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Generate impression based on findings. | Male 64 years old Reason: AKI, ?signs of rejection History: AKI, ?signs of rejection RENAL TRANSPLANT:LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: The transplant kidney measures 13.1 cm. The parenchyma is hyperechoic. There is a 1.8-cm hypoechoic lesion in the midpole of the transplant kidney consistent with a cyst.COLLECTING SYSTEM/URETER: No significant hydronephrosis.URINARY BLADDER: Foley catheter within the bladder.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels There is a brisk systolic upstroke and normal diastolic flow of the renal artery anastomosis without evidence of stenosis. Decreased velocities and blunted upstroke in the segmental and arcuate arteries is demonstrated although there is antegrade diastolic flow. This may be related to the underlying parenchymal disease or segmental artery stenosis but there is no evidence for anastomotic stricture of the transplant renal artery.Peak systolic velocities are as follows.Right iliac artery: 1.3 m/secAnastomosis: 0.6 m/sRenal artery Proximal: Poorly evaluatedMid: 0.7 m/sec Hilum: 0.2 m/sec Segmental arteries:Upper pole 0.2 m/secMidpole 0.3 m/secLower pole 0.1 M/secArcher arteries:Upper pole: 0.3 m/secMidpole: 0.2 m/secLower pole: 0.2 m/secThe intrarenal resistive indices measure between 0.5 and 0.8. The renal vein is color Doppler patentOTHER: No significant abnormality noted | The transplant kidney parenchyma is abnormally echogenic suggesting parenchymal disease/rejection. There is a brisk systolic upstroke and normal diastolic flow of renal artery anastomosis without evidence of stenosis. Decreased velocities and blunted upstroke in segmental and arcuate arteries is demonstrated although there is antegrade diastolic flow. This may be related to the parenchymal disease or segmental artery stenosis but there is no evidence for anastomotic stricture of the transplant renal artery. |
Generate impression based on findings. | Male 51 years old Reason: 51M with renal cell carcinoma s/p resection presenting for surveillance scans. History: pulmonary micronodules and mediastinal node, assess for change CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged. None of the lesions is suspicious of metastatic disease.MEDIASTINUM AND HILA: No evidence of pleural effusions.CHEST WALL: AP window node, image 43 measures 1.4 x 1.4 cm. Previously 1.7 x 1.2 cm. No new nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal surgically absent. Left adrenal gland normal.KIDNEYS, URETERS: Right kidney surgically absent. Left kidney normal.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Roughly stable mediastinal node and lung micronodules. No evidence of tumor recurrence in right renal fossa. Normal appearing left kidney. No measurable neoplasm. |
Generate impression based on findings. | Female 44 years old Reason: RUQ, r/o obstructive cholelithiases History: RUQ and epigastric abdominal pain LIVER: The liver measures 18.2 cm. There is no focal liver lesion. Hyperechoic foci within hypoechoic liver parenchyma can be seen in the setting of acute hepatitis and background hypoechoic hepatic parenchyma. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Multiple gallstones in the gallbladder which is distended. There is borderline gallbladder wall thickening and pericholecystic fluid. Equivocal sonographic Murphy's sign. The common duct measures 0.5 cm. There is no biliary dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: Right kidney measures 10.9 cm. Left kidney measures 10.5 cm. There is no hydronephrosis.OTHER: Spleen measures 10.5 cm. | Cholelithiasis. Borderline gallbladder wall thickening and trace pericholecystic fluid. Findings are equivocal for acute cholecystitis. |
Generate impression based on findings. | Male 67 years old; Reason: metastatic head and neck cancer prior to treatment, please provide measurements if applicable. History: as above ABDOMEN:LUNGS BASES: Two nodules are seen in the right lower lobe.Largest nodule seen on series 4 image 13, 1.1 x 1 cm. Previously, series image 97, 0.8 x 0.6 cm. 6 mm nodule in the right lung base series 4 image 14, previously 0.3-cm series 3 image 101. LIVER, BILIARY TRACT: Small irregular shaped hypoattenuating lesion in posterior segment right lobe of the liver favor cyst. No other liver lesions. No biliary dilatation..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: Mild atherosclerotic calcifications, no evidence of aneurysm..BOWEL, MESENTERY: Percutaneous gastrostomy tube..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..1. | 2.Increase in size of nodules and right lung base. compared to chest CT of 2/02/15.3.Probable hepatic cyst. |
Generate impression based on findings. | Male 56 years old Reason: evaluate abdominal pain and weight loss History: abdominal pain and weight loss CHEST:LUNGS AND PLEURA: Ill-defined micronodules in the lingula some with subtle ground glass appearance, for example series 5 image 41. Correlate with smoking history and recommend 3 month follow-up.MEDIASTINUM AND HILA: Few small nodes. Largest node is in the right hilum measuring 1.4 x 1.1 cm series 3 image 40.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Few small central hypoattenuating foci in right and left kidney, too small to characterize, likely cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Groundglass nodule and other small micronodules. Correlate with smoking history and recommend 3 month follow-up for groundglass nodule.Small right hilar node. |
Generate impression based on findings. | Female 22 years old Reason: evaluate hepatic dopplers to evaluate for budd chiari History: abdominal pain, elevated tbili PORTAL VENOUS: The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.1 m/sec.HEPATIC ARTERIES: Patent with normal directional flow.HEPATIC VEINS: Patent with normal directional flow.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. | Patent hepatic vasculature, specifically patent hepatic veins and no evidence of Budd-Chiari. |
Generate impression based on findings. | Female 22 years old Reason: elevated LFTs, IUFD History: same LIVER: The liver measures 13.5 cm in length. There is no focal liver lesion. Hepatic parenchyma is mildly hyperechoic suggestive of fatty infiltration. The main portal vein is patent and demonstrates normal directional flow with peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Sludge within the gallbladder. No evidence of cholelithiasis or cholecystitis. There is no biliary dilatation.PANCREAS: Limited visualization of the pancreas. The pancreas appears unremarkable where visualized.KIDNEYS: The right kidney measures 8.0 cm. The left kidney measures 8.9 cm. There is no hydronephrosis. The renal parenchyma is bilaterally hyperechoic suggestive of medical renal disease.OTHER: The spleen measures 8.2 cm in length.AORTA: The proximal aorta measures 1.9 x 1.6 x 2.1 cm.The mid aorta measures 1.6 and 1.5 x 1.9 cm.The distal aorta measures 1.6 x 1.8 x 1.8 cm.The aortic bifurcation is obscured and is not evaluated. | Gallbladder sludge but no evidence of cholelithiasis or acute cholecystitis. No biliary dilatation.Hyperechoic renal cortex bilaterally suggestive of medical renal disease. |
Generate impression based on findings. | Female 43 years old Reason: Outside Request: s/p Da Vinci hyst. July 2014 c/o abd/pelvic pain starting in October. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Focal fat medial segment left lobe.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Clustering of small bowel mid abdomen probably normal variant. No definite evidence of internal hernia or malrotationBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Surgically absent uterus. Ovaries normal for age.BLADDER: No significant abnormality notedLYMPH NODES: Small nonpathologic sized nodes.BOWEL, MESENTERY: No significant abnormality noted. Specifically no free or loculated fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No findings to explain pelvic pain. |
Generate impression based on findings. | Male 20 years old Reason: Biliary obstruction History: jaundice LIVER: The liver measures 19.6 cm in length. There is no focal liver lesion. The main portal vein is patent and demonstrates peak systolic velocity of 0.3 m/sec. GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. There is no intra-or extrahepatic biliary duct dilatation.PANCREAS: The pancreas is poorly visualized and is unremarkable where seen.KIDNEYS: The right kidney measures 12.7 cm. The left kidney measures 12.9 cm. There is no hydronephrosis. Mild scarring of the right kidney is noted, likely secondary to patient's sickle cell disease.OTHER: Status post splenectomy. | Status post cholecystectomy. No evidence of intra-or extrahepatic biliary dilatation. |
Generate impression based on findings. | Male 35 years old Reason: acute renal failure s/p transplant not taking tacro History: Cr 7.1, abd pain RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Mild peritransplant fluid.KIDNEY: Hyperechoic transplant parenchyma suggestive of medical renal disease.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The bladder wall is thickened however this may relate to non-distention.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels There is a brisk systolic upstroke and normal diastolic flow.Peak systolic velocities are as follows.Right iliac artery: 1.6 m/secAnastomosis: 0.6 m/sRenal artery Mid: 0.6 m/sec Hilum: 0.4 m/sec The intrarenal resistive indices are normal measuring 0.5 to 0.8The renal vein is color Doppler patentOTHER: No significant abnormality noted | Echogenic transplant renal parenchyma suggestive of medical renal disease. Mild peritransplant fluid.Normal arterial waveform and velocities at the renal artery anastomosis. |
Generate impression based on findings. | 89 years, Male. Reason: r/o obstruction, eval stool burden History: abd pain, constipation, ? decreased flatus Moderate stool burden scattered throughout the colon. No evidence of obstruction. Generalized osteoporosis. | Moderate stool burden. |
Generate impression based on findings. | Headache and ventricular shunt. There is a right transfrontal ventricular shunt. There is appreciable change in size of the ventricular system. However, there is new parenchymal hypoattenuation surrounding the catheter. There is no evidence of intracranial hemorrhage. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The extracranial soft tissues are unremarkable, without evidence of disconnection of the imaged portions of the shunt catheter. There is diffuse thickening of the calvarium, which may be related to chronic shunting. | No appreciable change in size of the shunted ventricular system. However, new parenchymal hypoattenuation surrounding the catheter may indicate a shunt-associated infection. A brain MRI may be useful for further evaluation. |
Generate impression based on findings. | 79 years, Male. Reason: eval ng tube History: eval ng tube NG tube tip and side hole in gastric fundus.Pelvis excluded from field of view. Blurring of the respiratory motion. Extensive atherosclerotic calcification aorta and splenic artery. Nonobstructive bowel gas pattern. Postsurgical changes in the chest. | NG tube tip is a been advanced the tip is in the gastric fundus |
Generate impression based on findings. | 79 years, Male. Reason: h/o ngt adjustment, eval History: see above Is excluded from field of view.NG tube tip in gastric cardia and sidehole in the distal esophagus. Follow up films have already been obtained. Nonobstructive bowel gas pattern. Vascular calcifications. Postsurgical changes. | NG tube should be advanced and follow up films of already been obtained. |
Generate impression based on findings. | 79 years, Male. Reason: confirm ngt placement History: see above NG tube projects in distal esophagus.Follow-up films have already been obtained.Pelvis excluded from field of view. There are calcifications. | NG-tube projects over the distal esophagus. |
Generate impression based on findings. | 79 years, Male. Reason: dobhoff placement History: dobhoff placement for tube feeds Pelvis excluded from field of view. Dobbhoff tube projects over the distal gastric body. Nonobstructive bowel gas pattern. Atherosclerotic calcifications. Postsurgical changes chest. Cholecystectomy clips. | Dobbhoff tube projects over the gastric body. |
Generate impression based on findings. | 67 years, Male. Reason: h/o c diff ileus, eval History: see above Probably due to respiratory motion in the upper abdomen.NG tube tip projects over the distribution of gastric antrum.Nonobstructive bowel gas pattern. No significant ileus. | Normal bowel gas pattern. |
Generate impression based on findings. | 52 years, Female. Reason: stool burden/constipation History: abdominal pain; constipation Moderate stool burden. Stool distributed primarily in the transverse colon. No evidence of obstruction.Osseous and soft tissue structures are unremarkable. | Moderate stool burden. No obstruction. |
Generate impression based on findings. | Fall on Coumadin with history of altered mental status. Head CT: There is no evidence of acute intracranial hemorrhage. There is mild to moderate white matter hypoattenuation. The gray white differentiation is otherwise preserved. There is mild cerebral volume loss diffusely. There is no midline shift or herniation. There are prominent extra-axial CSF spaces, particularly in the left parietal convexity. The imaged paranasal sinuses and mastoid air cells are clear. There is a right frontal skull osteoma. There are bilateral lens implants. There is a carious tooth # 3.Head CTA: There is a punctate calcification in the left internal carotid artery. Otherwise, there is no evidence of significant steno-occlusive lesions or aneurysms.Neck CTA: There is a retropharyngeal course of the bilateral carotid arteries. There is no evidence of significant steno-occlusive lesions. There are multiple subcentimeter hypoattenuating thyroid nodules. There are multiple nodules in the partially-imaged lungs. Cervical Spine: There is no evidence of fracture. There is an incomplete posterior arch of C1, which is an anatomic variant. There is minimal anterolisthesis of C4 upon C5. There is mild multilevel degenerative spondylosis, which is most pronounced at C5-6. The vertebral body heights are preserved. The paravertebral soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage.2. Mild to moderate white matter hypoattenuation likely representing chronic small vessel ischemic disease. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.3. Prominent extra-axial CSF spaces, particularly in the left parietal convexity may represent hygroma.4. No evidence of cervical spine fracture.5. No evidence of significant steno-occlusive lesions in the head and neck.6. Multiple nonspecific subcentimeter hypoattenuating thyroid nodules. A thyroid ultrasound may be useful for further characterization.7. Multiple nonspecific nodules in the partially-imaged lungs. A baseline chest CT is recommended for further evaluation.8. Carious tooth # 3. |
Generate impression based on findings. | 77 years, Female. Reason: e/o obstruction History: abdominal pain NG tube projects over gastric fundus. Given findings and prior CT scan of 3 with 15 probably resolving obstruction. | Bowel distention diminished compared to prior CT scan on 3/4/15. |
Generate impression based on findings. | 77 years, Female. Reason: patient w/ copious diarrhea, SBO, eval for resolution, worsening of sbp History: fever, diarrhea Jejunal dilatation. Moderate gas in colon. Probably resolving obstruction given findings a CT scan.NG tube tip overlies the gastric fundus. The side hole in region of the gastric cardia. | Resolving obstruction. NG tube tip gastric fundus region. |
Generate impression based on findings. | 69 years, Male. Reason: assess for small bowel obstruction History: as above Residual barium throughout the transverse and left colon. Nonobstructive bowel gas pattern. Basilar opacities; please refer to chest x-ray report | No evidence of small bowel obstruction. |
Generate impression based on findings. | 49 years, Female. Reason: Please look at where is the capsule History: swallowed video capsule Endoscopic capsule and patentcy capsule seen in the right abdomen. Nonobstructive gas pattern. Not substantially changed from prior exam. Lung bases clear. Probable posttraumatic changes right inferior pubic ramus region. | Both capsules still present in the right abdomen. |
Generate impression based on findings. | 29 years, Female. Reason: Signs of small bowel obstruction? History: Abdominal pain N/V Nonobstructive bowel gas pattern. Osseous and soft tissue structures unremarkable except for stable calcification projecting over the lower pole of the right kidney. Note this is not seen on the CT scan of 7/26/2010. | Calcification projects over right lower pole kidney. No evidence of bowel obstruction. |
Generate impression based on findings. | 57 years, Male. Reason: abdominal pain in the setting of colon mass with recent stenting History: abdominal pain, new Angle stent in the distribution of the sigmoid colon with persistent marked dilatation of proximal large bowel and small bowel.Well-defined lucency projects over the liver of uncertain etiology. No bowel is seen in this region on the CT scan of 3/6/15. Correlate clinically.No intramural air or free air evident. | Despite presence of sigmoid stent, obstructive pattern process.Ill-defined lucency projects over liver of uncertain etiology. Correlate clinically and consider CT to rule out liver or peritoneal air.Discussed with hospitalist pager 9100 Dr. Krishnamoorthy. |
Generate impression based on findings. | Suspected Lemierre's disease versus neck abscess. Neck discomfort, leukocytosis, fusobacteria on blood culture. There is an extensive filling defect within the left internal jugular vein and some of the branches. There is diffuse surrounding fat stranding. There is mild left cervical lymphadenopathy, which is likely reactive. There is a partially-imaged opacity in the left upper lobe of the lung and a small nodule in the right lung apex. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There are multiple dental caries, some of which are associated with periodontal lucencies. The airways are patent. There is mucosal thickening within the alveolar recesses of the maxillary sinuses. The imaged intracranial structures are unremarkable. | 1. Left internal jugular venous thrombosis with associated inflammatory changes and pulmonary opacities are compatible with Lemierre's disease in the setting of septic thrombophlebitis and septic pulmonary emboli, but no evidence of a drainable abscess. 2. Extensive dental disease. |
Generate impression based on findings. | 65 years, Male. Reason: 65yoM with abd distention, + Cdif History: abdominal pain/distention CVC tip is projected over the right atrium/SVC junction. Enteric feeding tube projects over the pyloric region. Surgical clips in the right upper quadrant. Persistent generalized paucity of bowel gas. Nonspecific gas pattern. | Persistent generalized paucity of bowel gas. Nonspecific bowel gas pattern. |
Generate impression based on findings. | 35 years, Male. Reason: evaluate for obstruction or large stool burden History: patient with diffusely tender abdomen Paucity of bowel gas. Some nondistended fluid-filled loops of jejunum are seen. Less than average stool burden. I doubt that there is obstruction. No evidence of intramural air or free air. Small kidneys consistent with medical renal disease. Osseous and soft tissue structures are unremarkable. | Paucity of bowel gas. Low suspicion for obstruction. |
Generate impression based on findings. | Evaluate lumbar pedicles History: subacute compression fracture L1, planned kyphoplasty 03/9. There is a compression fracture of the L1 vertebral body with approximately 50 % loss of height and approximately 5 mm of retropulsion into the spinal canal. The pedicles appear to be intact. There appears to be diffuse osteopenia. There is mild straightening of the lumbar spine alignment in the sagittal plane. There is multilevel degenerative spondylosis, which appears to be most pronounced at L5-S1, where there is a posterior disc-osteophyte complex and severe right and moderate left neural foramen stenosis. The paravertebral soft tissues are unremarkable. | 1. Compression fracture of the L1 vertebral body with approximately 50 % loss of height and approximately 5 mm of retropulsion into the spinal canal with a background of apparent diffuse osteopenia. The pedicles of the L1 vertebra appear to be intact.2. Multilevel degenerative spondylosis, which appears to be most pronounced at L5-S1, where there is a posterior disc-osteophyte complex and severe right and moderate left neural foramen stenosis. |
Generate impression based on findings. | 98 years, Female. Reason: moved DHT History: MOVed dht Dobbhoff catheter has been advanced and is projected over the lower central abdomen, presumably gastric antrum. Trace bilateral pleural effusions and left basilar consolidation. Cholecystectomy clips noted. Nonobstructive bowel gas pattern. Enteric contrast opacifies the colon.Degenerative changes of the lumbar spine. | The Dobbhoff catheter has been advanced and is projected in the lower central abdomen presumably this gastric body or antrum.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 35 years, Male. Reason: Nausea, vomiting, eval for obstruction History: N/V, renal failure Paucity of bowel gas. No definite evidence of obstruction. Small kidneys. Borderline cardiomegaly. Osseous and soft tissue structures otherwise unremarkable. | No evidence of obstruction. |
Generate impression based on findings. | 85 years, Male. Reason: attempt to sit patient upright - eval for free air History: n/v Pelvis excluded from field of view. Nonobstructive bowel gas pattern. No evidence of free air given the limitations. NG tube tip at cardia with side hole possibly in distal esophagus. Tube should be advanced.Multifocal opacities in the lung bases. Please refer its chest x-ray. | NG tube should be advanced. No obvious free air. |
Generate impression based on findings. | 98 years, Female. Reason: Dobbhoff placement History: dysphagia Dobbhoff catheter is projected over the gastroesophageal junction. Nonobstructive gas pattern with enteric contrast outlining the colon. | Dobbhoff catheter is projected over the gastroesophageal junction. |
Generate impression based on findings. | Female, 24 years old. Patient coded. Surgical count is correct. No unexpected radiopaque foreign bodies within the field-of-view. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign bodyThese findings were discussed by Dr. Patel by telephone with Dr. Romero, the attending surgeon, at 6:35 p.m. 03/07/15. |
Generate impression based on findings. | 70 years, Male. Reason: DHT advanced further History: DHT advanced further Dobbhoff tube in stomach coiling back with tip in the distribution of the gastric fundus.Nonobstructive bowel gas pattern. | Dobbhoff tube tip in distribution of gastric fundus |
Generate impression based on findings. | 69 years, Male. Reason: Hx of bullet lodgement; need XR to clear for MRI History: As above Generalized diffuse ileus pattern. No evidence of obstruction intramural air or free air evident. No radiopaque foreign body visible. | No radiopaque foreign body visible. |
Generate impression based on findings. | Bilateral profound sensorineural hearing loss. Cochlear implant candidate. Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There are bilateral lens implants. There is left PCA and right MCA territory encephalomalacia. There is an incomplete posterior arch of C1. | Unremarkable temporal bone anatomy. |
Generate impression based on findings. | Worsened edema, midline shift: comatose. There is diffuse loss of grey-white matter differentiation in the bilateral cerebral hemispheres with associated effacement of the sulci. There is an unchanged focal hypoattenuating defect in the left frontal centrum semiovale. There is no evidence of acute intracranial hemorrhage. The ventricles are not significantly changed in appearance. There is no midline shift or herniation. The imaged mastoid air cells are clear. There is scattered paranasal sinus opacification. The skull and scalp soft tissues are unremarkable. There is partially-imaged extensive periodontal disease in the maxilla. | Diffuse cerebral edema and left frontal centrum semiovale infarct, but no midline shift or herniation. |
Generate impression based on findings. | Female 39 years old; Reason: eval acute infection History: h/o renal tx, febrile, recent PNA/flu - L-sided abd pain The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Left basal atelectasis and trace pleural effusion.LIVER, BILIARY TRACT: Cholecystectomy clips. Presumed clips are again noted in the right paracolic gutter.SPLEEN: No significant abnormality noted.PANCREAS: In region of previously described pancreatic pseudocyst there is extensive new mass and strandy inflammatory changes. The gas extends to the superior recess of the lesser sac on the left signs, along the lesser curvature of the stomach along the expected course of the pancreas within the central abdomen. The largest gas/fluid component measures 7.9 x 4.8 cm (series 4, image 41).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The right kidney is not visualized. The left kidney is severely atrophic.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged retroperitoneal lymph nodes are nonspecific but likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Broad-based ventral abdominal wall hernia.PELVIS:UTERUS, ADNEXA: Bulky uterus, presumed related to underlying fibroid disease.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Renal allograft in the left iliac fossa. No hydronephrosis or significant perinephric fluid. | 1.New peripancreatic inflammatory changes and gas in the upper abdomen in the region of previously described pancreatic pseudocyst. The findings are suspicious for pseudocyst superinfection or fistulation to bowel. |
Generate impression based on findings. | Newly diagnosed cervical esophageal cancer. There is cervical esophageal wall thickening. The trachea appears to be grossly intact. There is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is multilevel degenerative spondylosis and a fat-attenuation lucency in the T1 vertebra, which likely represents a hemangioma. The imaged intracranial structures are unremarkable. There are bilateral lens implants. The imaged portions of the lungs are clear. | Cervical esophageal wall thickening is compatible with the known cancer, which is otherwise better depicted on endoscopy. No evidence of gross trachea invasion or significant cervical lymphadenopathy. |
Generate impression based on findings. | Male 14 years old Reason: HCC, S/P THERASPHERE PROCEDURE History: HCC, S/P THERASPHERE PROCEDURE CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No pericardial effusion. No significant mediastinal, hilar or axillary lymphadenopathy. No appreciable coronary artery calcifications.CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Bilobar multifocal disease is again demonstrated the liver with tumor thrombus affecting the entire portal venous system. Multiple collaterals are again noted in the region of the hepatic hilum. Additional smaller foci of abnormal arterial enhancement are identified within the left hepatic lobe.Given the multifocality of the disease accurate measurement is difficult. Within this limitation the superior left hepatic lobe reference lesion measures 5.9 x 4.0 cm (series 10, image 26), previously 6.0 x 3.5 cm.An additional reference lesion in the inferior right hepatic lobe measures 5.4 x 3.9 cm (series 10, image 55) previously 5.2 x 4.1 cm.There is persistent segmental left intrahepatic duct dilatation, grossly stable compared to prior study.SPLEEN: Splenomegaly measuring up to 16 cm in length.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Scattered subcentimeter hypoattenuating renal lesions are too small characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace perisplenic fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites. No carcinomatosis. | 1. Findings consistent with provided history of diffuse multifocal hepatocellular carcinoma with tumor thrombus throughout the portal venous system. Allowing for differences in imaging technique overall the appearance is not significantly changed compared to prior study. 2. Splenomegaly |
Generate impression based on findings. | Born at 35 weeks via vacuum assisted vaginal delivery causing subgaleal hematoma, shoulder dystocia/left humeral fracture, and intubated at OSH for apnea after birth. Pregnancy was complicated by maternal history of diabetes and polyhydramnios. APGARs were 3, 5, 6 and 7. HIE on cooling protocol. Evaluate subdural/subgaleal hemorrhage. There is grossly unchanged subdural hemorrhage along the right greater than left tentorium, right aspect of the falx posteriorly and extending along the right parietal and temporal lobes, into the right middle cranial fossa. There is continued evolution of the scalp hematomas, which have slightly increase in size overall. There is slight inward displacement of the occipital bones. There remains slight hypoattenuation of the deep gray nuclei. There is unchanged prominence of the extra-axial space anterior and inferior to the temporal. The ventricles are unchanged in size. There is no midline shift or mass effect. There is diffuse edema extending into the facial soft tissues, right greater than left side. There is persistent opacification of bilateral mastoid air cells and middle ears. There is a partially imaged nasogastric tube. | 1. Grossly unchanged amount of right greater than left subdural hematoma.2. Continued evolution of the extensive scalp hematomas, which have slightly increase in size overall. 3. Unchanged apparent mild hypoattenuation of the deep gray nuclei may represent hypoxic ischemic injury versus artifact. A brain MRI may be useful for further evaluation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Evaluate for hemorrhagic transformation, ischemia. Left sided weakness, s/p TPA and IR thrombectomy. There is now diffuse hypoattenuation throughout much of the right middle cerebral artery territory. There is calcification in the proximal right middle cerebral artery. There is also a punctate calcification in the right parietal lobe region. There is no evidence of acute intracranial hemorrhage or mass. There is mild effacement of the right lateral ventricle. 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. | Interval evolution of the extensive right middle cerebral artery territory with development of diffuse edema, but no significant midline shift or hemorrhagic transformation. Calcifications in the right middle cerebral artery distribution may represent embolized plaque. |
Generate impression based on findings. | Stroke on anticoagulation: weakness. There are multiple scattered areas of hypoattenuation in the bilateral cerebral hemispheres. There is no evidence of acute intracranial hemorrhage. 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. | Multiple scattered cerebral infarcts without evidence of hemorrhagic transformation. |
Generate impression based on findings. | Vascular dementia with elevated blood pressures and associated HA. Eval for hemorrhage, CVA, other acute brain abnormality. There are multiple areas of cerebral white matter hypoattenuation, which have considerably progressed since 2007. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | Multiple areas of cerebral white matter hypoattenuation that have considerably progressed since 2007 likely represent small vessel ischemic disease of indeterminate age. No evidence of acute intracranial hemorrhage. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | Increasing headaches. There are left transparietal and right transtemporal ventricular shunt catheters in position. There is now a small amount of air in the scalp surrounding the left catheter reservoir device, which may be related to an intervention. The ventricular system and cystic dilatation of the superior vermian cistern appear to be grossly unchanged. There is absence of the septum pellucidum. There is no evidence of acute intracranial hemorrhage or herniation and there is otherwise no change in the dysmorphic appearance of the brain and cerebellum, with areas of apparent cortical dysplasia. The imaged portions of the shunt catheters appear to be intact. | 1. The shunted ventricular system and cystic dilatation of the superior vermian cistern appear to be grossly unchanged since the previous day. 2. Unchanged dysmorphic appearance of the brain and cerebellum. 3. No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Intracranial hemorrhage. Head CT: There is no significant interval change in the posterior left temporal lobe hyperattenuating hematoma with mild surrounding vasogenic edema. 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. Head CTA: There is no evidence of cerebral aneurysm, vascular malformation, active contrast extravasation, or significant steno-occlusive lesions. There is mild carotid siphon calcification.Neck CTA: There is a two vessel aortic arch. There is mild calcified plaque at the carotid bifurcations bilaterally. Otherwise, there is no evidence of significant steno-occlusive lesions. There is mild pannus at the level of the dens. There is multilevel degenerative spondylosis of the cervical spine. There is a nonspecific subcentimeter left apical nodule. | 1. No significant interval change in the posterior left temporal lobe intraparenchymal hematoma with mild surrounding vasogenic edema. 2. No evidence of cerebral aneurysm, vascular malformation, active contrast extravasation, or significant steno-occlusive lesions in the head and neck.3. Nonspecific subcentimeter left apical nodule. A baseline chest CT may be useful for further evaluation. |
Generate impression based on findings. | Altered mental status. Evaluate for intracranial hemorrhage and stroke. There is no evidence of acute intracranial hemorrhage or mass effect. There is mild diffuse cerebral volume loss and patchy cerebral white matter hypoattenuation. There are scattered vascular calcifications. There is no midline shift or herniation. There is partially-imaged opacification of the paranasal sinuses. The mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants. | Mild diffuse cerebral volume loss and patchy cerebral white matter hypoattenuation, which may represent age-indeterminate small vessel ischemic disease, but no evidence of acute intracranial hemorrhage or mass effect. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and no contraindications, MRI of the brain is recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | AMS, nonverbal, eyes open. There is a posterior left temporal lobe hyperattenuating hematoma that measures up to 18 mm with mild surrounding vasogenic edema. There is scattered cerebral white matter hypoattenuation. 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. Acute posterior left temporal lobe intraparenchymal hematoma that measures up to 18 mm with mild surrounding vasogenic edema, but no midline shift. 2. Scattered nonspecific cerebral white matter hypoattenuation may represent small vesel ischemic disease of indeterminate age. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | left side weakness No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | altered mental status, post cardiac arrest, follow up No evidence of acute ischemic or hemorrhagic lesion.No change of bifrontal extra axial fluid (CSF) collection since prior exam.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.No change of bifrontal extra axial minimal CSF collections since prior exam. |
Generate impression based on findings. | posterior headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The mastoid air cells are clear. Partial opacification on the left maxillary sinus. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | 81 years, Male. Reason: ng tube replacement There is a nasogastric tube with its tip projecting over the proximal body of the stomach with the sideport at the level of the GE junction. There is a nonobstructive bowel gas pattern. The pelvis is excluded from the field of view. Low lung volumes. Patchy bibasilar atelectasis. | There is a nasogastric tube with its tip projecting over the proximal body of the stomach with the sideport at the level of the GE junction, advancement of the tube by 5 cm is recommended. |
Generate impression based on findings. | 81 years, Male. Reason: evaluate ileus for improvement, worsening or SBO History: Persistent abdominal distention, N/V There is a nasogastric tube with its tip projecting over the fundus of the stomach with the side-port just distal to the gastroesophageal junction. Paucity of bowel gas without evidence of obstruction The pelvis is excluded from the field of view. Bibasilar atelectasis right greater than left. | Paucity of bowel gas without evidence of obstruction. |
Generate impression based on findings. | RFO trigger: evaluate for RFO Suspected RFO location: abdomen Name of suspected RFO: instruments and sponges Attending Surgeon name/pager: Nunes Upper abdomen excluded from the field-of-view. No unexpected radiopaque foreign object identified. There is a nonobstructive bowel gas pattern. There is moderate stool burden distributed throughout the colon. | No unexpected radiopaque foreign object identified.These findings were discussed with Dr. Nunes the attending surgeon on 3/8/2015 at 01:45 PM by the radiology resident on call. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Mucosal thickening is present within the right sphenoid sinus. Otherwise the visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative unenhanced brain CT. Specifically, there are no CT findings to explain the patient's psychosis. |
Generate impression based on findings. | 84 years, Male. Reason: NGT There is a nasogastric tube with its tip projecting over the fundus of the stomach and the sideport just beyond the GE junction. Left lower lobe consolidation/atelectasis. Biventricular pacemaker leads in expected location. There is a nonobstructive bowel gas pattern. There are marked degenerative changes of the lower lumbar spine/ankylosis of the SI joints. | NG tube with tip projecting over the fundus of the stomach. |
Generate impression based on findings. | Right hip pain. Exam limited by shielding which obscures part of the right pelvis. There is no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Partial opacification is noted within the right maxillary sinus. The remaining visualized portions of the paranasal sinuses and mastoid air cells are clear. The calvarium is intact without osseous lytic lesions. | Partial opacification is noted within the right maxillary sinus. Otherwise unenhanced brain CT. |
Generate impression based on findings. | 57 years, Male. Reason: abdominal pain History: abdominal distension Multiple markedly dilated loops of small bowel as well as dilatation of the ascending and transverse colon, with a paucity of bowel gas in the left lower quadrant colon proximal to the stent, consistent with large bowel obstruction, as seen on the prior CT examination. Previously identified pneumoperitoneum not well seen on this radiographic examination. Colonic stent present in the left lower quadrant. Excreted contrast present within the bladder. | Distal bowel obstruction as on the prior CT examination. Pneumoperitoneum not as well seen on this exam. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are diagnostic mammogram and right breast ultrasound dated 2/24/2015 performed at Advocate Sherman Hospital. For comparison, bilateral mammogram dated 3/27/2014 and right breast diagnostic mammogram and ultrasound dated 9/20/2013 are available. Patient has a history of right breast IDC status post neoadjuvant letrozole, with lumpectomy in 2013 with subsequent radiation. DIAGNOSTIC MAMMOGRAM (2/24/2015): Two standard views of the left breast, three standard views of the right breast, and laterally exaggerated right CC view were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A linear marker has been placed on a scar overlying the far posterior, upper outer right breast with stable underlying postsurgical changes including surgical clips. BBs are noted overlying the upper central right periareolar region, denoting site of palpable abnormality. Questionable retroareolar asymmetry subjacent to palpable marker. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. Catheter tubing overlies and obscures evaluation of the upper outer right breast and right axilla on MLO and XCCL views.Benign appearing lymph nodes are projected over the left axilla.RIGHT BREAST ULTRASOUND (2/24/2015): Submitted images from a targeted right breast ultrasound were reviewed.At the 12 o'clock position of the right breast, 2 cm from the nipple there is a heterogeneous, hypoechoic lobulated mass with angular margins measuring 2.9 x 1.7 x 1.1 cm (previously 2.9 x 1.3 x 1.6 cm), not significantly changed from prior examination. It is unclear whether this area has previously been sampled for histology.At the 9 o'clock position of the right breast, 3 cm from the nipple there is a 1.6 x 0.8 x 0.7 cm irregular hypoechoic area with shadowing. No significant vascularity is noted of this area.Sonographic images labeled "right breast axillary" demonstrate normal morphology right axillary lymph nodes. | 1. Irregular, heterogeneous mass at the 12 o'clock position of the right breast is largely unchanged compared to the examination dated September 20, 2013 though suspicious in appearnce. It is unclear whether this lesion has been histologically sampled. Biopsy of this area is recommended if not already performed, either based on palpability or sonographic guidance.2. Irregular hypoechoic area at the 9 o'clock position of the right breast. Repeat sonography in this area is recommended for further characterization.3. Normal morphology right axillary lymph nodes.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Right hip pain. Pain on mvts. Left hip pain. Single view of the right hip reveals no acute fracture or malalignment. There is severe osteoarthritis of the hip with joint space narrowing and osteophyte formation.Single view of the left hip reveals no acute fracture or malalignment. There is severe osteoarthritis of the hip with joint space narrowing and osteophyte formation. | Severe osteoarthritis of both hips without acute fracture evident. |
Generate impression based on findings. | 16 years old, Male, Reason: sports injury with pain.VIEWS: Right Tibia-fibula AP, lateral. Right Knee AP, oblique and lateral (5 views) 3/8/15 Right Tibia-fibula: Comminuted, minimally displaced fracture involving the tibial intercondylar eminence. This is better seen on dedicated knee films. No additional fractures noted.Right knee: Comminuted fracture of the intercondylar tibial eminence which is displaced approximately 5 mm from the tibia on the lateral view. A moderate-sized joint effusion is present. A lateral notch sign is present. No additional fractures are identified. The extensor mechanism appears intact. | Comminuted minimally displaced fracture involving the tibial intercondylar eminence. Please note that this fracture can be seen in setting of anterior cruciate ligament injury. |
Generate impression based on findings. | Lateral condyle fracture.VIEWS: Left elbow AP/lateral (two views) 03/09/15, 0505 100507 A splint obscures bone detail. A lateral condylar fracture is identified. The distal fracture fragment is displaced laterally and probably posteriorly. Soft tissue swelling is present. | Salter II or Salter IV fracture of the distal humerus. |
Generate impression based on findings. | 58 years, Female. Reason: Serial assessment of recently operated abdomen. Would like to assess for perf/anastomosis leak History: increased abdominal pain, oozing and drain site Retained contrast opacifies the majority of the colon. Cholecystectomy clips project over the right upper quadrant. Suture line is seen in the left upper quadrant. JP drain projects over the midline abdomen. There are nonspecific lucencies along the bilateral upper flanks, which would better evaluated with an upright chest or lateral decubitus radiographs. Left lower lobe atelectasis/consolidation pulmonary and vascular congestion is present. | Nonspecific lucencies over the bilateral upper flanks would be better evaluated with an upright chest or left lateral decubitus radiography. |
Generate impression based on findings. | Fever, tachypnea and cough. History of asthma.VIEW: Chest AP (one view) 3/9/15 at 0 40 hours. Cardiac silhouette size is top normal. Bibasilar opacity, either atelectasis or pneumonia and possible underlying pleural effusion of the left hemithorax. | Multifocal opacities with possible underlying left-sided pleural effusion. |
Generate impression based on findings. | Right lateral ankle pain. Question of fracture. There is a non-displaced oblique fracture of the distal fibula proximal to the tibiotalar joint. No additional fracture is identified. The medial tibiotalar joint appears intact. There is soft tissue swelling about the lateral malleolus. | Non-displaced oblique fracture of the distal fibula. |
Generate impression based on findings. | 58-year-old female experiencing seizure There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is unchanged diffuse parenchymal volume loss greater than expected for age as well as areas of low-attenuation within the periatrial white matter, most consistent with chronic small vessel ischemic disease. The ventricles are again prominent, greater than expected given the degree of atrophy, but unchanged. There is no midline shift or herniation. The visualized paranasal sinuses are clear as are mastoid air cells. The skull and extracranial soft tissues are unremarkable. | 1.No evidence of intracranial hemorrhage, mass, or cerebral edema.2.Redemonstrated small vessel ischemic disease of indeterminate ages.3.Diffuse parenchymal volume loss, greater than expected for age.4.Ventriculomegaly greater than expected given the degree of atrophy, but unchanged. |
Generate impression based on findings. | 40 years, Female. Reason: NGT in place? History: NGT in place, extensive vomiting There is a nasojejunal tube with its tip projecting over the proximal jejunum, past the ligament of Treitz. Mild gaseous distention of both large and small bowel consistent with mild ileus. The pelvis is excluded from the field of view. | Nasojejunal tube with its tip projecting over the proximal jejunum. Mild ileus type gas pattern. |
Generate impression based on findings. | malaise and fatigue, possible posterior fossa stroke No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | 22 years, Male. Reason: Abdominal pain, assess for obstruction There is a nonobstructive bowel gas pattern. Centralized air containing featureless small bowel may reflect bowel wall thickening/ascites. | Centralized air containing featureless small bowel may reflect ascites/bowel thickening. Further evaluation with contrast enhanced CT may be considered as clinically indicated. |
Generate impression based on findings. | 16 y/o with autism, pica. R/o obstruction. Identify non-food objects in GI. Constipation/stool burden.VIEWS: Abdomen upright and supine (two views) 3/8/2015 at 2134 hrs Nonobstructive bowel gas pattern. Moderate stool burden.No intraperitoneal free air.Several subcentimeter irregularly-shaped radiodense foreign bodies identified within the ascending colon. | Nonobstructive bowel gas pattern with at least two foreign objects within the ascending colon. |
Generate impression based on findings. | 65-year-old female with intracranial hemorrhage. Redemonstrated is a posterior left temporal lobe hyperattenuating hematoma that measures up to 18 mm with mild surrounding vasogenic edema. There is scattered cerebral white matter hypoattenuation. 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. | Stable posterior left temporal lobe intraparenchymal hematoma. |
Generate impression based on findings. | ataxia, right lower extremity weakness NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. There is normal contrast opacification through bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Bilateral Pcom arteries are patent and Acom artery is also patent.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage.Previously noted right thyroid nodule appears to be decreased in size (now measured about 34mm x 16.3mm x 15.5mm with bi-lobulated configuration. Ultrasonographic evaluation can be considered if clinically indicated for the thyroid lesion. | Normal head CT scan.Normal head and neck CTA.Decreased size and configuration of right thyroid lesion since prior exam. |
Generate impression based on findings. | 36-year-old male with significant obstructive disease of unknown etiology LUNGS AND PLEURA: Severe, upper lobe predominant panacinar emphysema. Left greater than right lower lobe patchy airspace opacities suspicious for infection or aspiration. Mosaic pattern throughout the bilateral lungs may represent airtrapping. Debris is noted within the trachea and bilateral mainstem bronchi. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion.CHEST WALL: No axillary, retrocrural, or cardiophrenic lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Severe, upper lobe predominant panacinar emphysema in a young patient raises question of alpha-1 antitrypsin deficiency. 2.Debris within the airway with bilateral lower lobe pulmonary opacities suspicious for aspiration/infection. |
Generate impression based on findings. | There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. Subtle increased attenuation along the anterior aspect of the left frontal lobe (seen on series 80392, image 17), is felt to be artifactual. Hypodensity is present within the white matter without associated mass effect. Diffuse volume loss is present, without a specific lobar predominant atrophy pattern. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The left maxillary sinus is completely opacified with thickened and sclerotic walls consistent with a chronic process. Scattered foci of mucosal thickening can also be found within anterior left ethmoid and left frontal sinuses. The remaining visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No CT evidence for an acute intracranial process.2.Small vessel disease of indeterminate ages. If there is clinical concern for acute ischemia, MRI would be recommended.3.Diffuse volume loss is present, without a specific lobar predominant atrophy pattern. |
Generate impression based on findings. | Stress view of the right ankle. Assess fracture. Single AP stress view of the right ankle again demonstrates a nondisplaced oblique fracture of the distal fibula. The medial tibiotalar joint does not appear to widen on the stress view. There soft tissue swelling about the lateral malleolus. | No widening of the medial tibiotalar joint with stress. |
Generate impression based on findings. | Male 1 day old Reason: re-evaluate UVC placement, lung fields History: 40 wk infant with FIO2 requirement and UVC pulled back.VIEW: Chest and abdomen AP (two views) 3/9/15 at 612 hours UVC terminates at the RA/IVC junction. NG tube tip is at the stomach. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Interval repositioning of UVC as described. |
Generate impression based on findings. | 11 week old, former 29-30 weeks gestational age patient. Abdominal distention. Evaluate for NECVIEW: Abdomen AP (one view) 3/9/2015, 0620 Enteric tube with distal sideport beyond the GE junction.Mild gaseous distention of multiple loops of bowel in a disorganized pattern, slightly decreased in prominence from prior.No pneumatosis intestinalis, portal venous gas, or pneumoperitoneum.Hazy opacities at the lung bases. | Mild gaseous distention of multiple loops of bowel, without pneumatosis intestinalis, portal venous gas, or pneumoperitoneum. |
Generate impression based on findings. | Male 1 day old Reason: evaluate UVC placement History: newly placed UVC. Respiratory distress.VIEW: Chest and abdomen AP (two views) 3/8/15 at 1825 hrs. NG tube terminates in the stomach. UVC tip is at the RA/SVC junction. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Misplaced UVC.Interval resolution of haziness.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | 11 week old, former 29-30 weeks gestational age patient. Abdominal distention. Evaluate for NECVIEW: Abdomen AP (one view) 3/8/2015 at 2159 hrs Enteric tube with distal sideport beyond the GE junction.Gaseous distention of the stomach.Mild to moderate gaseous distention of multiple loops of bowel in a disorganized pattern, more prominent compared to the prior exam.No pneumatosis intestinalis, portal venous gas, or pneumoperitoneum.Hazy lung base opacities are present in the base. | Mildly to moderately dilated bowel loops, without pneumatosis intestinalis, portal venous gas, or pneumoperitoneum. |
Generate impression based on findings. | 2 years old, Female, History: fever, cough concern for pneumonia.VIEWS: Chest AP/lateral (two views) 3/8/15 The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. Scattered foci of peribronchial thickening consistent with reactive airway disease/bronchiolitis. No consolidation is present. No pleural effusion or pneumothorax. | Reactive airway disease/bronchiolitis pattern. |
Generate impression based on findings. | Female 2 days old Reason: 29 week infant intubated, previous CXR showing potential pleural effusion. Please evaluate for effusion, focal infiltrate, pneumothorax History: Respiratory distress, intubatedVIEW: Chest AP (one view) 3/8/15 at 2014 hrs. ET tube, umbilical lines and NG tube unchanged. Cardiac silhouette is non sizable due to a complete opacification of the left hemithorax. Right upper lobe atelectasis also noted. No effusions or pneumothorax. | Complete atelectasis of the left lung and right upper lobe. |
Generate impression based on findings. | 63-year-old male with recent fall, open wound, pain, and feeding tube right fifth digit. There is a comminuted, predominantly transverse, fracture involving the base of the proximal fifth phalanx, with ulnar displacement of the distal fracture fragment, and associated dorsal soft tissue swelling.There is a nondisplaced fracture at the base of the fifth metacarpal as well.There are extensive degenerative changes in the hand and wrist, most significant at the first carpometacarpal joint. Joint narrowing of the third metacarpophalangeal joint and associated beaklike osteophyte formation along the lateral aspect of the third metacarpal is suggestive of calcium pyrophosphate deposition disease. | 1.Comminuted fracture along the proximal fifth phalanx, with ulnar displacement of the distal fracture fragment. 2.Nondisplaced fracture at the base of the fifth metacarpal.3.Significant degenerative disease, most significant at the first carpometacarpal joint.4.Suggestion of calcium pyrophosphate deposition disease of the third metacarpophalangeal joint. |
Generate impression based on findings. | Left ankle injury. Unable to dorsiflex the foot. Question of fracture. Three views of the left ankle and foot reveal no acute fracture or malalignment. No significant soft tissue swelling is identified. | No acute fracture or malalignment is evident. |
Generate impression based on findings. | 70 year old female status post left mastectomy in 2014 for invasive ductal carcinoma, presents today for routine follow up. She received radiation, chemotherapy, and hormonal therapy. No current breast complaints. No family history of breast cancer. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present. Stable focal asymmetry is present within the medial right breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Hypodensities are present within the white matter without associated mass effect. There is mild diffuse volume loss without a specific lobar atrophy pattern. There are no findings of ventricular obstruction or hydrocephalus. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Mucosal thickening is present within the anterior right ethmoid sinus, right sphenoid sinus, a posterior left ethmoid air cell, and the left maxillary sinus. The mastoid air cells are clear. An enteric feeding tube is present via the right nares. | 1.No CT evidence for acute intracranial process.2.Small vessel ischemic disease of indeterminate ages.3.Mild diffuse volume loss without a specific lobar atrophy pattern. |
Generate impression based on findings. | 15 years old female. History: chest painVIEWS: Chest AP/lateral (two views) 3/8/15 The aortic arch, cardiac apex, and stomach are left-sided. Cardiomediastinal silhouette is normal. No focal opacities to suggest infection. No displaced fractures are identified. At the level of the aortic arch there is a double density, one is convex and the other appears straight. The convex density likely represents the manubrium. | Normal examination. |
Generate impression based on findings. | 6 month old male. Persistent emesis. Assess for air fluid levels, obstruction. VIEWS: Abdomen AP and left lateral decubitus (two views) 3/5/2015, 2218 Several mildly dilated loops of bowel containing air-fluid levels. Stool and gas within the rectum.No pneumatosis intestinalis, portal venous gas, or free intra-abdominal air. | Abnormal bowel gas pattern, with dilation and air-fluid levels. |
Generate impression based on findings. | Male 61 years old Reason: persistent bacteremia, WBC tag study w/ right iliac fossa uptake, concern for psoas muscle abscell History: persistent bacteremia ABDOMEN:LUNG BASES: Bilateral small pleural effusions and dependent atelectasis. Cardiomegaly. Previously described right lower lobe nodule is slightly increased in size and now measures 1.7 x 1.1 cm on image number 14, series number 3.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral poorly perfusing atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Air tracking into the gluteal region on the right side. A decubitus ulcer in that location cannot excluded. Clinical correlation is recommended.OTHER: No significant abnormality noted | Slight interval increase in the size of the right lower lobe pulmonary nodule. Etiology of this nodule is unknown.Atrophic poorly perfusing kidneys.Generalized anasarca, ascites and pleural effusion. No evidence of right iliac fossa abscess is questioned. |
Generate impression based on findings. | Male 30 years old; Reason: eval appy History: R-sided abd pain, F/N/V/D ABDOMEN:LUNG BASES: Couple scattered reticular opacities, likely atelectasis or scarring.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: 3.4 x 3.8 cm fluid attenuation cystic lesion in the spleen, nonspecific.PANCREAS: Mild fatty atrophy.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Couple subcentimeter hypodensities are to small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse clinical colonic wall thickening, most pronounced in the ascending colon and cecum with pericolonic induration and thickening. In the cecum particularly, there is increased soft tissue density, which may represent stool versus focally increased reactive thickening. Additionally, there is a moderate length segmental thickening of a loop of ileum best seen on coronal image 59. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Diffuse colonic thickening, most pronounced in the cecum and ascending colon, further described above. These findings are suggestive of a nonspecific colitis, but in conjunction with a moderate length segment loop of thickened ileum, inflammatory bowel disease cannot be excluded, and is favored. |
Generate impression based on findings. | Female 45 years old with epigastric pain, back pain, elevated lipase and history of acute on chronic pancreatitis. Evaluate extent of pancreatitis, pathology, common duct obstruction, pancreatic cyst ABDOMEN:LUNG BASES: No pulmonary nodules or masses are noted. No pleural effusion or pneumothorax.Left breast partially calcified soft tissue density is again seen and appears unchanged.LIVER, BILIARY TRACT: No hepatic nodules or masses are identified. No intrahepatic biliary ductal dilatation. The common bile duct measures up to 1.2 cm in caliber, previously 0.6 cm. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Diffuse parenchymal calcifications with irregular pancreatic ductal dilatation compatible with chronic pancreatitis, however the pancreatic duct appears more prominent compared to prior study. Multiple hypodense foci in the pancreatic head and body are again seen. There are some areas of enhancing pancreatic tissue compatible with viability. Minimal peripancreatic fat stranding and induration is noted with no fluid collection or abscess. There has been interval thrombosis of the splenic vein with development of collaterals. The remaining vessels are patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense focus in the right midpole is too small to characterize but appears unchanged from prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free pelvic fluid. | 1. Findings compatible with acute on chronic pancreatitis. Interval thrombosis of the splenic vein with development of collaterals.2. Pancreatic duct and hypodense lesions appear more prominent compared to prior study with no obvious mass lesion identified. Recommend MRI/MRCP after resolution of the acute findings to exclude an occult neoplasm.3. Interval prominence of the common bile duct likely related to cholecystectomy and no definite mass lesion or stones are identified. 4. Trace free pelvic fluid likely related to acute pancreatitis or may be physiologic.Findings were discussed with Dr. Lane Benes by phone on 3/9/2015 at 12:10 PM. |
Generate impression based on findings. | 31-year-old female with headache and possible shunt infection. Redemonstrated is a right transfrontal ventricular shunt with hypoattenuation surrounding the catheter. The ventricles are unchanged in size or shape. There is no abnormal enhancement. There is no evidence of acute intracranial hemorrhage. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The extracranial soft tissues are unremarkable, without evidence of disconnection of the imaged portions of the shunt catheter. Redemonstrated is diffuse thickening of the calvarium, which may be related to chronic shunting. | Stable right ventricular shunt and ventricular sizes, without ventricular dilatation, and no associated abnormal enhancement. |
Generate impression based on findings. | 16 days old, Male, History: neonatal fever, mother with unknown GBS status, concern for pneumonia. Constipation and blood in stool.VIEWS: Chest and abdomen AP (two views) 3/8/15 Aortic arch, cardiac apex, and stomach are left-sided. No focal pulmonary opacities to suggest pneumonia. Cardiothymic silhouette is within normal limits. No pneumatosis, free air, or portal venous gas. Nonobstructive, disorganized bowel gas pattern. Moderate stool burden is present. | No pneumonia. No NEC. |
Generate impression based on findings. | headache, dizziness, right lower extremity weakness No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.If clinically indicated, brain MRI can be considered for further evaluation. |
Generate impression based on findings. | 21-year-old female with history of chest pain and shortness of breath. Evaluate for pulmonary embolism. PULMONARY ARTERIES: Technically adequate study. No acute pulmonary embolus. No evidence of right heart strain. Main pulmonary artery size is within normal limits.LUNGS AND PLEURA: No focal air space opacities, pleural effusions, or pneumothorax.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Scattered mildly enlarged axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of acute pulmonary embolus.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Leg pain, redness. Assess for gas, pain out of proportion, concern for necrotizing fasciitis. There is diffuse, circumferential subcutaneous fat stranding involving the lower leg extending from the knee to the partially visualized ankle. No foci of gas are identified to suggest gas forming organisms. No loculated/drainable fluid collection is identified. There is a small knee joint effusion. There are vascular calcifications. | Extensive subcutaneous stranding compatible with inflammation and/or edema of the lower leg without evidence of osteomyelitis. |
Generate impression based on findings. | Female 49 years old Reason: r/o stone History: pain on right side, suprapubic pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral mild thickening of the adrenal glands nonspecific.KIDNEYS, 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: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of renal stones |
Generate impression based on findings. | 30-year-old male with elevated d-dimer and shortness of breath, evaluate for pulmonary embolism PULMONARY ARTERIES: Technically adequate examination without evidence of pulmonary embolism. The main pulmonary artery measures 2.6 cm.LUNGS AND PLEURA: No pleural effusion or pneumothorax. Scattered, left greater than right, basilar predominant nodular, groundglass opacities. No focal consolidation.MEDIASTINUM AND HILA: The heart size is normal. No significant mediastinal hilar lymphadenopathy.CHEST WALL: The osseous structures are within normal limits. No axillary, retrocrural, or cardiophrenic lymphadenopathy. Mild gynecomastia.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Left adrenal nodule measuring 8 HU compatible with an adrenal adenoma. | 1.No evidence of pulmonary embolism.2.Nonspecific, nodular groundglass opacities are nonspecific but may represent edema, aspiration or atypical infection.3.Left adrenal nodule likely represents an adenoma.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male; 57 years old. Reason: Ill defined lucency over liver on AXR; rule out liver or peritoneal air. History: Abdominal distension ABDOMEN:LUNG BASES: New small pleural effusions and mild bibasilar dependent subsegmental atelectasis. Please see report from CT chest performed concomitantly.LIVER, BILIARY TRACT: Stable ill-defined hypodense lesions in the right lobe liver, likely metastases. Reference segment 6 lesion measures 2.5 x 3.1 cm, unchanged (series 4/90). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval increased dilation of small bowel loops of diffusely with increased ascites and new mild pneumoperitoneum. This is highly suspicious for interval viscus perforation. Interval placement of colonic stent in the sigmoid colon, with the stent only partially visualized on this examination. The site of perforation is likely in the sigmoid colon, which is off the field-of-view.BONES, SOFT TISSUES: No significant abnormality noted | 1. Interval increased small bowel dilation, increased ascites, and new pneumoperitoneum. These findings are highly suspicious for interval viscus perforation, likely involving the sigmoid colon which is off the field-of-view since the pelvis was not included on this examination.2. New small pleural effusions and mild bibasilar dependent subsequent atelectasis. Please see report from dedicated CT chest performed concomitantly.Findings discussed by on call radiology resident with Dr. Shogan at 8:10 p.m. on 3/8/15. |
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