaluation of the foot is limited. If there is clinical concern for foot pathology, including osteomyelitis, then dedicated foot imaging is recommended. | Generalized subcutaneous soft tissue edema but no discrete loculated fluid collection to suggest abscess. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign right biopsy in 1993. History of breast cancer in maternal grandmother in her mid 50s, mother in her late 50s, and sister at 48. Prior screening MRI from 11/1/2012 within normal limits. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography. 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: NSD - Screening Mammogram. |
Generate impression based on findings. | History of rheumatoid arthritis, connective tissue disease, and hypersensitivity pneumonitis. Evaluate for changes in ILD. LUNGS AND PLEURA: Patchy areas of groundglass opacity with volume loss, greater in the upper zones, and mild diffuse peripheral bronchiectasis/bronchiolectasis with architectural distortion and subpleural reticulation consistent with chronic hypersensitivity pneumonitis. This is similar in appearance to 11/2014.Mild lobular areas of air trapping in the lung bases.Right upper lobe suture from prior wedge biopsy.No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Decreased size of some of the scatter mildly enlarged mediastinal lymph nodes, including a left hilar node that is 6 mm (3/31; previously 8 mm). Reference right 12-mm paratracheal node is unchanged.Mild coronary artery calcification.Normal heart size without pericardial effusion.CHEST WALL: Mild degenerative changes of the thoracic spine with new age indeterminate mild compression deformities of T4 and T6 vertebral bodies.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia.Cholecystectomy clips. | 1. Findings consistent with ILD due to chronic hypersensitivity pneumonitis without significant interval change.2. New age indeterminate mild vertebral body compression deformities of T4 and T6. |
Generate impression based on findings. | 50 year-old female with upper abdominal pain for assessment of SMA syndrome or paraduodenal hernia Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary peristaltic wave at the level of the aortic arch with mild proximal escape. Barium pill swallow demonstrated slight hang up at the aortic arch with eventual clearing (series 18). The patient's symptoms were not replicated.The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed without delay (cine series 11). The duodenal bulb and sweep were within normal limits. The bowel loops were freely mobile during fluoroscopically monitored palpation. No specific evidence of paraduodenal hernia. TOTAL FLUOROSCOPY TIME: 6:41 minutes | 1.Mild motor abnormality of the esophagus.2.No evidence of SMA syndrome as clinically questioned. No specific evidence of paraduodenal hernia. |
Generate impression based on findings. | 71-year-old female with history of scleroderma and MGUS and spontaneous right hip fracture on Fosamax 2006 and osteopenia/osteoporosis. Evaluate for lytic lesions/plasmacytoma. SKULL: No discrete myelomatous lesion.CERVICAL SPINE: Multilevel degenerative arthritic changes and mild subluxations. No discrete myelomatous lesion.THORACIC SPINE: The bones appear demineralized. Moderate wedging of T12 vertebra. LUMBAR SPINE: The bones appear demineralized. Degenerative arthritic changes of the lower lumbar spine.RIBS: The bones appear diffusely demineralized. No discrete myelomatous lesions.PELVIS: No discrete myelomatous lesions. Degenerative arthritic changes affecting the pubic symphysis and left hip.UPPER EXTREMITY: No discrete myelomatous lesions bilaterally. Postsurgical and arthritis changes involving the hands bilaterally. LOWER EXTREMITY: Postsurgical changes of a right hip hemiarthroplasty device in anatomic alignment without evidence of hardware complication. No discrete myelomatous lesions bilaterally. | Diffuse bone demineralization and other findings as above without discrete myelomatous lesions. |
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. A cluster of coarse calcifications is present within the left upper breast, posterior depth.No suspicious masses, microcalcifications or areas of architectural distortion are present. | Benign-appearing cluster of coarse calcifications is present within the left upper breast, posterior depth. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Metastatic breast cancer on Xeloda. Please assess response to treatment. There is redemonstration of osseous metastatic disease throughout the axial skeleton, including the spine, pelvis, skull, and multiple ribs which appear similar in size and distribution. | Stable osseous metastatic disease. |
Generate impression based on findings. | Thyroid cancer with prior recurrence, TG not suppressed. LUNGS AND PLEURA: No pleural fluid or pneumothorax. No focal air space opacities, suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Post surgical changes of thyroidectomy and lymph node dissection. Normal heart size. No pericardial fluid or lymphadenopathy. No visible coronary artery calcifications.CHEST WALL: Left axillary lymph node upper normal in size (4/30), unchanged compared to FDG-PET CT dated 1/25/2013.Dense glandular breast tissue bilaterally, probably unchanged but incompletely assessed by CT scan.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range is unremarkable. | No signs of intrathoracic metastatic disease. |
Generate impression based on findings. | Pain Tibial metaphyseal revision with a wedge shaped graft placed into a lateral osteotomy. Overall appearance is grossly similar to the intraoperative imaging in terms of size and orientation however there is a questionable additional graft fragment that projects posteriorly that may have been dislodged or fractured. Please correlate with surgical proceedure and consider serial imaging if there is concern. Overlying severe degenerative changes are similar. | Tibial revision with a wedge graft inserted into an osteotomy. See description above. |
Generate impression based on findings. | 43 years, Female, Reason: history of cervical cancer, radiation planning History: none. PELVIS: FemaleUTERUS, ADNEXA: There is a large cervical mass compatible with patient's biopsy proven cervical squamous cell carcinoma measuring approximately 6.4 x 6.8 x 8.1 cm (501/36, 71/37). The lesion extends along the anterior aspect of the upper vagina with sparing of the lower one third of the vagina. On axial T2 images, the lesion extends from approximately images 50 to 71. There is full thickness myometrial invasion with extension into the parametrial tissues. There is a nodular component to the right parametrial tissues (501/42) as well as diffuse soft tissue extending into the left parametrial tissues (501/36). There is no evidence of rectal invasion. The mass is inseparable from the posterior wall of the bladder (405/288). BLADDER: Enlarged left ureter proximal to tumor which is likely causing obstruction.LYMPH NODES: Enlarged left internal iliac lymph node measuring 2.1 x 1.8 cm (501/39)BOWEL, MESENTERY: No evidence of rectal involvement.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis. | 1.Large cervical squamous cell carcinoma with extension into the parametrial tissues, bladder and upper vagina as above.2.Left internal iliac node is suspicious for metastases.3.Dilated left ureter proximal to obstructing tumor. Recommend renal ultrasound for further evaluation. |
Generate impression based on findings. | Breast mass, initial breast cancer evaluation. Question of metastases. No abnormal osseous foci are identified to indicate metastatic disease.There is soft tissue activity in the left breast likely corresponding to the patient's malignancy. Degenerative uptake is noted in the feet, knees, shoulders, and left sternoclavicular joint. Increased uptake in the sinuses may represent sinusitis. | No evidence of bone metastases. Soft tissue uptake in the left breast corresponds with known breast cancer. |
Generate impression based on findings. | Possible clavicle fracture.VIEWS: Left clavicle AP/axial (two views) 03/06/15 Callus formation surrounds a fracture of the mid third of the left clavicle. Alignment is anatomic. | Healing clavicle fracture around 6 weeks of age. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Mother diagnosed with breast cancer at age 35. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Benign calcifications are present within the left breast. Unchanged subcentimeter masses in the right breast are likely benign.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: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Gun shot Mild osteoarthritic changes with mild narrowing of the genohumoral distance and preservation of the humoral head. No discreet soft tissue abnormality or retained bullet fragment observed.Mild incompletely visualized rib deformity suspected right 5th or 4th rib, consider dedicated imaging if further characterization is needed clinically. | Mild OA without a retained bullet |
Generate impression based on findings. | Reason: Evaluate for stenosis in blood supply to R parietooccipital region. DM. HTN. History: homonymous hemianopsia Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery is larger than the right vertebral artery.The thyroid gland appears heterogeneous in density.Multilevel degenerative changes present in the cervical spine with left-sided facet hypertrophy at C2-3, right-sided facet hypertrophy at C3-4 and C4-5 and endplate osteophytes at C3-4 and C4-5 associated with uncovertebral osteophytesBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. There is fetal origin of the left posterior cerebral artery associated with a hypoplastic left P1 segment.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.No evidence for intracranial aneurysm.2.No evidence for cervicocerebral occlusive disease. |
Generate impression based on findings. | Dermatofibrosarcoma protuberans of the lower extremity on Gleevec. LUNGS AND PLEURA: Respiratory and cardiac motion artifact limits sensitivity for detection of pulmonary nodules. Within this limitation, no new abnormalities are identified. Probable suture line in the lingula with associated scar or atelectasis; assessment for recurrence in this area is limited by motion artifact. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Heterogeneously solid anterior mediastinal mass. At the reference level, the mass measures 2.9 x 12.9 cm in transaxial dimensions (3/59), previously 4.9 x 16 cm.No pericardial fluid. Cardiophrenic lymphadenopathy, some of which is not reliably distinguishable from the mass. The mass compresses the right ventricle and pulmonary outflow tract as well as the right atrial appendage and on some images the epicardial fat plane is not distinct. Overall heart size is probably normal. Mild coronary artery calcifications. The thyroid gland is enlarged.CHEST WALL: Unchanged small lymph nodes. Degenerative changes of the spine with osteophyte formation.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. The anterior diaphragm just to the right of midline adjacent to the xiphoid process appears irregular on the sagittal images (series 80263, image 66). Also on the sagittal images, tumor can be seen in infiltrating into the soft tissue planes between the pericardial fat pad and the adjacent peritoneal reflection (pleuroperitoneal fold), but not into the chest wall, unchanged. | Decrease in measurements of anterior mediastinal mass. No new sites of disease are appreciated. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts (5 images) 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. Left central asymmetry is less prominent than on prior studies. | 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. | 50 year-old female patient status post fundoplication with recurrent GERD. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus revealed no morphologic abnormalities of the mucosal surfaces. There are postsurgical changes from Nissen fundoplication with a lip of fundus above the wrap, but below the diaphragm. The intraabdominal portion of the esophagus appears to measure 3.2 cm on some views. Again noted was a nonobstructive B ring approximately 17 mm above the diaphragm, concerning for occasional recurrent slipping of the fundoplication. During the exam, no provoked gastroesophageal reflux was observed despite extensive maneuvers. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the aortic arch with proximal escape, delayed secondary wave and occasional tertiary waves.TOTAL FLUOROSCOPY TIME: 3:50 minutes | 1.Findings concerning for fundoplication slippage.2.No reflux observed.3.Minor esophageal motility abnormality. |
Generate impression based on findings. | 66 year old female who has a complaint of left breast soreness. Physician palpated area within the lower inner left breast. Family history of breast carcinoma in her sister at age 63. 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. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.LEFT BREAST ULTRASOUND: A targeted left ultrasound was performed for the patient's area of concern. Additionally, targeted sonography of the left lower inner quadrant was performed for the palpable region of concern.At the 3 o'clock position of the left breast, in the area of the patient's stated soreness, there is no solid or cystic mass identified. No abnormal vascularity is appreciated within this region.Sonography of the left lower inner quadrant was performed, with representative images taken at the 8 o'clock position. No solid or cystic masses identified. No abnormal vascularity is identified within this region. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 59 year old woman with history of right axilla pain with possible palpable mass 6 weeks ago, no palpable mass per MD exam. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Specifically, no suspicious mammographic findings at the site of palpable marker placed in the right axilla.SONOGRAPHIC | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 56 year old female with pain and swelling. Mild osteoarthritis affects the left knee, similar to prior. | Mild osteoarthritis. |
Generate impression based on findings. | Images are somewhat limited by patient motion. Postoperative changes are again seen from a right frontal parietal craniotomy. There is a prominent right lateral frontal scalp fluid collection measuring 1.8 x 6.9 cm in greatest axial dimensions. This is increased in size since the previous exam, with thick peripheral enhancement. The fluid remains isointense to fluid within the resection cavity which is significantly FLAIR hyperintense. The collection also appears contiguous on coronal T2-weighted images with extra-axial fluid underlying the craniotomy flap, which measures 7 mm in greatest thickness and extends into the lateral aspect of the right middle cranial fossa.There is susceptibility and diffusion restriction within the dependent aspect of the right frontal resection cavity, consistent with blood products. There is also minimal marginal diffusion restriction along medial aspect of the cavity which may represent evolving postoperative ischemia. Ill-defined mild diffusion restriction is seen within the right caudate and putamen anteriorly. There is mild marginal intrinsic T1 hyperintensity is noted along the margin superimposed enhancement which is more nodular appearing along the superior margin of the cavity. The cavity itself measures 3.8-cm transverse by 5.8-cm AP by 5.2 cm CC. The area of nodular enhancement measures 2.3 x 2.2 cm in greatest axial dimensions on 15/137, by 1.6 cm CC on 1500/137. No significant nodular enhancement was seen in this location on the immediate postoperative exam. Minimal nodular enhancement is also seen along the inferior medial margin of the cavity on 1500/167.On perfusion imaging, there is focal elevated rCBV along the focal area of nodularity at the superior posterior margin of the resection cavity. There is questioned additional elevated rCBV along the inferomedial margin of the resection cavity where an additional enhancing nodule was noted.Extent of FLAIR hyperintensity along the right frontal lobe white matter has slightly decreased. There remains right sided cerebral sulcal effacement as compared to the left, with asymmetric decreased size of the right lateral ventricle. Persistent mild mass effect remains on the right frontal horn.The cisterns remain patent. There is no midline shift. 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 a prominent left sphenoid mucosal retention cyst. | 1. Interval evolution of postoperative changes involving the right frontal lobe from tumor resection, with focal prominent area of nodularity and corresponding hyperperfusion along the posterior superior margin of the resection cavity concerning for residual/recurrent tumor.2. Increased size of right lateral frontal scalp collection, isointense to a small amount extra-axial fluid underlying the craniotomy flap as well as fluid within the resection cavity.3. Slight decreased extensive nonspecific surrounding FLAIR hyperintensity in the right frontal lobe with persistent mild mass effect upon the right frontal horn, which likely represents a combination of vasogenic and/or nonenhancing tumor.4. Mild diffusion restriction involving the right caudate and putamen. FLAIR signal appears symmetric, and this is of uncertain clinical significance. Attention to this question finding can be made on follow-up exam. |
Generate impression based on findings. | 53-year-old male with Crohn's colitis with colonic stricture for evaluation of length of stricture. The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. There is a fixed, long segment, narrowing of the colon involving the distal transverse, splenic flexure, and proximal descending colon measuring approximately 14 cm in length. This stricture is attenuated to approximately 7-8 mm in diameter. There are multiple polypoid lesions within this segment compatible with post-inflammatory polyps. The colon distal to the stricture is featureless with loss of haustral markings. The remainder of the colonic mucosa is normal in appearance with no evidence of ulceration, edema, or mass lesions. Small amounts of barium and air were refluxed into the terminal ileum. Spot films of the terminal ileum were normal. The appendix was not visualized. No significant tortuosity or redundancy of the colon is noted.TOTAL FLUOROSCOPY TIME: 5:37 minutes | 1.Long segment stricture involving the splenic flexure with postinflammatory polyps as described above. 2.Featureless descending colon compatible with chronic colitis. |
Generate impression based on findings. | Resection of left posterior mediastinal mass.VIEW: Chest AP (one view) 03/06/15, 1528 Left chest tube remains in place. Surgical clips and staples are present to the left of T5 and T6.Partial resection of left sixth rib is again noted.No pneumothorax is seen. Patchy opacities are present bilaterally with focal opacity in the anterior segment of right upper lobe and left lower lobe. Cardiac silhouette size is normal. | No pneumothorax after surgery. |
Generate impression based on findings. | Female 54 years old; Reason: assess for any inflammation, masses or tumors History: severe epigastric pain. Normal EGD and ultrasound ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Small hypodense hepatic foci possibly representing small cysts. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: Pancreas is normal in morphology.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small renal cysts. No hydronephrosis.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: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Etiology of the patient's severe epigastric pain is not evident on the current exam. |
Generate impression based on findings. | 62 year old female who was recalled from screening mammogram for left breast calcifications. History of benign left breast biopsy 11 years ago. No family history of breast cancer. An ML view and two spot magnification 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. There is redemonstration of a small cluster of calcifications within the central upper left breast, which is not significantly changed from examination dated October 14, 2014. | Small cluster of calcifications within the central upper left breast, not significantly changed from October 14, 2014. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Non Hodgkin lymphoma. There is extensive cervical, upper mediastinal, and bilateral axiallary lymphadenopathy. For example, a left supraclavicular lymph node measures 14 x 27 mm, previously 18 x 30 mm, a left level 1A lymph node measures 9 x 11 mm, previously 11 x 13 mm, and a right axillary lymph node measures 21 x 35 mm, previously 24 x 39 mm. There is mild enlargement of the adenoids. The airways are nevertheless patent. There is reflux of air into the left parotid duct due to puffed-cheek technique. The thyroid and salivary glands are otherwise unremarkable. The major cervical vessels are patent. There is degenerative cervical spondylosis that is most pronounced at C6-7. There is a small lipoma in the right posterior upper neck subcutaneous tissues. The imaged intracranial structures and orbits are unremarkable. There is moderate mucosal thickening in the left maxillary sinus. The imaged portions of the lungs are clear. | Extensive cervical, upper mediastinal, and bilateral axillary lymphadenopathy. However the lymph nodes are generally smaller than in 2013. |
Generate impression based on findings. | Female 69 years old Reason: locally advanced unresectable pancreatic cancer completed chemoRT in July 2014. Evalaute for interval change History: pancreatic cancer CHEST:LUNGS AND PLEURA: Unchanged calcified right lower lobe pulmonary nodule, likely reflecting sequela of prior granulomatous disease.MEDIASTINUM AND HILA: No significant abnormality.CHEST WALL: No significant abnormality.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma.SPLEEN: Punctate intraparenchymal calcifications compatible prior granulomatous disease.PANCREAS: Ill-defined poorly marginated hypoattenuating mass in the pancreatic head neck junction now measures approximately 2.7 x 3.5 cm (image 82, series 3), stable. The associated upstream and pancreatic ductal dilatation appears similar to the prior examination, although the degree of associated pancreatic parenchymal atrophy has increased.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Partially calcified right renal artery aneurysm is unchanged. There is no evidence of hydronephrosis or hydroureter. RETROPERITONEUM, LYMPH NODES: The referenced gastrohepatic lymph node now measures 0.6 x 0.7 cm (image 73, series 3), stable. Additional small scattered retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are moderate degenerative changes of the lower lumbar spine.OTHER: No significant abnormality noted. | 1.Hypoattenuating pancreatic head neck junction mass not significantly changed in size, with stable associated pancreatic ductal dilatation and increased pancreatic parenchymal atrophy.2.Unchanged gastrohepatic node, with no new sites of metastatic disease identified |
Generate impression based on findings. | Female 71 years old; Reason: 71 yr old patient with ovarian cancer 2007 TAH/BSO, 11/2011 ductal mucinous breast cancer with follow up RT, 12-18-14 radical interval debulking eval disease process History: none CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Right chest wall port terminates at the cavoatrial junction. No mediastinal lymphadenopathyCHEST WALL: Postsurgical changes in the lower cervical spine.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. There is mild intrahepatic ductal dilatation.There is soft tissue along the surface of the liver measuring approximately 1.7 cm in thickness (image 84/series 3)SPLEEN: Nonspecific hypodensities in the spleen.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: Thickening of the gastric antrum. The omentum has been resected. There is significant nodularity in the peritoneum. A right perihepatic nodule measures 2.0 x 1.2 cm (image 125/series 3). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Soft tissue in the pelvis (image 180/series 3) is hard to separate from adjacent small bowel and likely represents a bulky pelvic disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive peritoneal disease in the pelvis along the serosal surface of the small bowel. Scattered pelvic ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post debulking with significant residual disease in the upper abdomen and pelvis |
Generate impression based on findings. | 34-year-old male with nausea, vomiting, abdominal pain shortly after eating. Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.The stomach was filled with debris although normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed without delay. A small duodenal diverticulum was noted incidentally. The gastric mucosal surface was not evaluated due to significant amount of debris within the stomach. Patient reported eating one hour prior to the study.The duodenal bulb and sweep were within normal limits. Contrast opacified the proximal jejunum without evidence of obstruction. TOTAL FLUOROSCOPY TIME: 4:24 minutes | Limited examination of the esophagus, stomach, and duodenum without significant abnormality. No evidence of gastric outlet obstruction or SMA syndrome. |
Generate impression based on findings. | Male 82 years old; Reason: enlarged left testicle History: large left testicle RIGHT TESTIS: Right testes measures 3.5 to 1.9 x 2.6 cm. No focal testicular lesion. LEFT TESTIS: Left testes measures 4.5 x 2.4 x 1.7 cm. No focal testicular lesion.RIGHT EPIDIDYMIS: 1.0 x 1.6 x 1.6 cm LEFT EPIDIDYMIS: 1.4 x 0.9 x 0.9 cmOTHER: Large left hydrocele. | Large left hydrocele. |
Generate impression based on findings. | Sudden onset exertional dyspnea. Evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Calcified nodules consistent with prior healed infection.No pleural effusion.MEDIASTINUM AND HILA: Small calcified mediastinal and hilar lymph nodes consistent with prior healed infection.Normal heart size without a pericardial effusion.Mild coronary artery calcification. Moderate thoracic aorta calcification.Small hiatal hernia.CHEST WALL: Mild degenerative changes of the thoracic spine. Narrow AP dimension of the thorax.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcified periportal lymph nodes from prior healed infection.Calcified atherosclerotic disease of the abdomen aorta. | No evidence of pulmonary embolism or significant acute abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 18 year-old male with mid-dorsal foot pain. Evaluate for stress fracture. No acute fracture or malalignment. No periosteal reaction. Mild dorsal soft tissue swelling. | Soft tissue swelling with no underlying acute fracture or malalignment. |
Generate impression based on findings. | Evaluate pancreas. Lipase greater than thousand The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: Bilateral small pleural effusions with overlying compressive atelectasis. Patchy ground glass anteriorly at the left lung base. Motion artifact degrades images the lung bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Pancreatic head is somewhat indistinct with mild surrounding inflammation. Given history, this is compatible with acute pancreatitis. An enhanced study would better characterize these abnormalities.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Indwelling IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter terminates in the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left hip disarticulation.OTHER: Vascular calcification. | Mild inflammatory changes surrounding the pancreatic head. Given history, this is compatible with acute pancreatitis. Small bilateral pleural effusions. Limited study secondary to lack of intravenous contrast. |
Generate impression based on findings. | 59-year-old male with pain/swelling. Evaluate for acute process status post slipped/fall directly onto knee. No acute fracture or malalignment. Moderate osteoarthritis affects the right knee. Multiple small calcific densities project over the medial and lateral compartments of the joint and may represent loose bodies. Small to moderate sized joint effusion. | Joint effusion with no acute fracture or malalignment. Additional findings as described above. |
Generate impression based on findings. | Oral cavity cancer and CRT. CHEST:LUNGS AND PLEURA: Prominent subpleural lymph nodes along the caudal aspect of the right major fissure. No suspicious lesions.MEDIASTINUM AND HILA: Atherosclerotic calcification of the thoracic aorta and its branches. No lymphadenopathy. Physiologic volume of pericardial fluid. No visible coronary artery calcifications.CHEST WALL: Degenerative changes of the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Previously described intrapancreatic splenule is isoattenuating to the pancreatic parenchyma on the current exam and not visible.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | T4aN2bM0 left buccal mucosa and upper lip treated with chemoradiation. There are postoperative findings related to left marginal mandibulectomy and left upper lip reconstruction. There is ill-defined soft tissue in the left upper lip surgical bed region, but no definite gross mass lesions. There is a persistent defect in the left mandible that extends to the inferior alveolar nerve canal, without discernible soft tissue mass lesions. There is no significant residual cervical lymphadenopathy. For example, a calcified left level 1B lymph node measures 3 mm in short axis, previously also 3 mm. The mandible and maxilla are edentulous. There is unchanged mild deformity of the upper trachea anteriorly presumably at the site of a prior tracheotomy. Otherwise, the airways are patent. There is persistent partial opacification of the mastoid air cells. There is multilevel degenerative cervical spondylosis. The thyroid and salivary glands are unchanged. There is mild left carotid bifurcation plaque. The imaged intracranial structures are unremarkable. There are lens implants. | Postoperative findings in the oral cavity region without definite gross tumor and no evidence of significant residual lymphadenopathy in the neck. |
Generate impression based on findings. | POD#0 EVD placement for communicating hydrocephalus. There has been interval insertion of a right transfrontal ventricular catheter that terminates in the right lateral ventricle. There is now pneumoventricle, but otherwise no significant change in size of the dilated third and lateral ventricles. There is also persistent extensive confluent periventricular white matter hypoattenuation. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There are degenerative changes affecting the bilateral temporomandibular joints, right more than left. | Interval ventricular catheter insertion without significant interval change in size of the ventricular system and presumed transependymal CSF flow, but no evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Facial weakness. Evaluate for CVA. There is no evidence of acute intracranial hemorrhage or mass effect. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with age-indeterminate small vessel ischemic changes. There is mild parenchymal volume loss. The ventricles and basal cisterns are otherwise unremarkable. There is no midline shift or herniation. There is scattered opacification of the bilateral ethmoid and right maxillary sinuses. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage or mass effect.2. Mild age-indeterminate small vessel ischemic changes. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern, MRI of the brain is recommended. |
Generate impression based on findings. | Nausea and vomiting. Lower abdominal pain. Possible lymphoma. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: Mild interstitial scarring. No masses.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Multiple hypodense splenic lesions, larger compared to prior but difficult to evaluate given absence of intravenous contrast.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic native kidneys bilaterally. Numerous hypodense nodules bilaterally, some of which have increased in size compared to prior. Most of these appear to represent cysts although some are non-specific.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta and its branches, particularly the splenic artery, without aneurysmal dilatation. IVC filter noted.BOWEL, MESENTERY: No significant abnormality noted. Hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Chronic deformity of the left femoral head. OTHER: Atrophic renal transplant in the right iliac fossa | 1.No specific findings to account for the patient's symptoms. 2.Increasing renal cysts suggestive of acquired renal cystic disease. 3.Marked interval atrophy of the right iliac fossa transplant kidney.4.Enlarging hypodense splenic nodules; lymphoma remains a consideration. |
Generate impression based on findings. | 3-D T1 post contrast images are minimally limited by patient motion. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a large mucosal retention cyst near completely opacifying the right sphenoid sinus. There is mild mucosal thickening in the maxillary sinuses.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm. | 1. Unremarkable contrast-enhanced MRI of brain and noncontrast MRA head.2. Near complete opacification of right sphenoid sinus due to a large Meckel's retention cyst. |
Generate impression based on findings. | Metastatic breast cancer on endocrine therapy. Evaluate for progression. Again seen is abnormal uptake of radiotracer in the right sternum, which appears increased from the prior exam. A faint focus of increased uptake in the anterior right 6th rib as described before is unchanged and non-specific. There is increased heterogeneous uptake within the right frontal calvarium. A focus of uptake within the mandible is likely due to periodontal disease. | 1. Interval increased uptake in the right sternum is suspicious for metastatic disease.2. Heterogeneous right frontal bone uptake is also suspicious for metastatic disease. |
Generate impression based on findings. | Post averaging just from previous right anterior temporal lobectomy for tumor resection are again seen. There is a stable CSF signal intensity circumscribed resection cavity in the right middle cranial fossa with subtle surrounding FLAIR hyperintense. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or 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. | Continued stable appearance of postoperative changes involving the right middle cranial fossa, without evidence of tumor recurrence. |
Generate impression based on findings. | 36-year-old female with pain at the medial malleolus. Evaluate for fracture. Minimal soft tissue swelling about the medial malleolus. No underlying acute fracture or malalignment. | Soft tissue swelling without acute fracture or malalignment. |
Generate impression based on findings. | 48-year-old male status post left knee unicompartmental arthroplasty. Interval post surgical changes of a left medial unicompartmental arthroplasty device in anatomic alignment. No radiographic evidence of hardware complication. Skin staples, drain, and foci of gas within the overlying soft tissues likely reflect recent surgery. | Postsurgical changes without radiographic evidence of hardware complication. |
Generate impression based on findings. | 54-year-old female with right thigh mass, evaluate for interval change. Again seen is a large anterior thigh mass underlying the rectus femoris and between the vastus medialis and vastus lateralis, predominantly of fat density with some internal septations, appearing similar to prior. No underlying osseous involvement. The remainder of the visualized soft tissue structures are within normal limits. | Large anterior thigh mass appearing similar to prior, likely representing a benign lipoma. |
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