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Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable circumscribed mass in the left 6 o'clock position, anterior depth. Other bilateral asymmetries are also unchanged. Benign calcifications in both breasts, including arterial calcifications, are also stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable bilateral asymmetries and masses. 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. | NM LUNG PERFUSION W VENT PARTICUL, 3/9/2015 4:31 PM The comparison chest radiograph performed on 3/7/15 demonstrates left chest wall ICD with no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There are small foci of Xe-133 retention during the wash-out phase in the lung bases.Two small foci of abnormal perfusion and lung bases, which match ventilation images. Otherwise no perfusion abnormalities identified. | No scintigraphic findings to support pulmonary embolism. |
Generate impression based on findings. | 34 wga newborn. Respiratory distressVIEW: Chest and abdomen AP (two views) 3/9/2015 at 1645 hrs The aortic arch, cardiac apex, and stomach are left-sided.The cardiomediastinal silhouette is normal.Diffuse lung haziness may represent RDS or TTN. No pleural effusions, or pneumothorax.Disorganized bowel gas pattern is nonobstructive and likely age-related. | Findings consistent with RDS or TTN. |
Generate impression based on findings. | Lumbar pain. Three views of the lumbar spine reveal no acute fracture. Alignment is anatomic. Vertebral body heights are maintained. There are lower lumbar facet arthritic changes. There is severe osteoarthritis of the left hip with bone on bone apposition. | 1. Lower lumber facet arthritic changes without fracture. 2. Severe osteoarthritis of the left hip. |
Generate impression based on findings. | NJ tube repositioning Preliminary imaging demonstrated kinked nasojejunal tube, nonobstructive bowel gas pattern. GI team including attending physician Dr. Semrad retracted the preexisting enteric tube over a guidewire. Tube was flushed with continued retraction with subsequent improvement in kinked appearance. GI team was satisfied with final position of NJ tube, aware of mild kinking near expected region of ligament of Treitz, tip seen beyond ligament of Treitz and located in left mid abdominal jejunum. FLUOROSCOPY TIME: 52 seconds | Fluroscopy provided for successful repositioning of NJ tube as described. |
Generate impression based on findings. | 60 year-old male status post fall down stairs on Saturday, left shoulder pain. Two views of the left shoulder reveal moderate to severe osteoarthritis affecting the glenohumeral joint. Alignment of the shoulder is within normal limits. The acromial clavicular joint appears intact. A partially visualized distal clavicular fracture is present, (better seen on radiograph of the left clavicle from the same date). | Moderate to severe posterior arthritis of the glenohumeral joint. Partially visualized distal left clavicular fracture. |
Generate impression based on findings. | 45 year old female transplant evaluation. Difficult scan due to patient's body habitus. LIVER: Measures 13.8 cm in length and is heterogenous in echotexture. The portal vein is probably visualized and appears patent. GALLBLADDER, BILIARY TRACT: Normal echogenicity. Gallbladder wall measures 3 mm in thickness. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 5 mm in caliber. No intra or extrahepatic biliary ductal dilatation. PANCREAS: No significant abnormality noted.SPLEEN: Measures 8.2 cm in length and is normal in echogenicity. KIDNEYS: The right kidney measures 12.0 cm in length. The left kidney measures 10.7 cm in length. No definite evidence of hydronephrosis. ABDOMINAL AORTA: Not visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Foley in a decompressed bladder limits evaluation. | Limited exam due to patient's body habitus however there is diffuse heterogeneous echotexture of the liver is nonspecific and maybe related to diffuse infiltrative disease or hepatic steatosis. |
Generate impression based on findings. | A 60 years old male with history of pituitary tumor resection in 2010, before that surgery a normal echocardiography and a non-ischemia Spect stress test were reported. Today the patient arrived to the emergency room due to one episode of chest pain 1 week ago and one this morning. The ECG showed no acute ischemic changes and cardiac enzimes were normalCPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. No significant stenosis.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are multifocal mixed plaques with extensive calcifications from the LAD ostium to mid vessel with multifocal noncalcified plaque to the apical segment. The non calcified component at the proximal segment contributes to a 60% stenosis and 80% at mid LAD. The 1st diagonal demonstrates a moderate ostial non-calcified plaque. The 2nd diagonal is diminutive, demonstrating a mild stenosis at the bifurcation. The 3rd diagonal is apical and difficult to visualize. LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to one dominant obtuse marginal branch. There are multifocal mixed plaques with positive remodeling. The noncalcified components reveal 2 significant tandem lesions: one 60-70% stenosis immediately proximal to bifurcation with OM1, the second lesion distal to OM1 with 80% stenosis.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying an early branching posterior descending artery and a posterolateral branch. There is significant calcification, one mixed lesion at proximal RCA 2cm from ostium with mild-to-moderate stenosis of the non-calcified component. Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 95ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm, the axial measurement is 3.8cm x 3.8cm. The aortic arch is not included in the field of view. The main pulmonary artery is normal in size.Pericardium: No pericardial effusion.Lungs: Limited coverage due to acquisition without significant abnormality.Chest wall: The breast are not included in this field of view.Findings were discussed by phone with the resident caring for the patient at time of image interpretation at approximately 1515 hrs. | Diffuse, multifocal mixed plaque with the noncalcified components contributing to stenoses at proximal LAD (60%), mid LAD (80%), and LCx prox to OM1 (60-70%) and distal to OM1 (80%), RCA mild to moderate 2cm from ostium. |
Generate impression based on findings. | 73 year old female with discoloration. Evaluate right stump for hematoma Nonspecific increased echogenicity and thickening of the right lower extremity stump measuring 6.1 cm x 1.4 cm x 5.6 cm in comparison to the left. No loculated fluid collections are noted. | Findings are nonspecific but may be related to edema in the right lower extremity stump. No loculated fluid collection is identified. |
Generate impression based on findings. | 73 year old male with elevated liver enzymes. Evaluate for signs of cirrhosis. LIVER: Measures 13.2 cm in length. Coarse echotexture of the liver is noted and is nonspecific. GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Slight prominence of the common hepatic duct and common bile duct measuring up to 1.3 cm in caliber.PANCREAS: There is a cyst in the the pancreatic head measuring 1.1 cm x 0.8 cm x 0.9 cm. An additional small cyst in the pancreatic body/tail is noted. RIGHT KIDNEY: Measures 10.2 cm in length and contains a cyst at the upper pole measuring 1.1 cm x 0.8 cm x 1.1 cm. Normal echotexture of the kidney with no evidence of hydronephrosis. OTHER: Suggestion of right pleural effusion. Left kidney is poorly visualized measuring 10.8 cm in length. Spleen measures 11.3 cm in length and appears normal. | 1. Coarse echotexture of the liver maybe related to an infiltrative process or hepatic steatosis. 2. Mild prominence of the common bile duct likely related to cholecystectomy. 3. Two pancreatic cysts are noted in the head and body/tail which are nonspecific and can be further evaluated with MRI/MRCP if warranted. 4. Suggestion of right pleural effusion. |
Generate impression based on findings. | 43 year old male with HBV, evaluate for HCC. LIVER: Measuring 14.0 cm with normal echotexture and no focal liver lesion is identified. The portal vein is patent with normal flow.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. Gallbladder wall measures 2 mm in thickness with no pericholecystic fluid. Two polyps are again noted, the largest of which measures up to 5 mm in largest dimension and do not appear significantly changed from prior study. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation is noted.PANCREAS: Normal echogenicity of the pancreas with no pancreatic ductal dilatation.RIGHT KIDNEY: Measures 10.0 cm in length and is normal in echogenicity with no hydronephrosis.OTHER: Normal echogenicity of the spleen measuring 10.0 cm in length. Normal echogenicity of the left kidney measuring 10.6 cm in length with no hydronephrosis. | 1. No focal hepatic lesions. 2. Stable gallbladder polyps. |
Generate impression based on findings. | 32 year old female with cirrhosis, HCV. Screen for HCC. LIVER: Cirrhotic liver morphology with no focal hepatic lesions. Portal vein is patent with appropriate direction of flow. GALLBLADDER, BILIARY TRACT: Cholelithiasis with no evidence of cholecystitis. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation. PANCREAS: The tail is obscured by overlying bowel gas however the remaining pancreatic parenchyma is normal in echogenicity with no pancreatic ductal dilatation. RIGHT KIDNEY: The right kidney measures 11.7 cm in length and contains a 1 cm stone in the right lower pole with no hydronephrosis. OTHER: Enlarged spleen measuring 16.1 cm in length. The left kidney measures 12.0 cm in length and contains a lower pole stone measuring 1.6 cm with no hydronephrosis. | 1. Cirrhotic liver morphology with no focal hepatic lesions. Splenomegaly. 2. Cholelithiasis with no evidence of cholecystitis. 3. Bilateral non-obstructing nephrolithiasis. |
Generate impression based on findings. | 78-year-old female status post fall with left shoulder pain and limited range of motion. Three views of the left shoulder reveal diffuse demineralization of the visualized osseous structures. Osteophytes are present at the left acromioclavicular joint. There is no fracture or malalignment. | No acute fracture or malalignment. |
Generate impression based on findings. | 54 year old female with cirrhosis. HCC screening. Limited exam to patient body habitusLIVER: Diffuse increased echogenicity of the liver which limits sensitivity and evaluation for focal hepatic lesions. Liver is enlarged measuring 21.8 cm in length. GALLBLADDER, BILIARY TRACT: Common bile duct measures 6 mm in caliber. No significant abnormalities noted.PANCREAS: Limited exam due to overlying bowel gas and body habitus however no significant abnormality is noted within these limitations. RIGHT KIDNEY: Measures 12.3 cm in length and is normal in echogenicity with no hydronephrosis. OTHER: No significant abnormality noted. | Limited examination due to patient body habitus and diffuse increased echogenicity of the liver consistent with hepatic steatosis which limits sensitivity and evaluation for focal hepatic lesions. |
Generate impression based on findings. | 65 year old female with likely NASH, hematuria and dysfunction limited exam to body habitus. LIVER: Diffuse increased echogenicity of the liver which limits evaluation for focal hepatic lesions. Liver is enlarged measuring 24.1 cm in length. GALLBLADDER, BILIARY TRACT: Cholelithiasis with no evidence of cholecystitis. No pericholecystic fluid. Sonographic Murphy's sign is negative. Gallbladder wall measures 3 mm in thickness. Common bile duct measures 5 mm in caliber. No intra or extrahepatic biliary ductal dilatation is noted. PANCREAS: Limited evaluation due to body habitus and overlying bowel gas however no significant abnormality noted. SPLEEN: Not visualized. KIDNEYS: The right kidney measures 12.8 cm in length and contains a partially calcified cyst measuring 5.3 cm x 6.0 cm x 4.8 cm. No evidence of hydronephrosis. The left kidney is not visualized. ABDOMINAL AORTA: The aorta is not visualized.INFERIOR VENA CAVA: The IVC is not visualized. OTHER: The bladder is not visualized. | 1. Poor visualization of the liver due to body habitus and hepatic steatosis which limits evaluation for focal hepatic lesions. 2. Cholelithiasis with no evidence of cholecystitis. 3. Right renal partially calcified cyst. No hydronephrosis. The left kidney is not visualized due to the limitations noted above. |
Generate impression based on findings. | 77-year-old female patient status post renal transplant transferred from outside hospital for further management of small bowel obstruction, now with fever and worsening tachycardia/tachypnea. Exam is not sensitive for detecting lesions in the bowel and solid organs due to the lack of oral and intravenous contrast. Given those limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Moderate right pleural effusion and overlying atelectasis appears similar compared prior examination. Left lung base scarring noted.MEDIASTINUM AND HILA: Moderate coronary artery calcifications again noted. No hilar or mediastinal lymphadenopathy.CHEST WALL: Left-sided PICC with tip in the vena cava.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: 9-mm nodule in the medial limb of the left adrenal gland is again noted.KIDNEYS, URETERS: Small atrophic native kidneys. Right renal cyst is unchanged compared to prior. Transplanted kidney in the right iliac fossa appears unchanged compared to prior examination. Specifically, no perinephric fat stranding, fluid collections, or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic changes affect the abdominal aorta and its branches. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Enteric feeding tube tip is in the stomach. Interval improvement in appearance of small bowel obstructive gas pattern with proximal small bowel diameter measuring 3.3 cm. No pneumoperitoneum.BONES, SOFT TISSUES: Multilevel degenerative changes noted in the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Ileus type pattern. No pneumoperitoneum.BONES, SOFT TISSUES: Multilevel degenerative changes affect the thoracolumbar spine.OTHER: Presacral fluid is unchanged. | 1.Improved bowel dilatation with persistent mild ileus pattern.2.Persistent right pleural effusion and overlying atelectasis. |
Generate impression based on findings. | Head: Redemonstrated is a large left parietal intraparenchymal hematoma without significant interval change. There is surrounding edema. There is local mass effect without midline shift or herniation. There is a small area of low attenuation within the left middle frontal gyrus with suggestion of volume loss and may be related to prior infarct. Arterial phase: Calcifications of the cavernous carotid arteries bilaterally with mild narrowing. There is moderate focal stenosis of the intracranial left distal vertebral artery just proximal to the basilar artery. There is a short segment stenosis of the proximal basilar artery. There is no evidence of intracranial aneurysm. No large vessel occlusion. Patent right posterior communicating artery. Left PCOM not well seen.Venous phase: Major venous intracranial structures are patent without evidence of venous sinus thrombosis. Small filling defect in the left transverse sinus likely represents an arachnoid granulation. Right transverse sinus is dominant. | 1. Stable left parietal hematoma with surrounding edema and mild local mass effect. 2. No evidence of venous sinus thrombosis. Multifocal areas of abnormal leptomeningeal enhancement better appreciated on MRI from same day.3. Intracranial atherosclerotic disease with short segment moderate stenosis involving the left distal vertebral and proximal basilar arteries. |
Generate impression based on findings. | 49-year-old female patient with history of recent hysterectomy, now with no bowel movement and diffuse abdominal tenderness. Evaluate for obstruction. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy. Two discrete cystic structures in the pelvis are noted with a thin rim of enhancement.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Fluid and stool in mildly distended colon without bowel wall thickening or transition point. BONES, SOFT TISSUES: Irregular nodule in the right rectus abdominus muscle with surrounding fat stranding in the expected location of the abdominal incision measures approximately 1.7 x 1.6 cm (series 3 image 84).OTHER: No significant abnormality noted | 1.Nodule in the right rectus muscle is concerning for an endometrial rest/endometrioma, however, cannot rule out a desmoid.2.Two discrete cystic structures in the pelvis are favored to represent cystic adnexa given location and morphology. Appearance is unusual for postoperative seromas or collections. Recommend correlation with pelvic ultrasound.3.Mildly distended colon may represent colonic ileus. |
Generate impression based on findings. | Left fourth finger pain and swelling which started about one month ago. Three views of the left hand reveal marked soft tissue swelling about the proximal interphalangeal joint of the left ring finger. No acute fracture or malalignment of the bones of the hand are identified.Three views of the left ring finger again show marked soft tissue swelling about the PIP joint. There is cortical irregularity and loss loss along the medial and dorsal aspect of the middle phalanx. When correlated to prior PET/CT on 10/14/2014, this appears to correlate with an area of increased FDG uptake. | 1. No acute fracture is evident.2. Cortical loss along the left ring finger middle phalanx with increased FDG uptake on a prior PET is concerning for either tumor, given known osseous metastases, or infection. |
Generate impression based on findings. | 6 year old male with head trauma. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns 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 is unremarkable. There is a mild amount of partially imaged swelling and stranding within the right supraorbital subcutaneous soft tissues | 1.No evidence of acute intracranial hemorrhage or skull fracture.2.Small partially imaged hematoma within the right supraorbital subcutaneous soft tissues.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Rule out PE, shortness of breath PULMONARY ARTERIES: The quality of this examination is diagnostic for evaluation of pulmonary embolism. No pulmonary embolus is present. The pulmonary artery is normal in size.LUNGS AND PLEURA: Bilateral pleural effusions, moderate on the right and small on the left. Respiratory motion artifact is present.Severe centrilobular and paraseptal emphysema. Atelectasis and patchy consolidation of the right middle lobe. Central bilateral bronchovascular thickening narrowing the central bronchi without intrinsic filling defect favoring perivascular edema. There is mild thickening of the anterior major fissure with a focus of consolidation of the anterior right upper lobe (11/89). There is a pulmonary nodule in the anterior right lobe (11/127). It is adjacent others foci of consolidation and may be a component of infection. The overall appearance is suggestive of pulmonary edema, possible pneumonia within the right middle lobe. Continued short interval follow-up with repeat CT is recommended to ensure resolution.Basilar groundglass represents a component of mild edema.MEDIASTINUM AND HILA: Calcified, mildly enlarged aortopulmonary, low right paratracheal and bilateral hilar lymph nodes. Left hilar lymphadenopathy attenuates the central upper and lower lobe bronchi (11/67, 69) right hilar adenopathy compresses the central upper lobe bronchus (11/67) with diffuse bronchial wall thickening of all lobes.Cardiomegaly with left ventricular enlargement. No significant pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Metallic fragment posterior to the left kidney and represents a bullet, noted on previous radiograph of 12/2013. | No evidence of pulmonary embolism.Extensive centrilobular and paraseptal emphysema. Moderate right and small left pleural effusions with left ventricular enlargement. Basilar edema. Bilateral prominent hilar lymph nodes with central bronchovascular thickening which may represent edema in the setting of congestive heart failure.Right middle lobe atelectasis and consolidation, nodularity involving the anterior lower lobe. Superimposed pneumonia is a consideration. Close interval follow-up is recommended.PULMONARY EMBOLISM: PE: None Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Evaluate for PE, hypoxia PULMONARY ARTERIES: The quality of this examination is diagnostic for the evaluation of pulmonary embolism. No pulmonary embolus is present. The main pulmonary artery is dilated measuring up to 3.7 cm in diameter which are suggestive of pulmonary arterial hypertension. There are linear calcifications which appear to be endoluminal at the distal right pulmonary artery which may be sequela of prior (chronic) pulmonary emboli which have calcified.LUNGS AND PLEURA: Moderate bilateral pleural effusions associated with compressive atelectasis, worse at the bases.Mild, diffuse bronchial wall thickening which can be seen the presence of bronchitis or asthma.Small centrilobular nodules are predominantly upper lobe distribution are nonspecific, considerations include bronchiolitis or aspiration. New ground glass within the right upper lobe favoring atelectasis. No pneumothorax.MEDIASTINUM AND HILA: Interval removal of the anterior mediastinal drain with residual gas in the tract with postoperative anterior mediastinal hematoma and fluid. Minimal pericardial effusion. The heart size is normal.There is high density focus projecting over the central left subclavian vein which may represent a catheter fragment, less likely postoperative conduit (80668/50). The possibility of other intravascular foreign body cannot be excluded. This appeared in the postoperative state, subsequent to 2/25/15.CHEST WALL: Low-density filling defect within the left brachiocephalic vein may represent a fibrin sheath from prior catheter.The sternum is well approximated by hardware with gas at the subxiphoid subcutaneous tissue at previous site of drainage catheter.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism.Postoperative basilar atelectasis with small pleural effusions. Small, circumferential pericardial effusion.Centrilobular nodules with foci of ground glass are predominantly upper zone distribution may represent bronchiolitis or aspiration.Linear fragment projecting over the central left subclavian vein favors that of a catheter fragment, postoperative conduit or potential other foreign body.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Clinical question: Evaluate for metastatic disease. Signs and symptoms: Waxing and waning mental status. Nonenhanced head CT:There is mild ectopia of cerebellar tonsils with crowding at the level of foramen magnum. No prior exams for comparison.There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokesthere is a single tiny focus of low-attenuation in the subcortical white matter of left frontal lobe. Possibility of a small focus of small vessel ischemic stroke of indeterminate age should be considered.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.No finding to suggest metastatic disease on this nonenhanced study.3.Tiny focus of low-attenuation in the left frontal subcortical white matter is a nonspecific finding. 4.If clinical concern for stroke is high recommend follow-up with an MRI exam. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and grade I right-sided differentiation.Moderate bilateral intracranial vertebral and cavernous carotid vascular calcification are noted.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Numbness, evaluate for stroke. Signs and symptoms: As above. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive however for early detection of acute nonhemorrhagic ischemic strokes.Prominence cerebral cortical sulci and more noticeably of the cerebellar and vermian folia for his stated age of 64 concerning for underlying parenchymal volume loss.Patchy foci of periventricular and subcortical in attenuation suggestive of age indeterminate small vessel ischemic strokes of mild degree.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes.3.Suspected parenchymal volume loss. |
Generate impression based on findings. | Clinical question: No CVA. Signs and symptoms: Left-sided facial droop. Evaluate for CVA. Nonenhanced head CT:There is no detectable acute intracranial process. CT however he is being sensitive for early detection of an acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: AMS. Nonenhanced head CT:There is no detectable acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are moderate to advanced degree of a ventricular and subcortical attenuation of white matter highly suggestive of age indeterminate small vessel ischemic strokes. If clinical concern for acute stroke is high recommend follow-up with an MRI exam.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces.Unremarkable calvarium and orbits.Chronic sinusitis more prominent in the right maxillary sinus. | 1.No acute intracranial process.2.Moderate to advanced age indeterminate small vessel ischemic strokes.3.Sinusitis. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Fall. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF is space as time gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Rule out stroke. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes. There is mild prominence of cerebellar and vermian folia for patient's stated age of 44. Recommend correlation with history and risk factors.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Mass? ICH? Signs and symptoms:Falls, AMS, HIV. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is significant prominence of cortical sulci and ventricular system for patient's stated age of 67 highly suggestive of parenchymal volume loss.There is no detectable parenchymal edema, hemorrhage, mass, mass effect or midline shift.There are no prior exams for comparison.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No detectable acute intracranial process.2.Very prominent cerebral cortical sulci and ventricular system for patient's stated age of 67 concerning for parenchymal volume loss. |
Generate impression based on findings. | Clinical question: Rule out SBH cranial fracture. Signs and symptoms: Head trauma in altercation, multiple hematomas. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial or calvarial findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation.Unremarkable calvarium.There is a focus of soft tissue thickening with subtle increased density in the right supra-orbital soft tissues consistent with small focus of soft tissue hemorrhage and edema without underlying bony abnormality. Unremarkable images through the orbits.Unremarkable paranasal sinuses, mastoid air cells and middle ear cavities. | 1.No detectable acute posttraumatic intracranial or calvarial findings.2.Small right supraorbital soft tissue hemorrhage and edema. |
Generate impression based on findings. | Clinical question: Evaluate for hydrocephalus. Signs and symptoms: Altered mental status, patient with EVD. Nonenhanced head CT:The examination is severely compromised due to motion artifact. This precludes assessment for subtle parenchymal findings.Compared to prior exam there is evidence of interval decreased size of the supratentorial ventricular system. The supratentorial ventricular system however still remain prominent. A right paramedian frontal approach ventricular catheter with the tip in the right frontal horn the lateral ventricle remains similar to prior exam.There is also interval decrease in the amount of intraventricular air since prior study.Diffuse periventricular low-attenuation white matter demonstrate no convincing evidence of interval change. | 1.Decreased size of supratentorial ventricular system and with a stable right frontal approach ventricular catheter.2.Supratentorial ventricles however remain still prominent.3.Stable extensive periventricular and subcortical low-attenuation white matter similar to prior study. |
Generate impression based on findings. | There is an expansile periodontal cyst arising between the splayed roots of ADA tooth number 9 and number 10 that measures up to 24 mm, without evidence of associated dental caries. There is hyperenhancement of the cyst wall lining and a focal dehiscence of the overlying buccal maxillary alveolus. There is a 5 mm thick subperiosteal abscess originating at the site of cortical disruption that extends superiorly along the anterior left maxillary sinus wall and into the floor of the left post-septal orbit, where it measures up to 3 mm in thickness. In addition, there is a subperiosteal fluid collection within the superior and posterior portions of the left maxillary sinus that measures up to 15 mm. There is also extensive mucosal thickening and secretions within left maxillary sinus and a retention cyst in the right maxillary sinus. There is mild thinning and demineralization of part of the left orbital floor. There is mild left intraconal stranding and swelling of the inferior rectus and oblique muscles with mild left proptosis. The left orbital apex is intact and the right orbit appears to be unremarkable, with opacification of the bilateral superior ophthalmic veins. The pterygopalatine fossae appear to be intact bilaterally. However, there is extensive stranding within the subcutaneous tissues of the left face. There are mildly prominent reactive left suprahyoid lymph nodes. The imaged intracranial structures appear to be grossly unremarkable. | Infected cystic odontogenic lesion in the left maxillary alveolus associated with left premaxillary subperiosteal abscess with extension into the inferior left orbit and left maxillary sinus with concomitant sinusitis, orbital cellulitis and myositis, and facial cellulitis.Discussed with Dr. Baroody at 8:20 AM on 3/10/15. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 74 years, Female. Reason: 74F with HF, MR, CAD s/p CABG, MVR. Confirm position of Dobbhoff tube There is a Dobbhoff tube with its tip projecting over the inferior genu of the duodenum. Generalized paucity bowel gas. Epicardial pacer leads are in place. The pelvis is excluded from the field of view. One left-sided and two right-sided chest tubes are in place, unchanged from the prior chest radiograph. Partially imaged Swan-Ganz catheter. Sternotomy hardware and staple line is also partially imaged. Cardiomegaly and retrocardiac opacity, likely atelectasis. | Dobbhoff tube with its tip projecting over the genu of the duodenum. |
Generate impression based on findings. | Clinical question: 60-year-old male with history of metastatic lung cancer, recent C2 -- C5 laminectomy, CVA neck pain, now with alteration of mental status. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable accurate intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Examination demonstrates no findings to suggest presence of a metastatic disease on this non-enhanced exam.Mild periventricular and subcortical low attenuation white matter consistent with previously known small vessel ischemic strokes of indeterminate age.The cerebral cortex, cortical sulci, ventricular system and the CSF spaces are otherwise unremarkable.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes but2.No evidence of a metastatic lesion on this non-enhanced study.3.Findings of mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 75 years, Male. Reason: NG advanced History: NG advanced NG tube has been repositioned, now looped within the mid to proximal thoracic esophagus with the tip projecting out of the field-of-view superiorly. Cardiomegaly unchanged. Pacemaker leads in appropriate position. The pelvis is excluded from the field of view. | NG tube looped in the thoracic esophagus with the tip projecting out of the field of view superiorly.These findings were relayed to Dr. Ali Mansour via telephone at 07:45 on 3/10/2015. |
Generate impression based on findings. | 81-year-old male patient with decreased output from JP drain. Evaluate for abdominal fluid collection. Exam is not sensitive for detecting lesions in the bowel and solid organs due to the lack of oral and intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: Bilateral pleural effusions with overlying atelectasis, right greater than left, mildly improved compared to prior.LIVER, BILIARY TRACT: Improving mild periportal edema and for resolution of post procedural pneumobilia. There is a fluid collection near the measures 5.2 x 5.1 cm (series 3 image 44) that is suboptimally evaluated due to lack of IV contrast.A surgical drain enters the abdomen and courses along the inferior margin of the liver, unchanged compared to prior.SPLEEN: Subcapsular splenic fluid collection is not significantly changed from prior examination.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large left renal simple cyst is again noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications are again noted throughout the aorta and its branches.BOWEL, MESENTERY: Gastrostomy tube noted. Again seen are postsurgical changes from hepaticojejunostomy. Improving ileus. Small amount of fluid is again noted throughout the mesentery.BONES, SOFT TISSUES: Diffuse anasarca.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Mildly enlarged prostate.BLADDER: Urinary bladder catheter with iatrogenic air.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Improving ileus.BONES, SOFT TISSUES: Diffuse anasarca noted.OTHER: Fluid collection is again noted in the pelvis measuring 2.5 x 4.8 cm (series 3 image 124), previously 2.8 x 5.8 cm. | 1.Small amount of unorganized fluid in the gallbladder fossa may represent an immature fluid collection. However, evaluation is limited by the lack of intravenous contrast.2.Interval decrease in size of organized fluid collection the pelvis.3.No significant change in splenic subcapsular fluid collection.4.Improving ileus. |
Generate impression based on findings. | 75 years, Male. Reason: NG History: NG There is a nasogastric tube with its tip projecting over the body of the stomach and with its side-port at the level of the GE junction. There is a nonobstructive bowel gas pattern. The pelvis is excluded from the field of view. Cardiomegaly unchanged. AICD pacemaker leads in appropriate position. | There is a nasogastric tube with its tip projecting over the body of the stomach and with its side-port at the level of the GE junction. |
Generate impression based on findings. | 70 years, Male. Reason: GI bleed History: GI bleed The NG tube has been removed. Tubing looped over the midline chest is of uncertain significance, and clinical correlation is recommended. Bibasilar pulmonary opacities persist. There is a generalized paucity of bowel gas. Right femoral central venous catheter tip projects over the iliac bifurcation. Prior vertebroplasty evident at L2. The pelvis is excluded from the field of view. | The NG tube has been removed. Tubing coiled over the midline chest is of uncertain significance and clinical correlation is recommended. |
Generate impression based on findings. | Reason: s/p elbow dislocation VIEWS: Left elbow AP and lateral (2 views) 3/9/2015 at 1716 hrs A splint limits fine osseous detail.Interval reduction of a left elbow fracture, now in near anatomic alignment. | Reduction and splinting of left elbow fracture. |
Generate impression based on findings. | Abdominal distentionVIEW: Chest and abdomen AP (two views) 3/10/15 at 545 hours. Interval ET tube removal. NG tube terminates at the stomach. UVC tip is at the right atrium. UAC terminates at T7. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax.Disorganized, slightly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval removal of ET tube , NG tube placement and repositioning of UVC as described.Disorganized, slightly distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | 70 years, Male. Reason: placement of MN tube History: massive variceal bleed There is a nasogastric tube with its tip projecting over the gastric antrum. Patchy bibasilar air space opacities are present. There are dense calcifications of the splenic artery. Vertebroplasty evident at L2. Right femoral central venous catheter tip projecting over the bifurcation of the iliac veins. | NG tube with tip projecting over the gastric antrum. |
Generate impression based on findings. | 15 years old, Male, History: R knee pain, concern for fractureVIEWS: Right Tibia-fibula AP, lateral; right knee AP, oblique and lateral (5 views) 3/9/15 Right Tibia-fibula: No fracture or malalignment. Right Knee: A lateral notch sign is present which can be seen the setting of a ligamentous injury. Knee joint effusion. The extensor mechanism appears intact. | Joint effusion and lateral notch sign which can be seen in the setting of a ligamentous injury. MRI follow-up is recommended to further evaluate. |
Generate impression based on findings. | Female 6 months old Reason: Interval changes in intubated patient, pre-extubation film History: 6 m/o female with h/o HIE, stridor, g-tube dependence intubated with aspiration PNAVIEW: Chest AP (one view) 3/10/15 at 514 hours. ET tube terminates above the thoracic inlet. Gastrostomy tube noted. Cardiac silhouette size is normal. Interval worsening in left retrocardiac opacity, likely atelectasis. No effusions or pneumothorax. | Misplaced ET tube.Worsening pain left retrocardiac atelectasis. |
Generate impression based on findings. | 86 years, Female. Reason: evaluate for ileus, signs of intra-abdominal infection History: fever There is a nonobstructive bowel gas pattern. The bones appear demineralized. There are surgical clips projecting over the midline upper abdomen. There are degenerative changes of the lower lumbar spine and laminectomies at L4 and L5. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 18 years old Reason: interval changes in pleural effusions History: 18 y/o male with MELAS trach and vent dependent here with complicated PNA on increased vent settingsVIEW: Chest AP (one view) 3/10/15 547 hours. Tracheostomy skeletal deformities are again noted. Cardiac silhouette size is normal. Interval worsening in right-sided pleural effusion. Persistent bibasilar patchy opacities like atelectasis. No pneumothorax. | Interval worsening in right sided pleural effusion with persistent multifocal patchy opacities. |
Generate impression based on findings. | 62 years, Male. Reason: new DHT History: new DHT There is a Dobbhoff tube with its tip projecting over the prepyloric stomach. Artifact from a cooling blanket is present. There are sternotomy fixation wires in place. Three chest tubes are in place. There is an endotracheal tube with its tip just above the carina. A Swan-Ganz catheter is in place with its tip projecting over the main pulmonary artery. Left upper extremity PICC line tip terminates just distal to the confluence of the innominate vein and SVC. There is a right pleural effusion and retrocardiac opacity likely representing atelectasis. Vertebroplasties evident at multiple levels. | Dobbhoff tube with tip projecting over the prepyloric stomach. |
Generate impression based on findings. | 6 years old, Female,History: fever, cough, concern for pneumoniaVIEWS: Chest AP/lateral (two views) 3/9/15 Aortic arch, cardiac apex and the stomach are left-sided. The trachea appears patent. The cardiothymic silhouette is normal. Mild peribronchial thickening is compatible with reactive airway disease/bronchiolitis. No focal airspace opacities. | Mild reactive airway disease/bronchiolitis pattern. |
Generate impression based on findings. | 30 year-old female patient with pain and induration. Evaluate for wound infection. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction.BONES, SOFT TISSUES: There is a large irregularly shaped subcutaneous collection within the lower anterior abdominal wall that measures 14.5 x 3.7 x 2.5 (width x CC x AP) with internal foci of air.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Appropriate dilatation of the endometrial cavity.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: There is a moderate amount of free fluid in the pelvis. | 1.Subcutaneous fluid collection in the lower anterior abdominal wall may represent a postoperative hematoma, however, cannot rule out an infected fluid collection.2.Expected postoperative appearance of the uterus. |
Generate impression based on findings. | 5 years old, Male, History: tachypnea, crackles, feverVIEWS: Chest AP/lateral (two views) 3/9/15 The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. Mild linear bibasilar opacities likely compatible with subsegmental atelectasis. Peribronchial thickening is present compatible with reactive airways disease/bronchiolitis. There is depression of the diaphragms also consistent with reactive airways disease/bronchiolitis. | Reactive airway disease/bronchiolitis pattern. |
Generate impression based on findings. | 11 year old male. Felt pop today playing soccer, r/o fx History: tendernessVIEWS: Left knee AP, lateral, and oblique (3 views) 3/9/2015, 1729 Joint effusion with pseudothickening of the quadriceps tendon. No soft tissue swelling.The osseous structures appear normal. | Joint effusion with no fracture. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (2/20/15), ultrasound images of left breast (2/20/15), images from ultrasound guided biopsy of the left breast and post procedural left mammographic images (2/24/15) performed at Lake Forest Hospital. For comparison, digital mammographic images (2/14/14, 2/8/13, 2/3/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (2/20/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There is a stable post-surgical scar at upper outer quadrant in the right breast, from a surgery for DCIS in 2007.There is a new mass, measuring 8 mm, at upper outer quadrant in the left breast. The mass persists with spot compression.No suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF LEFT BREAST (2/20/15):A lobulated mass with angular margins measuring 10 x 6 mm is visualized at one o'clock position, 2-cm from nipple in the left breast. This lesion corresponds to the mammographic findings. A normal-appearing lymph node is visualized in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF THE LEFT BREAST AND POST PROCEDURAL LEFT MAMMOGRAPHIC IMAGES (2/24/15):Ultrasound-guided needle biopsy of the mass at one o'clock position in the left breast is performed with appropriate needle placement. Post procedural mammographic images show a marker clip (coil) within the target mass at upper outer quadrant in the left breast.Per outside radiology report, the pathology result is malignant; infiltrating ductal carcinoma, grade 3. | Biopsy proven invasive ductal carcinoma in the left breast at one o'clock position.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 68-year-old male status post fall down stairs x 3 days ago presenting with left clavicular pain. Single view of the left clavicle reveals a distal comminuted fracture, with approximately one shaft width inferior displacement of the distal fracture fragments. The AC joint appears intact. There is minimal tenting of the skin overlying the proximal fracture fragment, as well is diffuse soft tissue swelling. | Comminuted fracture of the distal left clavicle. |
Generate impression based on findings. | 14 year old female with hx HgbSS, CP, now with increasing secretions and crackles on exam, desats to high 90sVIEW: Chest AP (one view) 3/9/2015, 1817 Right chest port, tip at the cavoatrial junction. Gastrostomy tube in place. Cholecystectomy clips.The cardiothymic silhouette is normal.Streaky basilar opacities are increased from the prior exam.Leftward thoracolumbar curvature | Streaky basilar opacities compatible with atelectasis. |
Generate impression based on findings. | 5 years old, Male, Reason: evaluate for abscess or other infection History: abdominal pain and distention, fever, emesis, anorexia ABDOMEN:LUNG BASES: Bibasilar atelectasis present. No evidence of pleural effusion.LIVER, BILIARY TRACT: There are no focal hepatic lesions identified. The portal vessels appear patent. There is no significant intra-or extrahepatic biliary dilatation. There is free air noted on falciform ligament.SPLEEN: Spleen is normal.PANCREAS: Pancreas is normal.ADRENAL GLANDS: Glands are normal.KIDNEYS, URETERS: The kidneys are unchanged in size compared to the prior study measuring up to 10 cm bilaterally. There is right renal scarring. The nephrograms appear slightly delayed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nasogastric tube is in place with tip in stomach. Postsurgical changes from an appendectomy are noted in the right lower quadrant. There dilated loops of opacified small bowel measuring up to 2.8 cm most notably in the left lower quadrant. There is unopacified bowel distally which is not collapsed, air filled, with feces noted in the ascending colon. There is an ill-defined heterogeneous collection seen in the mid abdomen measuring 4.2 x 6.1 cm. This may represent small bowel with adjacent phlegmonous changes, although it is difficult to delineate due to technique. It is conceivable that this may represent a transition point of an early or partial obstruction. There is pneumoperitoneum present with air adjacent to the falciform ligament.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a moderate amount of free fluid within the abdomen and pelvis which measures simple fluid density is related to recent instillation of fluid through the peritoneal dialysis catheter.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is collapsed with a Foley catheter in place. There is air in noted in the most superior aspect of the anterior bladder.LYMPH NODES: There is a focus of soft tissue density in the right pelvic sidewall measuring 3.3 x 1.6 cm (series 80264, image 90). This collection was present on the prior exam previously measuring 3.4 x 1.8 cm and measuring slightly higher density previously. This may represent a resolving hematoma, loculated fluid collection, or necrotic lymph node.BOWEL, MESENTERY: A dialysis catheter is coiled into the pelvis. Postsurgical changes from an appendectomy are noted in the right lower quadrant. There dilated loops of opacified small bowel measuring up to 2.8 cm most notably in the left lower quadrant. There is unopacified bowel distally which is not collapsed, air filled in with feces noted in the ascending colon. There is an ill-defined heterogeneous collection seen in the mid abdomen measuring 4.2 x 6.1 cm. This may represent small bowel with adjacent phlegmonous changes, although it is difficult to delineate due to technique. It is conceivable that this may represent a transition point of an early or partial obstruction.BONES, SOFT TISSUES: The osseous structures are normal.OTHER: Peritoneal dialysis catheter is noted in the pelvis. | 1.Dilated loops of opacified small bowel likely representing an early or partial obstruction. Interval follow-up abdominal radiograph is recommended to further evaluate.2.Ill-defined heterogeneous collection seen in the mid abdomen may represent small bowel with adjacent phlegmonous changes. It is conceivable that this represents a transition point of the early or partial obstruction.3.Soft tissue density along the right pelvic sidewall may represent a hematoma, loculated fluid collection, or necrotic lymph node.4.Pneumoperitoneum and ascites is likely related to recent fluid instillation through peritoneal dialysis catheter. |
Generate impression based on findings. | Right ankle fracture. Assess ankle fracture. There is an oblique fracture through the posterior distal tibia with approximately 6 mm of superior displacement and slight dorsal angulation of the distal fracture fragment. The fracture line extends into the tibiotalar joint. There is lateral and posterior subluxation of the talus relative to the tibia. There is a comminuted fracture of the medial malleolus. There is a predominantly oblique, comminuted fracture of the distal fibula with approximately 4 mm of dorsal angulation of the distal fracture fragment. There is extensive subcutaneous stranding in the soft tissues of the ankle compatible inflammation and/or edema. There are foci of air within the medial anterior ankle joint; correlate for open wound or recent instrumentation. | 1. Trimalleolar fracture as described above with intra-articular extension of the posterior tibial fracture. 2. Lateral and posterior subluxation of the talus relative to the tibia.3. Foci of air within the anterior medial ankle joint; correlate for an open wound or recent instrumentation. |
Generate impression based on findings. | 57-year-old female with history of multiple falls, most recently one day ago, with generalized pain in the hips, upper legs, knees. Single view of the pelvis reveals bilateral severe osteoarthritis, right greater than left, not significantly changed compared to prior exam. Subtle cortical irregularity along the right greater trochanter correlates with known minimally displaced comminuted fracture.Two views of the right hip demonstrate severe osteoarthritis, including bone-on-bone narrowing, extensive subchondral cyst formation, subchondral sclerosis, and osteophyte formation, as well as flattening of the superior aspect of the femoral head. Similar appearance of the aforementioned minimally displaced right greater trochanteric fracture (described on CT of the hip dated 1/6/15).Two views of the left hip demonstrate aforementioned severe osteoarthritis, including bone-on-bone joint space narrowing, subchondral cyst formation and subchondral sclerosis as well as osteophyte formation. No evidence of fracture or malalignment.Two views of the right femur demonstrates the aforementioned severe osteo- arthritis of the right hip. It is difficult to visualize the aforementioned greater trochanteric comminuted fracture. No other right femoral fracture or evidence of malalignment.Two views of the left femur demonstrate the aforementioned severe osteoarthritis of the left hip. There is no evidence of fracture or malalignment.Four nonweightbearing views of the right knee reveal no joint effusions, fractures, or malalignment. There is mild osteoarthritic changes.Four nonweightbearing views of the left knee reveal no joint effusions, fractures, or malalignment. There is mild osteoarthritic changes. | Severe osteoarthritis of the hips, right greater than left. The known comminuted, minimally displaced greater trochanteric fracture on the right is difficult to visualize on this exam, but appears unchanged. No evidence of acute fracture or malalignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A benign intramammary lymph node is again seen in the right upper outer quadrant. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female; 73 years old. Reason: obstruction? History: vomiting/diarrhea ABDOMEN:LUNG BASES: Minimal bibasilar dependent subsegmental atelectasis and/or scarring.LIVER, BILIARY TRACT: No focal liver lesions. Status post cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland round, well-circumscribed mass containing internal macroscopic fat and coarse calcification measuring 3.1 x 2.2 cm, unchanged and most compatible with a benign myelolipoma.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: Severe atherosclerotic disease of the iliac arteries redemonstrated. There is mild pelvic descent involving the bladder, vagina, and rectum. | 1. No evidence of bowel obstruction or other acute abdominopelvic abnormality.2. Stable left adrenal gland mass, most compatible with a benign myelolipoma. |
Generate impression based on findings. | Call back from screening mammogram for an asymmetry in the right breast. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. With spot compression, a small asymmetry at retroareolar region disperses into normal breast tissue.Focused ultrasound for a right retroareolar region did not detect any abnormalities. | 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 recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Medial knee pain, patient slipped on ice on 3/8/2015 patient. Unable to bear weight on knee. Question of right knee injury. Four views of the right knee reveals soft tissue swelling of the medial aspect of the knee. No acute fracture or malalignment is identified. There is no joint effusion. | Soft tissue swelling without acute fracture. |
Generate impression based on findings. | Pain in right big toe and fourth digit after fall approximately 1 month ago. Right foot swelling. Three views right foot reveal no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | 54 year-old female with dyspnea/left quadrant pain/right CVA tenderness. Rule out infection/obstruction/metastases. CHEST:LUNGS AND PLEURA: Right basilar consolidation has increased. Right pleural thickening and nodularity is redemonstrated. Large loculated right pleural effusion with right chest tube unchanged. Associated compressive atelectasis. Right sided septal thickening is again seen. New trace left pleural effusion is also noted.MEDIASTINUM AND HILA: Small pericardial effusion and pericardial nodularity is redemonstrated. Right chest wall port catheter tip at the cavoatrial junction. Stable increased number of small, nonenlarged mediastinal lymph nodes.CHEST WALL: Innumerable subcutaneous and muscular soft tissue nodules in the chest and abdominal walls including in the breasts and axillae are grossly unchanged in size and number. A reference right anterior chest wall lesion measures 2.8 x 1.9 cm (image 50, series 80352), from previously 2.6 x 1.9 cm. New lytic lesions of T11 and T12. Sclerotic lesions in T1 and T9 unchanged. Small lytic lesion in T9 also unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic metastases grossly unchanged in size or number. SPLEEN: Multiple cystic splenic lesions measuring up to 1.8 cm are not significantly changed.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal lesion suspicious for metastasis, not significantly changed.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube again noted. Increased ascites and mesenteric edema. BONES, SOFT TISSUES: Increased size and definition of large L4 lytic lesion.OTHER: No significant abnormality noted. | 1.New or increased right lower lobe consolidation, compatible with infection.2.Mild right-sided pulmonary edema.3.Large loculated right pleural effusion unchanged.4.Redemonstrated right pleural thickening and diffuse metastatic disease, with new osteolytic lesions of T11 and T12.5.Increased abdominal ascites and mesenteric edema. |
Generate impression based on findings. | Evaluate for trauma, concern for elder abuse. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is global parenchymal volume loss. No hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent mild chronic small vessel ischemic changes.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. Evidence of bilateral lens replacement. | No evidence of intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | 83 years, Male. Reason: abdominal distention History: abdominal distension There is a Dobbhoff tube with its tip projecting over the body of the stomach. Numerous gas filled loops of small bowel consistent with ileus. Partially imaged right central venous catheter tip projecting over the cavoatrial junction. The rectal catheter has been removed. A small hyperdense ovoid structure in the distribution of the urinary bladder likely represents a bladder stone. | Mild diffuse ileus type gas pattern. |
Generate impression based on findings. | 84 years, Female. Reason: evolution of infx History: sirs Gastrostomy tube in place, position unchanged. There is a nonobstructive bowel gas pattern. Amorphous round calcified mass in the midline pelvis likely represents a uterine fibroid. There are dense calcifications of the abdominal aorta and its branches. Incompletely imaged bibasilar opacities, new/increased on the right. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Status post craniotomy, headache, status post right acoustic neuroma resection There are immediate postsurgical changes of right sided retrosigmoid craniotomy for resection of tumor involving the right cerebellopontine angle. There is moderate degree of pneumocephalus throughout the subarachnoid spaces. No large intracranial hemorrhage. There is posterior and leftward displacement of the brainstem which was present previously. There is no hydrocephalus.There are postoperative findings related to multiple prior craniotomies. Evaluation of residual tumor can be better assessed with MRI. There appears to be residual tumor within the right internal auditory canal. Again seen, and better evaluated on MRI is the known medulla ependymoma, planum sphenoidale meningioma, vestibular schwannomas, left orbital schwannoma, and scalp lesions. There is partial opacification of the paranasal sinuses with fluid levels. | 1. Postoperative changes related to right retrosigmoid craniotomy and resection of cerebellopontine angle mass. Residual lesion is suspected within the right internal auditory canal. MRI can better assess for residual tumor. There is moderate degree of pneumocephalus. There is leftward and posterior displacement of the brainstem which was present previously2. Evidence of multiple prior craniotomies and multiple intracranial masses which are better characterized on recent MRI from 3/9/2015. |
Generate impression based on findings. | 34 year old male with right testicular pain and swelling. Evaluate for torsion. RIGHT TESTIS: 4.0-cm x 2.6 cm x 2.5 cm. LEFT TESTIS: 3.8 cm x 2.4 cm x 1.8 cm.RIGHT EPIDIDYMIS: 4.8 cm x 1.3 cm x 2.0 cmLEFT EPIDIDYMIS: 1.1 cm x 1.0 cm x 0.7 cmOTHER: Asymmetric enlargement of the right epididymis which is heterogeneous in appearance and hyperemic. There is associated small right hydrocele. Diffuse bilateral testicular microlithiasis. | 1. Findings compatible with acute right-sided epididymitis with no abscess. 2. Diffuse bilateral testicular microlithiasis with no mass identified. Continued surveillance by physical examination is recommended. |
Generate impression based on findings. | Sudden pain to right shoulder that began 8 days ago. No injury. Three views of the right shoulder reveal no acute fracture or malalignment. There is moderate osteophyte formation at the acromioclavicular joint. There is a little irregularity of the humeral head which is degenerative. | Moderate osteoarthritis of the acromioclavicular joint. |
Generate impression based on findings. | Female; 36 years old. Reason: rule out mass vs hernia History: RLQ pain , recent adrenal resection on R side Lack of intravenous contrast limits the sensitivity for solid organ pathology.ABDOMEN:LUNG BASES: Minimal bibasilar dependent subsegmental atelectasis.LIVER, BILIARY TRACT: 1.9 x 1.2 cm hypoattenuating lesion at the periphery of the anterior right hepatic lobe (series 3/40), most likely due to biopsy site of biliary adenoma seen during recent surgery. Cholelithiasis. No biliary ductal dilation.SPLEEN: Small cyst in the spleen (series 3/40), stable since prior MRI.PANCREAS: No significant abnormality notedADRENAL GLANDS: Status post completion right adrenalectomy.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous fatty stranding in the anterior right upper quadrant, most likely related to Chevron incision from recent surgery; cellulitis cannot be excluded. No evidence of abscess. Small fat containing umbilical hernia.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Right ovarian round hypoattenuating lesion measuring up to 2.8-cm (19 Hounsfield units), most likely a physiologic or hemorrhagic cyst (series 3/134).BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sacral Tarlov cysts.OTHER: No significant abnormality noted | 1. 2.8-cm hypoattenuating right ovarian lesion, most likely a physiologic or hemorrhagic cyst.2. Postsurgical changes in the right anterior abdominal wall. Abdominal wall cellulitis cannot be excluded. |
Generate impression based on findings. | 12 yo M with CP, sz d/o, asthma intubated for respiratory failure. Evaluate ETT.VIEW: Chest AP (one view) 3/9/2015,1958 ET tube terminates at the level of the thoracic inlet. Right PICC, tip in the SVC. Cholecystectomy clips.Severe thoracolumbar dextrorotoscoliosis.Cardiac silhouette is normal in size.Persistent left upper lobe and retrocardiac opacities. No pleural effusions. | ET tube tip at the level of the thoracic inlet. Unchanged multifocal pulmonary opacities. |
Generate impression based on findings. | 47 year old female status post left mastectomy in 2007 for DCIS, presents today for routine follow up. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A retroglandular saline implant is present.Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. | 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. | 72 year old female with right second toe pain and ulceration. There is bony destruction of the proximal and mid phalanx of the second toe at the proximal interphalangeal joint, with associated soft tissue swelling, as well as lucency of the distal aspect of the mid phalanx; highly suspicious for osteomyelitis. | Findings are highly suspicious for osteomyelitis of the second toe. |
Generate impression based on findings. | Reason: 68 yo w/ NSCLC History: f/u baseline CHEST:LUNGS AND PLEURA: Left upper lobe mass with endobronchial spread (series 5, image 91) now measures 4.9 x 4.0 cm, previously 4.3 x 2.4 cm in its largest dimension. Previously noted peripherally located necrotic left upper lobe mass is no longer visualized. This peripheral mass may have been a post-obstructive infection. No significant pleural involvement is noted as was present on the prior exam. Satellite nodules and irregular septal thickening extending towards the pleura likely reflect lymphangitic involvement. A right upper lobe nodule (series 5, image 128) appears larger and likely represents a metastatic focus. There is increased there are additional new, numerous nodules scattered throughout the right and left lungs. Irregular septal thickening, most prominent in the right upper lobe with centrilobular nodules likely represent lymphangitic spread. Moderate upper lobe predominant centrilobular emphysema is again noted. MEDIASTINUM AND HILA: Extensive necrotic mediastinal and right hilar lymphadenopathy has increased since the prior exam.Reference right hilar lymph node is increased in size measuring 3.4 cm, previously 1.8 cm (series 3, image 47). There is new endobronchial invasion into the right mainstem bronchus (series 5, image 132) and external compression of the bronchus intermedius (series 5, image 154). The superior and central right pulmonary artery is attenuated from external compression of lymphadenopathy, new since the prior exam. The pulmonary veins appear widely patent without apparent invasion.Reference right paratracheal lymph node is unchanged measuring 2.1 cm (series 3, image 39), previously 2.1 cm.The pulmonary artery is enlarged measuring 3.5 cm suggestive of pulmonary artery hypertension. The aorta measures 3.4 cm.CHEST WALL: Small cardiophrenic lymph nodes, not significantly changed since the prior exam are noted. Slightly sclerotic lesion in the L2 vertebral body (series 80219, image 58) may represent a metastatic lesion.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic metastatic lesions appearing increased in size and number when compared to the prior exam. Soft tissue studding is noted within the gallbladder is nonspecific. Cholelithiasis is noted, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left adrenal soft tissue density nodule is suspicious for metastasis, unchanged. Right adrenal gland nodularity is unchanged as well.KIDNEYS, URETERS: Subcentimeter hypoattenuating lesions in the left kidney likely represent benign cysts.PANCREAS: Pancreatic duct is enlarged measuring up to 6 mm and can be traced to the common bile duct. A subtle hyperdensity at the ampulla, possibly a stone, is noted, although this is equivocal.RETROPERITONEUM, LYMPH NODES: Enlarged retroperitoneal lymph nodes measuring up to 10 mm (series 3, image 119). Enlarged periportal lymph nodes are unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild diffuse subcutaneous edema. OTHER: No significant abnormality noted. | 1.Interval increase in left upper lobe mass with evidence of lymphangitic spread. Interval increase in mediastinal and hilar lymphadenopathy with endobronchial spread and mass effect on the right airway and pulmonary arteries as described above.2.Interval increase in size and number of multiple pulmonary nodules.3.Interval increase in size and number of multiple hepatic metastases.4.Left adrenal nodule and right adrenal nodularity is suspicious for metastasis.5.New L2 vertebral body lesion compatible with metastasis. |
Generate impression based on findings. | 12 yo M with CP, sz d/o, GT-dep, asthma with abdominal distension. Evaluate for obstruction. VIEW: Abdomen AP (one view) 3/9/2015 at 2000 hrs Gastrostomy tube in place. Surgical clips in the right abdomen.Nonobstructive bowel gas pattern.Thoracolumbar dextrorotoscoliosis. Partial dislocation of the left hip.Left pulmonary opacities partially visualized. | No evidence of obstruction. |
Generate impression based on findings. | 29-year-old male with pain in the left wrist after "deflecting a large object." Three views of the left wrist do not reveal any evidence of acute fracture or malalignment. The joint spaces are preserved. There is no significant soft tissue swelling.Three views of the left hand reveal no acute abnormality. There is no fracture or malalignment. | No acute fracture or malalignment. |
Generate impression based on findings. | Fall. 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. | No evidence of acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | 67-year-old female with history of thyroid cancer. Evaluate for nodules and abnormal nodes. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: As above. No residual or recurrent thyroid tissue is noted. LEFT LOBE: As above. No residual or recurrent thyroid tissue is noted. ISTHMUS: As above. No residual or recurrent thyroid tissue is noted. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 4 lymph node measures 0.4 cm x 0.6 cm x 0.3 cm which is benign in appearance. Right neck level 3 lymph node measures 0.3 cm x 0.2 cm x 0.6 cm which is benign in appearance. Left neck level 3 lymph node measures 0.2 cm x 0.4 cm x 0.7 cm and is benign in appearance. Left neck level 4 lymph node measures 0.3 cm x 0.5 cm x 1.2 cm also benign in appearance. OTHER: No significant abnormality noted. | No residual or recurrent thyroid disease is present. No lymphadenopathy. |
Generate impression based on findings. | 76-year-old female with generalized left hip pain after fall on 3/6/15. Three views of the pelvis reveal degeneration and sclerosis of the right sacroiliac joint. The left sacroiliac joint is within normal limits. The hip joints are unremarkable. No evidence of fracture or malalignment.Two views of the left hip are within normal limits, without acute abnormality. There is no fracture or malalignment. | No evidence of acute fracture or malalignment. Degenerative changes are present in the right sacroiliac joint. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in paternal grandmother at age 80. Two standard digital views of both breasts and one additional MLO view of the right breast were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 30 day old male former week gestational age. Hypoxia, increased WOB. Evaluate ETT placement, presence of effusion/atelectasis VIEW: Chest AP (one view) 3/10/2015, 0217 ET tube tip at the level of the thoracic inlet. Enteric tube with sideport above the level of the GE junction. Right IJ catheter tip in the SVC. Unchanged mediastinal clip.Cardiothymic silhouette is upper limits of normal.Coarse multifocal opacities are not significantly changed. No pleural effusion or pneumothorax. | Unchanged complications of surfactant deficiency. |
Generate impression based on findings. | 55-year-old male with neutropenic fever, pleuritic CP, LUQ discomfort (known splenomegaly). Evaluate for PNA and source of LUQ discomfort. CHEST:LUNGS AND PLEURA: New 8mm left upper lobe nodule likely infectious (series 4, image 39). Scattered micronodules, some calcified. No focal consolidation. Trace left pleural effusion. Minimal scarring/atelectasis at the bases.MEDIASTINUM AND HILA: Right IJ catheter and right atrium. Low density cardiac blood pool is typical of anemia. Heart size is normal no pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Diffuse mottled appearance of the bones is again seen, compatible with known myelofibrosis.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal hepatic lesion. Sludge noted in the gallbladder.SPLEEN: Marked splenomegaly redemonstrated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral perinephric stranding, not seen around the previously imaged right kidney. No hydronephrosis or renal stone, and no ureteral stone to the level of the mid ureter.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: Diffuse mottled appearance of the bones is again seen, compatible with known myelofibrosis.OTHER: Small volume perihepatic ascites, new from previous exam. | 1.Bilateral perinephric stranding was not seen previously and is nonspecific though infection cannot be excluded.2.New small volume perihepatic ascites.3.8mm left lower lobe nodule is likely infectious, possibly fungal.4.Stable osseous changes of known myelofibrosis.5.Stable marked splenomegaly. |
Generate impression based on findings. | Patient is status post left craniotomy with overlying soft tissue swelling, pneumocephalus and small extra-axial collection in the left hemisphere. Metallic streak artifact from the grid limits the evaluation of the underlying parenchyma. No large intracranial hemorrhage. There is minimal rightward midline shift. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The imaged portions of the orbits are intact. | 1. Expected postsurgical changes of left-sided craniotomy and grid placement. Left frontal cortical malformation better seen on prior MRI.2. Minimal rightward midline shift. No large hemorrhage. |
Generate impression based on findings. | Hip pain. Question of osteoarthritis. Two views of the left hip reveal no acute fracture or malalignment. Surgical clip and fallopian tube occlusion device noted within the pelvis. | No acute fracture or significant findings of osteoarthritis. |
Generate impression based on findings. | Female 33 years old; Reason: evaluate for TOA/new pelvic abscess History: abdominal pain, history of pelvic abscess ABDOMEN:LUNG BASES: Postsurgical changes in the sternum.LIVER, BILIARY TRACT: Liver is normal in morphology. There are multiple calcified gallstones which is not present prior.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: Multiple small retroperitoneal lymph nodes.BOWEL, MESENTERY: No bowel obstruction. There is distortion of the small bowel loops due to adhesions in the right lower abdomen. There is some mild bowel wall thickening of the proximal bowel ileal loops.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal cystic lesion measures 3.9 cm. Right adnexal mass/cystic lesion measures 4.7 cm. This is associated with pelvic free fluid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Angulated bowel loops with mild bowel wall thickening likely due to adhesions.2.Mesenteric pelvic fluid and bilateral adnexal lesions. Further evaluation with pelvic sonography is suggested.3.Small retroperitoneal lymph nodes4.Cholelithiasis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal aunt and ovarian cancer in maternal aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable focal asymmetry in the upper outer quadrants. 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.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 73 years old Reason: abdominal distention rule out ileus History: abdominal distention rule out ileus. There appears to be a moderate amount of gas within the small bowel, suggestive of ileus. Intrathoracic stomach as seen on prior CT. Focal calcification in the left upper quadrant is compatible with splenic ringlike granuloma seen on prior CT.Surgical clips are seen in the lower midline abdomen extending to the right lower pelvis. | Moderate amount of gas within the small bowel, suggestive of ileus. |
Generate impression based on findings. | Left foot pain. There is narrowing of the first metatarsophalangeal joint with associated osteophyte formation, consistent with osteoarthritis. No acute fracture or dislocation. | Mild osteoarthritis at the first metatarsophalangeal joint. No evidence of acute fracture or dislocation. |
Generate impression based on findings. | Uncontrollable pain on left side. Evaluate for fracture. Three views of the ribs reveal no acute fracture. | No acute fracture is evident. |
Generate impression based on findings. | 87 years, Female. Reason: NJ tube placement History: as above There is a nasojejunal tube with its tip projecting over the proximal jejunum. Cholecystectomy clips are present in the right upper quadrant. There is a nonobstructive bowel gas pattern. There is a small left pleural effusion. There is levoscoliosis of the thoracolumbar spine as well as severe degenerative changes of lower lumbar spine, sacroiliac joints and bilateral hips. | Nasojejunal tube with its tip projecting over the proximal jejunum. |
Generate impression based on findings. | 20 year-old male with lower back pain. Two views of the lumbar spine do not reveal any evidence of acute fracture or malalignment. The joint spaces are well preserved. No significant degenerative disease is present. | No evidence of spondylolysis, as clinically queried. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in paternal cousin at age 32. History right 3 o'clock cluster of cysts. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained.The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable right asymmetries.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.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 46-year-old male with history of right heel pain x 1 week. There is no evidence of fracture or malalignment. Boehler's angle is within normal limits. A small plantar heel spur is present. Soft tissues are unremarkable. | No acute fracture or malalignment. |
Generate impression based on findings. | Again seen is a fracture involving the floor of the anterior cranial fossa in the right frontal bone with buckling and displacement of the superior orbital roof and supraorbital ridge. There is stable underlying retro-orbital hematoma and extra-axial hematoma along the right cerebral convexity measuring 3 mm, slightly decreased in attenuation. There is decreased, but significant extraconal swelling anteriorly. A fracture of the right orbital floor appears stable.Additionally, there is a nondepressed fracture of the squamous left temporal bone and diastasis of the left occipitomastoid suture, both appearing similar to the prior examination. There is a small amount of subarachnoid hemorrhage tracking along the left transverse and sigmoid sinuses and the left tentorial leaf. Area of heterogeneous attenuation in the left lateral cerebellar hemisphere involving both gray and white matter appear similar to the prior examination and represents small amount of parenchymal hemorrhage with cytotoxic edema. There is residual edema in the left occipital lobe which appears to decreased in extent from the prior examination.There is no new hemorrhage identified. Foci of air in the suprasellar cistern no longer visualized. The ventricles are within normal limits with no midline shift. Bilateral maxillary sinuses, ethmoid air cells, and mastoid air cells are opacified. The right middle ear remains opacified and there is new opacification of the left middle ear. | 1.No new hemorrhage from 3/9/15. 2.Comminuted right frontal bone fracture with stable retro-orbital and extra-axial hematoma. Decreased anterior extraconal swelling.3.Left temporal bone fracture with diastases of the occipitomastoid suture. Stable adjacent subarachnoid hemorrhage and left cerebellar contusion. Slightly decreased left occipital lobe edema.4.As high maxillary sinuses, ethmoid air cells, and mastoid air cells with opacified right middle ear cavity and newly opacified left middle ear cavity. |
Generate impression based on findings. | Right distal fibula fracture. Evaluate fracture lateral malleolus and for any medial clear space widening. Three views of the right ankle reveal a nondisplaced of oblique fracture of the distal fibula. The fracture line is less distinct on this examination. There is no widening of the medial tibiotalar joint with weight bearing. There is soft tissue swelling about the lateral malleolus. Orthopedic screws are again noted in the first metatarsal. | 1. Continued soft tissue swelling with a distal fibula fracture.2. No evidence of medial tibiotalar joint space widening with weightbearing |
Generate impression based on findings. | Female 76 years old; Reason: r/o fluid collection History: abd pain and fevers ABDOMEN:LUNG BASES: Heart size is enlarged. There are pacer leads within the right heart chamber. Small bilateral pleural effusions and bibasilar atelectasis.LIVER, BILIARY TRACT: Liver has a nodular contour suggestive of chronic liver disease. There is a new right hepatic lobe abscess with gas and fluid measuring 11 x 7 cm (image 50/series 3). There is associated perfusion abnormality in the hepatic lobe. The right portal vein - posterior branch is compressed.Gallbladder is decompressed but there is pericholecystic fluid.There is a small amount of fluid adjacent to the liverSPLEEN: Status post splenectomy. Abscess collection in the splenic bed measures 7.3 x 3.6 cm (image 30/series 3). There is a body wall drain.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis of either kidney.RETROPERITONEUM, LYMPH NODES: Thrombosis of the right gonadal vein.Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Postsurgical changes omentectomy with debulking. Most of the omental disease has been resected. There is residual disease along the body wall.BONES, SOFT TISSUES: Anterior midline staples.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the rectum with a surgical staple line. The thickened sigmoid colon loop has been resected.BONES, SOFT TISSUES: Degenerative changes affect the sacroiliac joints, right greater than left.OTHER: No significant abnormality noted. | 1.Findings of a large right hepatic lobe abscess with perfusion abnormality involving the right hepatic lobe representing infection or infarction.2.Splenic bed abscess. |
Generate impression based on findings. | 58 years, Male. Reason: location of NG/NJ tube placed yesterday History: s/p NG/NJ tube placement The pelvis is excluded from the field of view. There is a nasojejunal tube, which has retracted compared to the prior examination with the tip now just beyond the ligament of Treitz. Two cyst gastrostomy tubes are in place, position unchanged. There is a partially imaged right central venous catheter with the tip projecting at the cavoatrial junction. There is a small left pleural effusion. There is a nonobstructive bowel gas pattern. | Interval retraction of the nasojejunal tube with the tip now projecting just beyond the ligament of Treitz. |
Generate impression based on findings. | 25-year-old male patient with pelvic mass. CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules are noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The cardiac size is within normal limits.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Numerous bilateral renal cysts are incompletely evaluated. Left posterior approach percutaneous nephrostomy tube noted without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy noted.BOWEL, MESENTERY: No evidence of bowel obstruction.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 retroperitoneal lymphadenopathy noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: There is a large heterogeneous mass in the left hemiabdomen/pelvis measures 11.8 x 8.8 cm in the axial dimension (series 3 image 168). The mass appears to be arising from the retroperitoneum and encases the left common iliac vessels without significant attenuation. The mass involves the left iliacus and the iliopsoas muscles. Significantly enlarged left inguinal lymph nodes are also noted. | 1.Large likely retroperitoneal pelvic mass causing left ureteral obstruction is favored to represent lymphoma given morphology and patient's age. Sarcoma is considered less likely.2.Bilateral renal cysts are incompletely characterized.3.Left percutaneous nephrostomy tube in place without evidence of hydronephrosis. |
Generate impression based on findings. | 24 year-old female with right knee and ankle pain after skating injury. Three views of the right ankle reveal normal alignment comment there is no evidence of acute fracture or significant soft tissue swelling.Four nonweightbearing views of the right knee reveal normal alignment, no evidence of fracture or dislocation. Joint space appears well preserved. There is no significant soft tissue swelling or joint effusion. | No acute abnormality. |
Generate impression based on findings. | Male 0 days old Reason: Please evaluate for lung disease. IDM requiring O2 History: no lines - increasing respiratory distress; increasing O2 requirementVIEW: Chest and abdomen AP (two views) 3/10/15 Aortic arch, cardiac apex and stomach are left-sided. There is a bell-shaped appearance of the chest. Cardiac silhouette is normal in size and shape. No focal lung opacities. No effusions or pneumothorax.Disorganized, likely age related and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, , likely age related and nonspecific abdominal gas pattern. |
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