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Generate impression based on findings. | Right lower quadrant and suprapubic pain. Recurrent, ABDOMEN:LUNG BASES: No focal opacity is present. A pleural effusion is not identified.LIVER, BILIARY TRACT: Enhancement is normal. No biliary ductal dilatation is seen. The gallbladder is distended.SPLEEN: Normal in size and enhancement.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Enhancement is symmetric. No pelvicaliceal dilation is present.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenojejunal junction is normally positioned. No dilated proximal small bowel is seen. Contrast material is noted in proximal ileum/distal jejunum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free peritoneal air or fluid is seen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended and normal in appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The terminal ileum and distal ileum contain feces and are dilated. The colon contains a small to moderate amount of feces and is not collapsed. The appendix is not definitely identified. No inflammation is present in the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free fluid is present. | Small bowel feces sign without obstruction. This may be seen in patients with cystic fibrosis, severe dehydration, and a bezoar. |
Generate impression based on findings. | 60 year-old female with history of right mastectomy. LUNGS AND PLEURA: No consolidation, pleural effusion, or pneumothorax. Right upper, left upper, left lower lobe pulmonary nodules measure up to 7 mm (right upper lobe, image 26 series 2). Subtle right posterior pleural nodularity at the level of T5.MEDIASTINUM AND HILA: Heart size and is normal with no pericardial effusion. No significant mediastinal or hilar lymphadenopathy is present. No coronary calcifications are identified.CHEST WALL: Status post right mastectomy. Ipsilateral large right subpectoral anterior chest wall mass measures 7.1 x 6.3 cm (image 7, series 2). Several prominent right axillary lymph nodes measure up to 10 mm in short axis. A second anterior chest wall mass lies anterior to the cartilaginous second through fourth right ribs and measures approximately 5.4 x 2.1 cm axially (image 19, series 2). Right chest wall port catheter tip in the right atrium.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Right anterior chest wall masses and right axillary lymphadenopathy are concerning for regional metastases.Few pulmonary nodules measuring up to 7 mm and subtle pleural nodularity are nonspecific though may represent metastatic disease and attention on follow-up imaging is warranted. |
Generate impression based on findings. | 20 year-old female patient with hematuria and right-sided flank pain. 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: 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 notedRETROPERITONEUM, LYMPH NODES: There is a nonobstructive renal calculus in the superior pole of the right kidney that measures 3 mm. There is an incompletely characterized hypoattenuating lesion in the superior pole of the left kidney.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Free fluid in the pelvis is likely physiologic in etiology. | 1.Nonobstructive 3mm renal calculus in the superior pole of the right kidney. No hydronephrosis or perinephric fat stranding.2.Hypoattenuating lesion in the superior pole of the left kidney is incompletely characterized and is felt to most likely represent a cyst given that the patient does not have left flank symptoms. |
Generate impression based on findings. | Low back pain. Evaluate for an acute process. No acute fracture is evident. Alignment is anatomic. Vertebral body heights are maintained. | No acute fracture is evident. |
Generate impression based on findings. | 66-year-old female patient history of bladder cancer status post radical cystectomy. Evaluate for metastatic disease on delayed imaging. ABDOMEN:LUNG BASES: Interval resolution of left-sided pleural effusion. There is bilateral scarring and left lung base bronchiectasis. There are peripherally located nodular densities in the right middle lobe (series 9 image 1).LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenic granulomata again noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left subcentimeter renal hypoattenuating lesion is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: There is interval increase in multiple subcentimeter lymph nodes bilaterally. A reference right retroperitoneal lymph node measures 6 mm in short axis (series 10 image 24), and a left paraortic lymph node measures 7 mm in short axis (series 10 image 43).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe S-shaped scoliosis again noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy and neobladder formation.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction. Postsurgical changes from Indiana pouch formation.BONES, SOFT TISSUES: Severe S-shaped scoliosis again noted. Interval resolution of lower anterior abdominal wall abscess formation.OTHER: No significant abnormality noted. | 1.Nonspecific interval increase in subcentimeter retroperitoneal lymph nodes, as described above. Otherwise, grossly unchanged examination.2.Right middle lobe nodules were not visualized on prior examination and are of uncertain clinical significance and may represent scarring. Attention should be paid to these nodules on subsequent examinations. |
Generate impression based on findings. | 80 year-old female with NSCLC. Restaging s/p XRT. CHEST:LUNGS AND PLEURA: Elongated right upper lobe mass-like lesion is unchanged. Left upper lobe nodule have decreased in size and solid component measures 8 x 4 mm (image 31), previously 10 mm. Left lower lobe nodule has decreased in size and solid component 8 x 6 mm (image 40), previously 11 mm. No new pulmonary nodules are identified. Mild centrilobular and paraseptal emphysema is present.MEDIASTINUM AND HILA: Hypoattenuating thyroid nodules unchanged. Heart size is normal with no pericardial effusion. No significant mediastinal or hilar lymphadenopathy. No coronary calcifications identified. Minimal aortic arch calcifications.CHEST WALL: Degenerative spinal changes appear similar to prior exam.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal mass, measuring 26 mm (series 4, image 90), previously 26 mm.KIDNEYS, URETERS: Right renal cyst.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: Moderate to severe degenerative changes affect the visualized spine.OTHER: No significant abnormality noted. | Slight interval decrease in size and solid component of left upper lobe nodules. Stable right upper lobe mass-like lesion. |
Generate impression based on findings. | Male 78 years old; Reason: follow up for colon cancer History: none CHEST:LUNGS AND PLEURA: Asymmetric bronchiectasis involving the right upper lobe. Minimal emphysematous changes.Right lower lobe pulmonary lesion measures 1.5 x 1.4 cm (image 59/series 5) previously, 1.9 x 1.4 cm.Spiculated medial right lower lobe pulmonary lesion measures 2.0 x 1.5 cm (image 69/series 5) previously, 2.0 x 1.9 cm.The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. Coronary calcifications are present in a triple vessel distribution.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. There are a few scattered hepatic hypodensities. Some of which arenear fluid attenuation and represent cysts.Subcentimeter nodular focus within the posterior wall of the gallbladder (image 115/series 3) may represent either a noncalcified stone or a small gallbladder wall polyp or mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal gland is slightly nodular.KIDNEYS, URETERS: There are bilateral renal calculi. There is mild urothelial thickening in both renal pelvises. There are small bilateral renal cysts. Mild collecting system dilatation greater on the left.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes from a hemicolectomy. No bowel obstruction.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wallOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Metallic foreign bodies noted in the right gluteal soft tissues.OTHER: No significant abnormality noted | 1.No significant change in the size of the reference lung lesions.2.Bilateral renal calculi with thickened urothelium. |
Generate impression based on findings. | 74-year-old male patient with urothelial cancer. CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules are again noted. Left upper lobe groundglass nodule is unchanged and measures 4 mm (series 8 image 15) additional ground glass nodule in the right upper lobe measures 3 mm (series 8 image 27). Again seen are bilateral basilar intra-and intralobular septal thickening, which is nonspecific.Right anterior pleural thickening appears similar compared to prior examination.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Severe coronary artery calcifications.CHEST WALL: Postsurgical changes from median sternotomy. Right trapezius intramuscular lipoma noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter left hepatic lobe hypoattenuating lesion likely represents a cyst and is unchanged from prior examination. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left lower pole renal cyst is unchanged compared to prior.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes affect the abdominal aorta and its branches. Scattered small retroperitoneal lymph nodes.BOWEL, MESENTERY: No evidence of bowel obstruction. Colonic diverticula noted without evidence of diverticulitis.BONES, SOFT TISSUES: Severe multilevel degenerative changes affect the thoracolumbar spine. Sclerotic lesions in the L1 vertebral body are unchanged compared to prior examination. Dextroscoliosis affects the lumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with neobladder formation.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted. | Stable lung nodules without evidence of intra-abdominal metastatic disease. |
Generate impression based on findings. | Evaluate for CVA. There is a large hematoma centered in the left Sylvian fissure measuring 6.4 cm in AP dimension. There are smaller foci of intraparenchymal hemorrhage in the left parietal lobe. There is local mass effect with effacement of the left lateral ventricle. There is left to right midline shift of 7 mm as well as uncal herniation. There are foci of hypoattenuation in the bilateral basal ganglia, suspicious for lacunar infarcts. There is encephalomalacia in the right cerebellar hemisphere. There is minimal opacification of the left ethmoid air cells. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. Large hematoma centered in the left Sylvian fissure with smaller intraparenchymal components in the left parietal lobe, resulting in local mass effect, left to right midline shift of 7 mm as well as uncal herniation.2. Foci of hypoattenuation in the bilateral basal ganglia, which are suspicious for lacunar infarcts. 3. Encephalomalacia in the right cerebellar hemisphere, likely related to prior infarct. Findings discussed with Dr. Savitch on 3/10/2015 immediately after completion of examination. |
Generate impression based on findings. | Reason: r/o extra and intracranial vessel stenosis History: R DWI+ lesions; left CEA 05/16/2014, right CEA 12/2/2014 HEAD:There is redemonstration of chronic left occipital infarct with volume loss. There is also focal low density along the right precentral gyrus and right occipital lobe corresponding to acute infarcts seen on recent MRI. The ventricles, sulci, and cisterns are symmetric without evidence of midline shift or hydrocephalus. There is no evidence of acute hemorrhage. The gray-white matter differentiation is normal. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD: Atherosclerotic calcification of the bilateral cavernous carotid arteries with moderate narrowing, left worse than right. Left cavernous carotid is narrowed in the distal petrous portion, stable from prior. There is moderate narrowing of the left proximal A1 segment, stable from prior CT angiogram.Posterior communicating arteries are not well visualized. There is mild mid basilar focal narrowing, unchanged from prior CT angiogram. Moderate to severe narrowing of the left V4 segment with calcified and noncalcified atherosclerotic plaques, stable from prior study. There is worsened now moderate narrowing of distal left V3 segment of vertebral artery compared to prior CT angiogram, where only mild irregularity was noted. Mild narrowing of the distal right V3 segment, stable from prior CT angiogram. There is worsening of distal right V4 segment compared to prior CT angiogram, with complete nonvisualization of a small segment just proximal to the vertebrobasilar junction. The superficial and deep intracranial venous drainage is grossly unremarkable.There is lucency around the left posterior maxillary residual dental root with possible adjacent dental caries.CTA NECK:There is extensive atherosclerotic disease of the aortic arch. There is common origin of the brachiocephalic artery and left common carotid artery. Origin of the left subclavian artery is unremarkable. Evaluation of the left subclavian artery is slightly limited by contrast streak artifact. Left vertebral artery origin is unremarkable. There is a short stump (6-mm) of the right vertebral artery at the origin with near complete occlusion of the remainder of the vessel. There is distal reconstitution of right vertebral artery with collaterals down to C3/4 level. This appears worsened compared to prior CT angiogram where collateral reconstitution was seen down to C5/6 level. There is marked interval improvement of the bilateral carotid artery perfusion from CEA. There remains mild irregularity but no significant stenosis of the bilateral carotids. Bilateral thyroid nodules and focal thickening of isthmus are noted. Partially imaged apical bilateral atelectasis and ground glass opacity appears similar to prior CT angiogram. | 1.Interval improvement of bilateral carotid artery appearance status post bilateral CEA, without residual stenosis or calcification.2.Interval decreased visualization of distal reconstitution of right vertebral artery through collaterals, with chronic occlusion just distal to origin.3.Interval worsening of appearance of bilateral distal vertebral arteries.4.Stable moderate narrowing of bilateral cavernous carotids, with moderate proximal left A1 segment stenosis.5.Redemonstration of known acute infracts in the right occipital lobe and precentral gyrus. Chronic left occipital lobe infarct.6.Redemonstration of thyroid nodules and apical pulmonary atelectasis. |
Generate impression based on findings. | Clinical question: Evaluate sinuses. Signs and symptoms: History of sinus disease on recent MRI exam. Nonenhanced sinus CT:Frontal sinuses are well pneumatized and unremarkable.Ethmoid sinuses are pneumatized and unremarkable.Sphenoid sinus is well pneumatized and with patent bilateral sphenoethmoidal recesses.Bilateral maxillary sinuses are well pneumatized and with patent bilateral ostiomeatal units. There is a large retention cyst in the left maxillary sinus measuring at 27 x 20 x 26-mm and unremarkable maxillary sinuses otherwise.Images through the nasal passage demonstrate moderate to severe rightward deviation of nasal septum and with a small rightward projecting bony septal spur which is in contact and deforms the mucosa of the right inferior turbinate.Unremarkable images through the orbits.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable. | 1.Retention cyst measuring 27 x 20 x 26-mm in left maxillary sinus.2.Unremarkable paranasal sinuses otherwise.3.Rightward nasal septum deviation and a bony septal spur which is in contact and deforms the right inferior turbinate mucosa. |
Generate impression based on findings. | Clinical question: Evaluate sinuses, assess for interval change in sinus disease. Signs and symptoms: Chronic left-sided nasal congestion and PND on the left. Medtronic nonenhanced sinus CT:Left frontal sinus is well pneumatized and without evidence of disease. There is anatomical variation of absent right frontal sinus.Ethmoid sinuses are well pneumatized with the exception of a single left posterior ethmoid air cell opacification.Sphenoid sinus is well pneumatized and the patent left uncompromised right sphenoethmoidal recesses.Maxillary sinuses are well pneumatized and patent bilateral ostiomeatal units and without the use of disease. Tiny right maxillary sinus retention cyst however is detected.Images through the nasal passage demonstrate mildly collapsed left nasal valve and unremarkable otherwise. | 1.No evidence of sinusitis and without interval change since prior exam. 2.Tiny retention cyst of right maxillary sinus as detailed.3.Images through the nasal passage demonstrate mildly collapsed left nasal valve.4.No appreciable interval change since prior outside institute examination. |
Generate impression based on findings. | 10 years old, Female, Reason: 10 year old with t-lymphoblastic lymphoma History: Mediastinal mass LUNGS AND PLEURA: Within the left upper lobe there is a new 9 mm x 8 mm spiculated nodule (series 6, image 22). No pneumothorax, pleural effusion, or dense consolidation. The trachea and central bronchi are patent.MEDIASTINUM AND HILA: The heart size is normal without evidence of pericardial effusion. No significant mediastinal, internal mammary, cardiophrenic, hilar, or retrocrural lymphadenopathy.The anterior mediastinal mass is smaller in size measuring 4.6 x 1.7 cm (series 5 image 34), previously measuring 2.6 x 5.6 cm. The previously noted mass effect on the adjacent vessels is no longer present.CHEST WALL: Right-sided chest port with tip in at the cavoatrial junction.UPPER ABDOMEN: The partially visualized abdominal contents are normal in appearance. | 1.New spiculated nodule in the left upper lobe measuring up to 9 mm is most likely malignant due to appearance on same day PET exam.2.Interval decrease in size of anterior mediastinal mass with no compression to the major airways or vascular structures. |
Generate impression based on findings. | 4 year old female. History of congenital talipes equinovarus. Bilateral developmental hip dysplasia. Evaluate scoliosis.VIEWS: Thoracolumbar spine. AP and lateral (2 views) 3/10/2015, 0018 Thoracolumbar spine has normal alignment without significant lateral curvature.No segmentation or fusion defects in the thoracolumbar spine.Posterior fusion defects of the sacrum.Gastrostomy tube in place. | No scoliosis. |
Generate impression based on findings. | 33-year-old male with left knee pain. Two views of the left hip demonstrate normal alignment, without acute fracture or significant degenerative disease.Four nonweightbearing views of the left knee demonstrate no acute fracture or malalignment. There is no joint effusion or significant soft tissue swelling. | No acute abnormality in the left hip or knee. |
Generate impression based on findings. | Female 49 years old evaluate for radiopaque foreign body. Per operating room attending, needle counts were correct. A 12-mm curvilinear thin metallic structure projects over the mid pelvis is most likely due to an overlying staple. There is no tapering appearance suggests that this is a needle. Otherwise, no unexpected radiopaque surgical foreign body. Partially imaged CVC tip in the right atrium. NG tube is past the ligament of Treitz, within the jejunum. Right of quadrant surgical changes noted. Residual enteric contrast is seen residing in the right lower quadrant, most likely the cecum.Nonobstructive bowel gas pattern. | 12-mm curvilinear thin metallic structure projects over the mid pelvis is most likely due to an overlying staple. There is no tapering appearance suggests that this is a needle. However, clinical correlation is needed to rule out radiopaque foreign body.These findings and the need for clinical correlation were directly communicated with the attending surgeon, Dr. Renz, in the operating room Dr. Alkesh Amin via telephone at 12:53 pm on 3/10/2015. |
Generate impression based on findings. | 49-year-old female with a history of dorsal talar avulsion fracture on 2/4/15; a follow-up examination. The linear density dorsal to the head of the tail is is less conspicuous on today's exam, compatible with interval healing of the dorsal talar avulsion fracture. There is no new acute fracture, malalignment, or significant soft tissue swelling. | Interval healing of dorsal talar avulsion fracture. |
Generate impression based on findings. | Newly diagnosed 8mm nodule in the left lung LUNGS AND PLEURA: Using similar measurement technique with 1 mm slice thickness, the left apical pulmonary nodule has not significantly changed in size, measuring 6 mm (5/29).Stable paraseptal predominant emphysema.Additional apical pleural parenchymal scarring unchanged. No new suspicious pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: The heart size is normal. There is low-density to the blood pool which raises a question of anemia. No pericardial effusion is present. No significant mediastinal lymphadenopathy is identified.CHEST WALL: No axillar lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Left apical 6-mm solid nodule has not changed in size since 11/2014. No associated lymphadenopathy. Continued observation with a repeat CT in 6 months is recommended. |
Generate impression based on findings. | 24 years, Male. Reason: 24 yo with g tube History: high residuals Markedly underinflated lungs with nonspecific air space opacities, left greater than right, may represent atelectasis/aspiration/infection. Spinal hardware is unchanged in position. Midline abdominal surgical clips are noted. Patient's known ventriculocholecystic shunt is partially imaged with its tip coiled in the expected anatomic location of the gallbladder. Additional orphaned shunt tubing is seen more laterally, and unchanged in location with a prior exam. There are bilateral femoral catheters. A left pigtail catheter is unchanged. IVC filter is unchanged in position. Gas distended small bowel measuring up to 3.5 cm is not significantly changed from the prior exam and likely represents chronic ileus. | Multiple dilated loops of small bowel are again identified, and likely represent ileus, unchanged from prior exam. |
Generate impression based on findings. | Clinical question: History of sinus surgery, recurrent symptoms. Signs and symptoms: History of sinus surgery, recurring symptoms. Nonenhanced Medtronic sinus CT:Well pneumatized right frontal sinus without evidence of disease. There is anatomical variation of hypoplastic left frontal sinus without evidence of disease.Ethmoid sinuses are well pneumatized and unremarkable. There is evidence of a chronic rule out fracture of left lamina papyracea with mild herniation of retro-orbital fat through the fracture similar to prior exams.Sphenoid sinus is not pneumatized and unremarkable.Bilateral maxillary sinuses are well pneumatized and without evidence of sinusitis.Examination demonstrates a bony defect in the inferior aspect of the left medial maxillary wall representing a surgical defect. There is also a small bony defect of the medial wall of right maxillary sinus which is patent however there is mild mucosal thickening along the superior edge of defect on coronal images. Although the right ostiomeatal unit is identified there is a bony defect similar to prior exam and suggestive of endoscopic functional sinus surgery.Images through the nasal passage demonstrate postop changes and unremarkable otherwise. | 1.No evidence of any significant sinus disease. There is interval improvement since prior exam.2.Please see detailed report above. |
Generate impression based on findings. | Head/Brain: There is no evidence of intracranial mass or area of abnormal enhancement.Left calvarial burr holes are again noted along with a stable, thin subdural collection with peripheral calcifications along the floor of the left anterior cranial fossa. There is patchy white matter hypoattenuation indicating age indeterminate small vessel ischemic disease. No intracranial hemorrhage or evidence of acute cerebral or cerebellar cortical infarct. The ventricles and sulci are normal in size. The left internal jugular vein is hypoplastic. There is opacification of the left maxillary sinus and sphenoid sinus. The ethmoid air cells are clear. The mastoid air cells are unchanged and partially pneumatized.Soft Tissues Neck: Posttreatment changes are seen in the neck with wall thickening of the hypopharynx, larynx, and esophagus along with subcutaneous soft tissue stranding and obliteration of the fat planes. There is atrophy of the submandibular glands bilaterally. The patient has a tracheostomy. There is no evidence of mass or abnormal enhancement. There are no pathologically enlarged lymph nodes.Scattered atherosclerotic plaque is noted, most severe and slightly progressed in the proximal left internal carotid artery. There also appears to be a stable, nonobstructing web in the proximal left internal carotid artery. There is kyphosis of the cervical spine and there are multilevel anterior osteophytes along with degenerative disc disease. Upper Thorax: Apical scarring/fibrosis is noted, likely a consequence of radiation, and better characterized on concurrent CT chest. There is no clinically significant adenopathy. There are no soft tissue masses. | Posttreatment changes without findings of recurrence. |
Generate impression based on findings. | Pain and stiffness. Question of extent of osteoarthritis. Two views of the right knee reveal severe joint space narrowing of the medial tibiofemoral compartment and patellofemoral joint. There is tricompartmental osteophyte formation. A large right knee joint effusion is noted. No fracture is evident.Two views of the left knee reveal severe joint space narrowing of the medial tibiofemoral compartment. There is tricompartmental osteophyte formation. No fracture is evident. | Severe osteoarthritis of both knees. |
Generate impression based on findings. | 67-year-old female with history of metastatic lung cancer, left femur pain, concern for metastases. There is mild inferomedial migration of the left femoral head with associated subchondral sclerosis, consistent with mild osteoarthritis. There is no acute fracture or malalignment. The left knee joint is unremarkable. | No evidence of metastatic disease to the left femur. Minimal osteoarthritic changes of the left hip. |
Generate impression based on findings. | Female 52 years old; Reason: s/p HIPEc and debulking for appendiceal CA History: Surveillance CHEST:LUNGS AND PLEURA: No dominant lung lesion. There are a few scattered pulmonary nodules along the right major fissure. The previously measured reference lesion has resolved. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Status post cholecystectomy. Hepatic and portal veins are patent. No suspicious hepatic lesions. A serosal implant near the caudate lobe measures 1.9 x 1.0 cm (image 80/series 3) previously, 1.9 x 1.3 cm.SPLEEN: Status post splenectomy. Several splenules are 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: Soft tissue nodule between the stomach and the liver measures 2.0 x 1.7 cm (image 80/series 3) previously, 1.2 x 1.2 cm. postsurgical changes about the cecum.There a few scattered mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference right inguinal node measures 2.6 x 1.4 cm (image 169/series 3) previously, 2.1 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increase in the nodule size located between the stomach and the liver in the left upper abdomen.2.Near complete resolution of the lung lesion. |
Generate impression based on findings. | 14 years old, Female, Reason: Concern for abnormal bone process; hx sicca and on CSA for atopic dermatitisVIEWS: Thoracic spine AP, lateral, swimmer's (3 views) 3/10/15 Vertebral body heights and disk spaces are normal. Mineralization of the osseous structures is normal. No evidence of fracture or malalignment. | Normal examination. |
Generate impression based on findings. | 49 year old female with history of right breast abscess, and left breast boil status post excision, presents for routine annual follow-up. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Extensive vascular calcifications are present in both breasts. Elsewhere, scattered benign calcifications are present. A linear marker has been placed on a scar overlying the right periareolar region. The previously identified right retroareolar asymmetry has resolved. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 21 year old male. Abdominal pain and vomiting x 3 days: Evaluation for obstruction Hx of AML s/p stem cell transplant.VIEWS: Abdomen AP upright and supine (two views) 3/10/2015, 1305 Nonobstructive bowel gas pattern. Moderate colonic stool burden.No free air. | No evidence of obstruction. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Persistent moderate centrilobular emphysema in the upper lobes.Right-sided volume loss secondary to right lower lobe rounded atelectasis adjacent to small right pleural effusion which is reduced in quantity when compared to previous CT examinations. The two discrete foci of rounded atelectasis in the right lower lobe are stable in size and appearance. There is debris within the bronchus intermedius and small foci of mucus plugging within the right lower lobe bronchioles.Stable scattered calcified and noncalcified pulmonary micronodules, similar to prior. No suspicious interval pulmonary nodule or left pleural effusion.MEDIASTINUM AND HILA: Using similar measurement technique, the high right posterior paratracheal mass has slightly increased in size, 3.8 x 4.6 cm (3/17), as compared to 3.7 x 4.1 cm. Progressive internal necrosis is demonstrated. It is difficult to determine a fat plane in the mass and the posterior trachea. There is a thin fat plane between the mass and the right lateral esophageal wall. No fat plane is identified between the right lobe of the thyroid gland in this mass (3/15). The heart size is normal. No pericardial effusion. Extensive calcifications of the transverse arch and descending thoracic aorta. Severe coronary artery calcification. CHEST WALL: Interval placement of a right port that terminates within the right atrium.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large inferior exophytic cyst on the right.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral iliac stents extend into the distal abdominal aorta. | Right posterior paratracheal mass measures slightly larger. No interval mediastinal lymphadenopathy.Chronic but decreased right pleural effusion with pleural thickening and two foci of rounded atelectasis in the right lower lobe.No new suspicious pulmonary nodule. |
Generate impression based on findings. | 65 year old female with history of nonhealing left lower extremity wound and concern for osteomyelitis. There is focal soft tissue swelling overlying the mid third of the tibia, likely corresponding to patient's known leg wound. The tibia and fibula remain well corticated, without evidence of osteomyelitis. The visualized bones of the foot appear demineralized. There is no acute fracture or malalignment. | Focal anterior soft tissue swelling of the lower leg without evidence of underlying osteomyelitis. |
Generate impression based on findings. | 24 day male. Cough and wheeze. R/o pneumoniaVIEWS: Chest AP/lateral (two views) 3/10/2015, 1314 The aortic arch, cardiac apex, and stomach are left-sided.The cardiomediastinal silhouette is normal.Mild peribronchial thickening and increased lung volumes compatible with reactive airway disease or bronchiolitis.No pleural effusions or pneumothorax. | Reactive airway disease/bronchiolitis pattern. |
Generate impression based on findings. | 44 year old female with 4-week history of right elbow and right knee pain. Four views of the right elbow demonstrate normal anatomic alignment, without fracture, joint effusion, or significant soft tissue swelling. Four views of the right knee demonstrate no acute fracture, malalignment, joint effusion or significant soft tissue swelling. AP view of the right knee is unremarkable. | No acute abnormality. |
Generate impression based on findings. | 52 years old Female. Reason: History of metastatic breast cancer to L5, evaluate lesion found on MRI in left intertrochanteric region of proximal femur (outside read of MRIs will also be requested). Date of PET scan is 08/27/2013 Examination from MD Anderson cancer center was submitted for interpretation. The study is dated 08/27/2013. Today's CT portion grossly demonstrates an apparent soft tissue density in the right breast. There is a mixed sclerotic and lytic lesion in the L5 vertebral body. The tip of the Port-A-Cath is at junction of the SVC in the right atrium.Today's PET examination demonstrates decreased metabolic activity in the lumbar spine, which is consistent with the post radiation change. There is mild FDG uptake in the lesion seen on CT at L5 vertebral body with SUVmax of 2.4. There is no definite abnormal FDG uptake in the left proximal femur as clinically questioned.There is a focus of increased activity in the left upper chest wall between the clavicle and first rib. The SUVmax in the abnormal uptake is 3.0. There is no abnormal FDG uptake in the apparent soft tissue density in the right breast. | 1. No definite evidence of FDG avid tumor, specifically no definite abnormal FDG uptake in the lesion in the left proximal femur seen on the MRI scan from 11/26/2014. Mild FDG uptake in the region at L5 vertebral body, which is nonspecific.1.Focus of the abnormal FDG uptake in the left upper chest wall between the left clavicle and first rib without definite CT correlation. This finding is nonspecific. Suggest correlation with subsequent imaging studies. |
Generate impression based on findings. | Status post fracture.VIEWS: Left tibia-fibula AP and lateral 3/10/15 (3 views) Cast material obscures fine bone detail. No fracture line is visualized. No periosteal reaction or callus formation is noted. Alignment is anatomic. | Anatomic alignment after casting. |
Generate impression based on findings. | 66 years, Male. Reason: s/p ngt History: ngt Please note the pelvis is not included in this examination. Partially visualized lung bases demonstrate right basilar punctate pulmonary nodules. Interval placement of an NG tube with its tip and side-port in the proximal stomach. Sternotomy hardware and vascular clips are unchanged in position. | NG tube tip in proximal stomach. |
Generate impression based on findings. | 7 year old male. 4th and 5th digit lt hand pain after fall. R/o fracture History: swelling, tenderness over proximal metacarpalsVIEWS: Left hand PA, lateral, oblique (3 views) 3/10/2015, 1252 Mild soft tissue swelling at the dorsum of the hand.The osseous structures are normal. | Soft tissue swelling with no acute fracture. |
Generate impression based on findings. | Male; 62 years old. Reason: evaluate for progression. History: hemangiopericytoma. CHEST:LUNGS AND PLEURA: Bilateral likely metastatic lung nodules, unchanged. Index left lower lobe nodule measures 9-mm, unchanged (series 9/29).Index left upper lobe nodule measures 4 mm, unchanged (series 9/53).Additional smaller bilateral lung nodules are grossly stable.No new nodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Right paravertebral soft tissue mass near the T1/T2 vertebral body level measures 3.5 x 1.7-cm, not significantly changed since prior study when it measured 3.5 x 1.6 cm (series 7/12). Adjacent bone destruction is also unchanged. Postsurgical changes with spinal fixation of the upper thoracic spine, unchanged.Index left axillary lymph node measures 1 cm, unchanged (series 7/22). ABDOMEN:LIVER, BILIARY TRACT: 16-mm hypoattenuating lesion in the left hepatic lobe has slightly increased since prior study when it measured 14 mm (series 7/88). 11-mm hypoattenuating lesion in the inferior right hepatic lobe has slightly increased since prior study when it measured 6 mm (series 7/101).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 1.8 cm hypoattenuating left perirenal lesion just superior to the left kidney has slightly increased in size since prior study when it measured 1.5-cm.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue mass likely in the wall of the second portion of the duodenum measures 3.1 x 3.3 cm, previously 3 x 3.2 cm and not significant changed (series 7/118).BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subcentimeter round lytic lesion in the right iliac wing (series 7/26) is either new or increased since prior study and most compatible with metastasis.OTHER: No significant abnormality noted | 1. Slightly increased size of liver lesions and left perirenal lesion, most compatible with progressing metastatic disease.2. Either new or increased lytic lesion in the right iliac wing, most compatible with metastasis. 3. Stable lung nodules.4. Stable duodenal mass.5. Stable right paravertebral thoracic mass. |
Generate impression based on findings. | Female 17 months old Reason: leg length discrepancy History: leg length discrepancyVIEWS: Pelvis AP 3/10/15 (one views) Both round, smooth and normally formed femoral heads are well directed to a normally developed acetabulum. | Normal examination. |
Generate impression based on findings. | 48-year-old male with left foot pain and dorsal foot mass. No acute fracture or malalignment is evident. There is mild diffuse demineralization of the bones in the foot. A plantar heel spur is present. No dorsal foot mass. | No acute fracture, malalignment, or evidence of dorsal foot mass. |
Generate impression based on findings. | 13 years old, Male, Reason: Evaluate for presence of abscess History: burning/stinging with urination s/p open appendectomy BLADDER Wall Thickness: Normal Contents: Distended and normal. No debris is noted within the bladder. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 10.1 cm Left: 10.1 cm Mean for age: 10 cm Range for age: 8.5 - 11.5 cmADDITIONAL OBSERVATIONS: There is no edema or abscess along the incisional scar. There is no free fluid or loculated fluid within the pelvis | No abscess seen along the incisional scar or within the pelvis. The kidneys are normal in appearance bilaterally. No debris is present within the bladder.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Humerus fracture.VIEWS: Left elbow AP/lateral (two views) 03/10/15 The K wires have been removed. The fracture line is less distinct. Periosteal reaction/callus formation has increased. Alignment is unchanged with lateral displacement and slightly posterior angulation. | Continued healing of distal humeral fracture. |
Generate impression based on findings. | Interval significant improvement of previously seen beaking/bridging of the frontal bones, with now a rounded contour. There are scattered small osseous gaps along the expected course of the coronal sutures, presumably postoperative. Small osseous irregularities are seen along the paramedian frontal bones as well, likely postoperative. Slight asymmetry of the upper orbital rim but follows expected curvature. There is slight calvarial contour indentation all along the lambdoid suture. Intracranial structures are grossly unremarkable. No evidence of hydrocephalus. | 1.Expected postoperative changes with residual small osseous gaps scattered along the coronal sutures. Improved frontal bone contour.2.Slight calvarial indentation along the lambdoid suture.3.Intracranial structures are grossly unremarkable. |
Generate impression based on findings. | 64-year-old female patient with history of GIST. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiac size within normal limits without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple subcentimeter hypoattenuating lesions are too small to characterize and likely represent cysts. Prominent portacaval lymph node is not significantly changed from prior exam.SPLEEN: Splenule and splenic granulomata noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating bilateral renal lesions are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable postsurgical changes from partial gastrectomy without evidence of mass recurrence.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 52-year-old male with left lower lobe mass LUNGS AND PLEURA: Centrilobular emphysema is again noted. Biapical scarring. Bilateral pleural thickening with scarring. Pleural calcifications in the right lung base. Unchanged, round atelectasis in the posterior basal basal segment of the left lower lobe.MEDIASTINUM AND HILA: Prominent mediastinal and bilateral hilar lymph nodes are again noted, not significantly changed since the prior exam. Heart size is normal. No pericardial effusion. No appreciable coronary artery calcifications.CHEST WALL: No axillary, retrocrural, or cardiophrenic lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia is unchanged. | No significant change in appearance of left lower lobe round atelectasis. No change in right calcified plaques and bilateral pleural thickening/scarring. |
Generate impression based on findings. | Reason: prostate cancer, high-risk disease History: as above No abnormal osseous foci are identified to indicate metastatic disease.Areas of radiotracer activity in the mid cervical spine, lumbar spine, knee joints, and ankle joints are consistent with degenerative changes. | No evidence of bone metastasis. |
Generate impression based on findings. | Reason: prostate cancer S/P 3 cycles on treatement -restaging. Please complete PCWG2 form No abnormal osseous foci are identified to specifically indicate metastatic disease. A small focus of activity in the right inferior calvarium was also present on the prior study, but appears somewhat sharper on the right lateral skull view currently. Otherwise, scattered areas of degenerative radiotracer uptake are unchanged. | 1. No specific evidence of bone metastasis.2. Small focus of activity in the right inferior calvarium also present on the prior study appears somewhat sharper on the right lateral skull view on this exam. This appearance is not typical of metastatic disease but is nonspecific. Continued close attention to this region on subsequent exams is recommended. |
Generate impression based on findings. | 75-year-old female with pain of the right midfoot. There is mild hallux valgus deformity. Incidental note is made of a small accessory navicular bone. A plantar heel spur is present. There is no acute fracture or malalignment. | No acute abnormality. |
Generate impression based on findings. | Reason: r/o adenoma History: primary hyperparathyroidism. Best seen on SPECT images is a small focus of activity posterior to the upper pole of the right thyroid gland which may indicate a parathyroid adenoma.Physiologic cardiac and salivary gland uptake is observed. | Small focus of activity posterior to the upper pole of the right thyroid gland is nonspecific and may indicate a parathyroid adenoma. |
Generate impression based on findings. | 22 year old female with AML. Pre BMT baseline. History of latent TB LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No focal airspace consolidation. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Continued mild improvement in mediastinal lymphadenopathy. A reference right paratracheal lymph node measures 9 mm (series 3, image 12), previously 10 mm.The cardiac size is normal, without significant pericardial effusion.Right IJ catheter, tip in the right atrium.CHEST WALL: No significant abnormality notedUPPER ABDOMEN: Upper abdomen | 1. Continued mild improvement in mediastinal lymphadenopathy.2. No evidence of infectious process or other acute abnormality. |
Generate impression based on findings. | 69 year-old female with left foot pain, concern for gout. Three views of the left foot redemonstrate evidence of triple arthrodesis with fusion of the subtalar joint, calcaneocuboid joint, and the talonavicular joint. There is moderate osteoarthritis seen at the navicular/cuneiform articulation. No fracture is evident. Mild joint space narrowing and subchondral sclerosis of the first metatarsophalangeal joint is consistent with osteoarthritis. There is no radiographic evidence of gout.Three views of the right ankle demonstrate well-corticated ossicles adjacent to the medial malleolus, which may be related to remote trauma. There is mild soft tissue swelling of the lateral ankle. A plantar heel spur is present. No radiographic evidence of gout. | 1. No radiographic evidence of gout.2. Findings related to triple arthrodesis of the left foot are unchanged when compared to remote prior. 3. Moderate osteoarthritis of the left first metatarsophalangeal joint.4. Soft tissue swelling of the lateral right ankle.5. No acute fracture or malalignment. |
Generate impression based on findings. | 65 years, Male. Reason: 65M with abd distention, eval for megacolon History: abd distention Blurring due to respiratory motion limits sensitivity of this exam. There is a paucity of bowel gas. There is a nasogastric tube with its tip projecting over the prepyloric stomach. | Persistent paucity bowel gas. |
Generate impression based on findings. | 16 years old, Female, Reason: Postoperative evaluation fractured ankleVIEWS: Left ankle AP, oblique and lateral (3 views) 3/10/15 Overlying cast obscures fine bone detail. Interval placement of plate and screws device along the fractured fibula which is now in anatomic alignment. A single screw does not traverse the plate and runs somewhat perpendicular to the remaining screws and plate device. There may be increased space between the talus and fibula. | Interval placement of plate and screws device along the fractured fibula which is now in near anatomic alignment. |
Generate impression based on findings. | 56-year-old female patient with stage IIIc rectal cancer status post therapy completed August 2014. Evaluate for recurrent disease. Note the examination is limited by patient motion artifact. Repeat images of the chest and abdomen were performed during delayed phase imaging.CHEST:LUNGS AND PLEURA: Stable bilateral subcentimeter pulmonary nodules. Reference right interfissure lymph node measures up to 6 mm (series 10841 image 54). Reference left lower lobe nodule measures up to 4 mm (series 10841 image 74).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Chest port tip at the cavoatrial junction. Cardiac size is within normal limits.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No suspicious appearing hepatic lesions. Cholelithiasis without evidence of cholecystitis.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: Right retrocrural lymph node measures 5 x 7 mm (series 3 image 73), not significantly changed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes from rectosigmoid resection. No evidence of recurrent mass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Status post left total knee arthroplasty. There is a left total knee arthroplasty device in anatomic alignment. There is no evidence of acute fracture. Foci of gas in the soft tissues is likely postsurgical. Surgical skin staples overlie the knee. A surgical drain is noted. | Left total knee arthroplasty device in anatomic alignment. |
Generate impression based on findings. | 10 years old Female. Reason: Restaging exam. History: T cell lymphoblastic lymphoma undergoing maintenance chemotherapy. RADIOPHARMACEUTICAL: 3.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 76 mg/dL. Today's CT portion grossly demonstrates stable soft tissue masses in the right anterior mediastinum. There is a new lung nodule in the left upper lobe. Streaky opacity in the right middle lobe is stable.Today's PET examination demonstrates increased metabolic activity in the nodule in the left upper lobe with SUVmax of 2.2. A new focus of increased activity is seen in the splenic flexure of the colon without definite CT correlation. There is stable mildly increased metabolic activity in the anterior mediastinal soft tissue mass with SUV Max of 1.9 (it was 1.6).There is mild left hydronephrosis and hydroureter, new as compared with a study.Physiological activity is seen in the liver, spleen, kidneys, intestines, ureters and bladder. | 1.New hypermetabolic nodule in the left upper lobe, which can be due to infection or tumor.2. New nonspecific focus of FDG uptake in the splenic flexure of the colon without definite CT correlation.3. Stable anterior mediastinal mass with mild FDG uptake, which can be due to posttherapy change. However tumor cannot be excluded.4. New mild left hydronephrosis and hydro-ureter. |
Generate impression based on findings. | Severe pain and decreased range of motion. Assess degree of osteoarthritis in the left hip. No acute fracture is evident. There is medial joint space narrowing and osteophyte formation of the left hip. Surgical clips noted in the soft tissues of the left leg. | Moderte osteoarthritis of the left hip. |
Generate impression based on findings. | Chronic bilateral shoulder pain, status post rotator cuff surgery and multiple steroid injections. Three views of the right shoulder reveal no acute fracture or dislocation. There is mild osteophyte formation at the acromioclavicular and glenohumeral joints.Three views of the left shoulder reveal no acute fracture or dislocation. There is mild to moderate osteophyte formation at the glenohumeral joint. A well corticated osseous fragment inferior to the humeral head may represent a loose body in the axillary recess. Post-surgical changes of the left distal clavicle with widening of the acromioclavicular joint. | 1. Mild right acromioclavicular and glenohumeral joint osteoarthritis.2. Moderate left glenohumeral joint osteoarthritis with a possible loose body. |
Generate impression based on findings. | 65 year-old female with right upper and right lower quadrant abdominal pain. LIVER: Normal echogenicity measuring 16.4 cm in length. GALLBLADDER, BILIARY TRACT: There is adenomyomatosis of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. Minimal prominence of the extrahepatic ducts with no obvious obstructing lesion.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Normal echogenicity measuring 11.8 cm in length. There is a renal cyst measuring 1.3 cm x 1.1 cm x 1.0 cm. No evidence of hydronephrosis.OTHER: Normal echogenicity of the left kidney measuring 12.3 cm in length. No evidence of hydronephrosis.Normal echogenicity of the spleen measuring 8.8 cm in length. The appendix is not visualized. No free fluid. | Minimal prominence of the extrahepatic ducts with no obvious obstructing lesion. |
Generate impression based on findings. | 49 year old female status post right mastectomy in 2011 for IDC, presents today for routine follow up. Patient received radiation and chemotherapy. History of left breast mastopexy in 2012. No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Stable asymmetry is present in the upper outer left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 15 month old male. Status Post-Op Cardiac SurgeryVIEW: Chest AP (one view) 3/10/2015, 1400 New ET tube, with tip below the level of the thoracic inlet and above the carina. Enteric tube terminates in the stomach. New right IJ catheter with tip at the cavoatrial junction. New right chest tube. New epicardial pacer leads and pericardial surgical drain. Surgical clips in the mediastinum, unchanged.A small focus of gas along the left aspect of the mediastinum likely represents a small amount of pneumopericardium or pneumomediastinum, and is likely postoperative.Cardiac size is normal.Decreased pulmonary vascular engorgement compared to the prior exam. No new focal pulmonary opacity. No pleural effusion or pneumothorax. | Postoperative changes in the heart and mediastinum, with improved pulmonary vascular engorgement. |
Generate impression based on findings. | Pain and swelling post fall. Evaluate for fracture of right fourth digit. There is a non-displaced fracture of the dorsal aspect of the base of the distal phalanx. | Non-displaced fracture of the dorsal aspect of the base of the distal phalanx. |
Generate impression based on findings. | 72-year-old male status post right total hip arthroplasty. Portable image of the right hip demonstrates interval right total hip arthroplasty in near-anatomic alignment, with surgical drains and iatrogenic gas in the soft tissues.Portable image of the pelvis demonstrates the aforementioned right total hip arthroplasty in near-anatomic alignment. Joint space narrowing and subchondral sclerosis of the left hip correlate with mild osteoarthritis.Metallic objects overlying the abdomen likely relate to ventral hernia mesh. There is bony overgrowth of the pubic symphysis. | Interval right total hip arthroplasty in near-anatomic alignment. |
Generate impression based on findings. | 43-year-old male patient with infection. Exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given those limitations, the following observations are made:CHEST:LUNGS AND PLEURA: Scattered diffuse ground glass nodules, right lung greater than left, are again noted. Interval improvement in focal consolidations in the lower lobes. Left lung base scarring/atelectasis noted. MEDIASTINUM AND HILA: Marked cardiomegaly with implant device extending to the left ventricle, ICD lead, and Swan-Ganz catheter in place. CHEST WALL: Generator device is again noted in the left anterior chest wall.ABDOMEN:LIVER, BILIARY TRACT: No hepatic lesions seen in this noncontrast examination.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.3-cm left fat containing adrenal nodule is again noted.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:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Ground glass opacities in the lungs likely represent infectious or inflammatory etiology.2.Stable left adrenal nodule may represent myolipoma versus adenoma.3.Stable cardiomegaly and support devices. |
Generate impression based on findings. | Male; 67 years old. Reason: CT scan after chemotherapy for locally advanced pancreatic cancer History: surveillance ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Minimal intrahepatic biliary ductal dilatation.SPLEEN: Spleen is upper limits of normal.PANCREAS: Again seen is a mass in the region of the pancreatic body extending posteriorly, and it appears grossly unchanged. It measures approximately 4.2 x 4.1 cm, previously 4.2 x 4.1 cm (series 11/41). Stable associated ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable marked narrowing at the portal confluence. Perigastric varices are again seen. At least 180 degree involvement of the celiac trunk and whole encasement of the hepatic and splenic arteries, similar to prior study.. There is also focal encasement of the superior mesenteric artery up to the level of its bifurcation.Unchanged peripancreatic lymph nodes.There is extensive aortoiliac atherosclerotic disease.BOWEL, MESENTERY: Soft tissue attenuation extends to the level of the greater curvature. Moderate amount of stool burden. No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Stable prostatomegaly.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: Trace pelvic free fluid, similar to prior study. | No interval change in size of pancreatic body mass with associated vessel encasement. No new sites of disease. |
Generate impression based on findings. | 73-year-old male with left hip pain. Two views of the left hip demonstrate severe osteoarthritis including near bone-on-bone joint space narrowing, extensive osteophyte formation, subchondral sclerosis and subchondral cysts. Prominent osteophytes exhibit mass effect on the femoral head resulting in superolateral subluxation. There are prominent vascular calcifications in the medial side. | Severe osteoarthritis of the left hip. |
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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign calcifications in both breasts have progressed in a benign fashion.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: NSC - Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 65-year-old female with bilateral lung masses, hemoptysis LUNGS AND PLEURA: Left upper lobe mass measuring 2.8 x 2.9 cm and series 4, image 80). Superior segment right lower lobe mass measures by 5.1 x 4.0 cm (series 3, image 50). This mass compresses the bronchus intermedius, particularly the lower lobe bronchus. Bilateral nonspecific micronodules are noted. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Multiple hypodense nodules in bilateral thyroid lobes. Multiple necrotic appearing mediastinal and hilar lymph nodes, the largest being a left paratracheal lymph node measuring 1.8 cm (series 3, image 31). The heart size is normal. No pericardial effusion. No appreciable coronary artery calcifications.CHEST WALL: No suspicious osseous lesions. No axillary, cardiophrenic, or retrocrural lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hypodense lesions within the liver likely represent benign cysts. | Left upper and right lower lobe mass with mediastinal and hilar lymphadenopathy as described above. |
Generate impression based on findings. | 72 year old female with history of right lumpectomy with adjuvant radiation therapy in 2000 presents for annual diagnostic mammogram. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. Study is limited due to her difficulty in standing. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Right breast is smaller than left breast. Linear scar marker overlies right upper outer quadrant, posterior depth at the site of lumpectomy. Minimal scarring with architectural distortion, dystrophic calcifications and skin retraction unchanged at the lumpectomy site. Innumerable benign calcifications are present in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 48 year old female with known right breast asymmetry presents for routine annual follow-up. No current breast complaints. Family history of breast carcinoma in her sister. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A round marker has been placed in a cutaneous lesion overlying the left breast. There is redemonstration of stable focal asymmetry within the medial right breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No intra- or extra-axial fluid collections. The ventricles and sulci are normal in size without evidence of hydrocephalus. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The imaged portions of the orbits are intact. The osseous structures are unremarkable. | Intracranial structures are unremarkable. No evidence of intracranial or calvarial metastatic disease. |
Generate impression based on findings. | Female 9 years old Reason: post-op History: fractureVIEWS: Left elbow AP and lateral on 3/10/15 (two views) Interval cast removal. Stable position of 4 K wires affixing a healing supracondylar fracture to anatomic alignment. Periosteal reaction and some callus formation is noted. | Healing fracture with no evidence of hardware complication after cast removal. |
Generate impression based on findings. | 85 years, Male. Reason: Evaluate NG tube position History: NG tube Interval placement of NG tube with its tip overlying the fundus of the stomach. The stomach appears less distended compared to prior exam. Bowel gas pattern is otherwise unchanged from to prior exam, nonspecific less than average stool burden. No evidence of mechanical obstruction.Please refer to same day chest region for further evaluation of lungs. | NG tube with tip overlying proximal stomach. Interval decrease in distention of stomach. |
Generate impression based on findings. | Fracture.VIEWS: Left foot AP/lateral (two views) 03/10/15 A cast obscures bone detail. There appears to be sclerosis at the sites of the fractures of the proximal first, second, third, and fourth metatarsals. Alignment is anatomic. | Healing metatarsal fractures. |
Generate impression based on findings. | 35-year-old female with metastatic triple positive breast cancer. Surveillance exam. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules and micronodules are present, which continue to decrease in size and number. The reference lesions are the largest remaining lesions and measure as follows (series 5): 6 mm nodule in the superior segment of the right lower lobe (image 145), previously 5 mm.5 mm nodule in in left upper lobe (image 119), previously 6 mm.Otherwise no focal consolidation or pleural effusion is present.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No significant mediastinal or hilar adenopathy. Stable hypoattenuating right thyroid nodule. Small amount of rebound thymic hyperplasia is present.CHEST WALL: The previously reference right axillary lymph node is more globular in shape, though decreases in long axis, measuring 17 mm from previously 19 mm (series 4, image 32). Sclerotic T8 lesion is redemonstrated, likely representing a metastasis.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Continued improvement in pulmonary metastases. |
Generate impression based on findings. | 49 years, Female. Reason: 49 yo F s/p liver transplant History: dobhoff placement NJ tube tip is past the ligament of Treitz, within the jejunum. Right lower quadrant surgical changes noted. Residual enteric contrast is seen residing in the right lower quadrant, most likely in the cecum. Nonobstructive gas bowel pattern. Additional post-surgical findings are unchanged from the prior exam. | NJ tube tip is past the ligament of Treitz and within the jejunum. |
Generate impression based on findings. | 48 year-old male with head and neck cancer CHEST:LUNGS AND PLEURA: Multiple pulmonary nodules compatible with metastatic disease. Unchanged right apical scarring. Right posterior pleural-based scarring appears to be cavitary, new since the prior exam. These areas are slightly more coalesced since the prior exam. No new pulmonary nodules.Interval increase below right lower lobe nodule and series 4, image 26) now more lobulated measuring 3.1 x 1 .8 cm, previously 2.2 x 1.5 cm.Additional reference right lower lobe pleural-based nodule series 4, image 178) now measuring 12 x 10 mm, previously 9 x 9 mm.Unchanged right pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No appreciable coronary artery calcifications. Status post laryngectomy, esophagectomy and gastric pull up with debris. Right chest port with tip at the superior cavoatrial junction. Slight interval decrease in size of precarinal lymph node, now measuring 7 mm, previously 9 mm (series 3, image 34). Interval decrease in size of right hilar lymph node now measuring 11 mm, previously 14 mm (series 3, image 36).CHEST WALL: Multiple right rib deformities and areas of sclerosis presumably related to prior thoracotomy. No axillary, retrocrural, or cardiophrenic lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Surgical clips are noted in the upper abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Slight interval increase in right pleural-based preference nodules as described above. No new pulmonary nodules.2.Unchanged right pleural effusion.3.Slight interval decrease in size of mediastinal hilar lymphadenopathy. |
Generate impression based on findings. | 43 year old female status post right mastectomy in 2013 for DCIS, presents today for routine follow up. No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient and her husband.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
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. Asymmetry in the left posterior central aspect. No microcalcifications or areas of architectural distortion are present. | Asymmetry in the left posterior central aspect, for which comparison with prior is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISONI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 36 years old Female. Reason: rule out recurrent disease. History: recurrent cervical cancer restaging. RADIOPHARMACEUTICAL: 15.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates a right internal jugular central venous catheter with tip at the cavoatrial junction. The right upper lobe pulmonary nodule has decreased in size. The small nonspecific right lower lobenodular opacity adjacent to the diaphragm is stable.Unchanged left hepatic lobe hypoattenuating lesion which is incompletely characterized on this noncontrast exam. Status post cholecystectomy. Right lower quadrant ileostomy is again seen. There are postsurgical changes within the pelvis.Today's PET examination demonstrates interval near complete resolution of abnormal FDG uptake in the decreasing lung nodule in the right upper lobe. Minimal FDG uptake is seen in the residual nodular density, which is consistent with posttherapy change.Diffuse and mild FDG uptake is seen in the pelvis at perirectal space which is stable. Linear of increased activity over the right femoral greater trochanter is most likely due to bursitis.Mild FDG uptake is seen in the ileostomy site, which is consistent with the post procedural change.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. Soft tissue activity in the left lower abdomen is stable. | 1.No evidence of FDG avid tumor.2.Interval resolution of hypermetabolic lung nodule in the right upper lobe. |
Generate impression based on findings. | Ovarian carcinoma with rising CEA 125 CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable thyroid isthmic nodule.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 2.6 x 0.8 cm low-attenuation serosal lesion adjacent to the medial aspect of the right lobe of the liver best seen on image 93 of series 701. This lesion is somewhat more conspicuous on the current examination.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absentBLADDER: No significant abnormality noted.LYMPH NODES: 1.1 x 0.7 soft tissue focus arising from the right external iliac region best seen on image 156; this is comparison to 0.8 x 0.6 cm on 9/4/2014.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Medially located right hepatic lobe serosal lesion somewhat more conspicuous on the current examination. Slightly increased soft tissue focus right external iliac region within the pelvis. These may represent early metastatic foci. |
Generate impression based on findings. | Female 64 years old; Reason: 64 y/o female with colon ca on Xeloda. Compare to prior History: colon ca CHEST:LUNGS AND PLEURA: There are few scattered pulmonary micronodules. There are no dominant lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is diffusely hypoattenuating compatible with fatty infiltration. Within segment 8 of the liver the hypervascular lesion measures 3.0 x 2.4 cm previously measured 3.0 x 2.0 cm. There is a cyst in the left lateral segment of the liver.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: Postsurgical changes in the cecum.BONES, SOFT TISSUES: Lumbar hemangioma.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Fatty liver without change in the reference hepatic lesion. Its interval stability and imaging features suggest a benign lesion. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of ovarian cancer. Prior history of bilateral breast biopsies with benign histologies. Family history of breast cancer diagnosed in paternal grandmother in her 70s. Two standard digital views of both breasts, additional right MLO view, and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Biopsy clip in the left breast 6 o'clock position, posterior depth is unchanged in position. New biopsy clip seen anteriorly in the 6 o'clock position with previously seen cluster of calcifications no longer visualized. Focal asymmetry in the left 12 o'clock breast is stable. Scattered calcifications, including arterial calcifications, are also stable.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: NSC - Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Family history of breast cancer in maternal grandmother and paternal aunt. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no suspicious solid or cystic mass identified. The known right breast cyst, seen to be stable on this year's mammogram, is present, partially visualized. Mildly dilated ducts without intraductal mass are also noted. | No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Inflammatory polyarthritis. Question of prior erosion, erosion surveillance. Three views of the left hand are provided. Mild osteoarthritis affects the basilar joint, similar to the prior study. No erosions are identified.Three views of the right hand are provided. Mild osteoarthritis affects the basilar joint. No erosions are identified. A small round lucency within the lunate is again seen and likely represents a cyst.Three views of the left foot are provided. No erosions are identified. Three views of the right foot are provided. There is a hallux valgus deformity. A well corticated defect along the margin of the first metatarsal head is unchanged and may represent a degenerative subchondral cyst. | No evidence of erosive changes of the hands or feet. |
Generate impression based on findings. | Clinical question: Septal perforation. Signs and symptoms: Chronic sinusitis. Medtronic fusion sinus CT:Frontal sinuses demonstrate minimal mucosal thickening in the dependent segment.The ethmoid sinuses demonstrate patchy foci of opacification bilaterally (right greater than left).Sphenoid sinus demonstrate minute because of thickening along its anterior wall with resultant occlusion of bilateral sphenoethmoidal recesses.Maxillary sinuses demonstrate extensive opacification on the left and with complete occlusion of the left ostiomeatal unit. There is mild patchy right maxillary mucosal thickening and a small retention cyst. There is compromise of the right ostiomeatal unit.Images through the nasal passage demonstrates a soft tissue defect of the anterior nasal septum measuring approximately 9 mm in cranial cephalad axis 12-mm in AP.There is mild rightward deviation of nasal septum without a bony septal spur. There is a slight collapse of the right nasal valve competent left.Well pneumatized bilateral mastoid air cells and middle ear cavities.Unremarkable images through the orbits. | 1.Extensive left maxillary sinusitis with occluded left ostiomeatal unit.2.Minimal chronic sinusitis of other sinuses.3.Small anterior nasal septum soft tissue defect measuring 12-mm in AP and 9-mm in cranial cephalad axis. |
Generate impression based on findings. | 64-year-old male with abdominal pain and metastatic pancreatic cancer. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary metastases are present, increased in size and markedly in number from the previous exam. No focal consolidation or pleural effusion is present.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. Mild coronary calcifications are present. Right IJ catheter tip at the SVC/RA junction. Right hilar node measures 11 mm in its short axis. No significant left hilar or mediastinal lymphadenopathy is present. Increased number of small predominantly left sided supraclavicular lymph nodes.CHEST WALL: Tiny sclerotic right lateral fourth rib lesion is nonspecific.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Innumerable hypoattenuating liver metastases have markedly increased in size and number, largest in the inferior right lobe measuring 9 cm.SPLEEN: Wedge-shaped areas of hypoattenuating splenic parenchyma likely represent new splenic infarcts.ADRENAL GLANDS: Left adrenal thickening; metastasis not excluded.KIDNEYS, URETERS: Bilateral subcentimeter renal hypodensities, too small to further characterize.PANCREAS: Pancreatic tail mass has enlarged, with new early extension into spleen and superior pole of left kidney. Left adrenal extension is again noted.RETROPERITONEUM, LYMPH NODES: Gastrohepatic and porta hepatis lymphadenopathy appears slightly increased in extent. Multiple retrocaval and aortocaval lymph nodes, some of which are new or increased from the previous exam.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increased extension of primary pancreatic tail malignancy with resulting new splenic infarcts.2.Marked interval progression of pulmonary and hepatic metastases. |
Generate impression based on findings. | Male; 66 years old. Reason: history of urteral cancer, small bowel obstruction History: small bowel obstruction ABDOMEN:LUNG BASES: Trace right pleural effusion with mild right basilar dependent subsegmental atelectasis.LIVER, BILIARY TRACT: Mildly distended gallbladder, which may be due to fasting state. No biliary ductal dilation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable appearance of atrophic right kidney with nonspecific right perinephric fat stranding. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease affects the abdominal aorta and its branches.BOWEL, MESENTERY: High-grade distal small bowel obstruction with transition point in the right anterior pelvis. A small amount of pelvic free fluid. No pneumatosis, portal venous gas, or free air. NG tube tip in stomach.BONES, SOFT TISSUES: Right mid anterior abdominal wall ileal conduit.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy with ileal conduit formation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative changes in the small bowel.BONES, SOFT TISSUES: Postoperative changes from a right iliofemoral bypass graft.OTHER: Mild expansion of the right common femoral vein with increased internal hyperdensity, suspicious for femoral DVT. | 1. High-grade distal small bowel obstruction. 2. Findings suspicious for right femoral DVT, for which ultrasound is recommended. |
Generate impression based on findings. | 67 year old female status post fall 3 days ago with left shoulder, elbow, wrist, and right hand pain. Left shoulder: The bones appear demineralized. There is no fracture or malalignment. Multiple subchondral cysts in the humeral head and glenoid as well as joint space narrowing and inferior osteophyte formation suggests osteoarthritis.Left humerus: The bones appear demineralized. There is no fracture, malalignment, or joint effusion. Left elbow: No evidence of fracture or malalignment. No significant soft tissue swelling.Right hand: The bones appear demineralized. There is deformity and shortening of the fifth metacarpal from an old, healed fracture. There is mild degeneration of the triscaphe and basilar joints. No acute fracture or dislocation. No evidence of bony erosion.Right wrist: The bones appear demineralized. Again seen is deformity of the fifth metacarpal from old healed fracture. No acute fracture or dislocation. No evidence of bony erosion. | 1. Diffuse demineralization, compatible with osteoporosis. 2. Osteoarthritis of the left shoulder. 3. Mild degeneration of the triscaphe and basilar joints in the right wrist. 4. No acute fracture or malalignment. |
Generate impression based on findings. | 67 year old male with right flank pain LIVER: Coarse echotexture of the liver measuring 15.3 cm in length. There is a benign-appearing cyst in the left hepatic lobe measuring 2.0 cm x 1.7 cm x 1.6 cm.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.0 cm in length. No hydronephrosis. OTHER: Left kidney measures 11.5 cm in length and is normal in echogenicity with no hydronephrosis. There is prominent column of Bertin, normal variant. Spleen is normal in echogenicity measuring 8.8 cm in length. | Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. Benign appearing cyst in the left hepatic lobe. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. Incidentally noted is a vessel looping in the proximal half of the right internal auditory canal, likely an AICA loop.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with at least moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1. No pathologic enhancing mass or significant abnormality of the internal auditory canals. 2. Non-specific foci and confluent areas of high T2/FLAIR signal in the subcortical and periventricular white matter, which likely represent at least moderate chronic small vessel ischemic disease. |
Generate impression based on findings. | Female 60 years old; Reason: met anal cancer s/p lung resection of tumor in December 2014. Evaluate for disease recurrence History: anal cancer CHEST:LUNGS AND PLEURA: Postsurgical changes in the right lower lobe from resection of the previously seen nodule. No new pulmonary nodules. There is mild upper lobe emphysematous changes. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Right chest wall port terminates at the cavoatrial junction. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant change in the subcentimeter hypodense right hepatic lobe foci.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodule in the left lateral adrenal limb is unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Hyperenhancement of the vaginal mucosa suggestive of a vaginitis.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Thickening of the anorectal junction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post resection of the right lower lobe pulmonary lesion; no specific evidence of metastatic disease. |
Generate impression based on findings. | Clinical question: AMS. Signs and symptoms: AMS. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter initiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses, mastoid air cells and middle ear cavities. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | 77-year-old male patient with history of prostate cancer and pancreatic cancer, status post distal pancreatectomy and splenectomy. Please obtain a baseline postsurgical CT scan. Per EPIC, surgery was approximately 1.5 months ago. CHEST:LUNGS AND PLEURA: Trace bibasilar atelectasis.Scattered micronodules are not significantly changed in size or number.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy. Prominent right hilar lymphatic tissue is unchanged. Moderate coronary artery calcifications again noted. Cardiac size is within normal limits without pericardial effusion.CHEST WALL: Moderate multilevel degenerative changes affect the thoracolumbar spine.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without CT evidence cholecystitis. Hepatic cysts are again noted and are unchanged compared to prior.SPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomy with a fluid collection anterior to the resection cavity that measures approximately 3.3 cm (series 3 image 112) x 9.0 cm (coronal series 80240 image 62).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 3.0 x 1.7 cm (series 3 image 25), previously 2.7 x 1.8 cm.BOWEL, MESENTERY: Omental and mesenteric fat stranding noted and likely due to prior surgery.BONES, SOFT TISSUES: Moderate multilevel degenerative changes affect the thoracolumbar spine. Posterior fusion hardware noted at L4 and L5.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Right external iliac lymph node measures 2.0 x 1.8 cm (series 3 image 162), not significantly changed.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: Left total hip arthroplasty noted with associated streak artifact, limiting evaluation of the pelvis.OTHER: No significant abnormality noted. | 1.Postsurgical changes from distal pancreatectomy and splenectomy with postsurgical collection anterior to the pancreatic resection bed.2.No significant change in retroperitoneal and pelvic lymphadenopathy. |
Generate impression based on findings. | Reason: HNSCC. Compare to previous. 13-0311 protocol. History: as above CHEST:LUNGS AND PLEURA: There are multiple pulmonary masses with reference measurements as follows:Right upper lobe: 6.8 x 7.9 cm (5/26), as compared to 6.3 x 7.2 cmLeft upper lobe: 3.6 x 4.8 cm (5/33), as compared to 3.1 x 4.2 cmLingula: 7.2 x 10.6 cm (5/50), as compared to 6.7 x 7.0 cm.No new pulmonary nodule or interval pleural effusion.MEDIASTINUM AND HILA: The heart size is normal. Trace pericardial effusion.The lingular mass extends medially and is contiguous with the left hilum and extends into the mediastinal fat, abutting the lateral left atrial appendage in superior pulmonary vein without direct extension into the vessel. Left hilar adenopathy measures 17 mm (3/25), compared to 13 mm. Several upper lobe pulmonary arterial branches extend into the apical mass and are attenuated by it.CHEST WALL: Right port catheter terminates in the right atrium.Stable pretracheal necrotic lymph node (3/6). The right apical mass extends anteriorly across the pleural space and into the subcutaneous tissue of the superior anterior chest wall. The lingular mass does not appear to invade the intercostal muscles.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is a new low density lesion at the caudate, adjacent to the intrahepatic inferior vena cava which is suspicious for hepatic metastasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval growth of the 3 reference pulmonary masses.Increased left hilar lymphadenopathy.Low-density lesion within the caudate suspicious for new hepatic metastasis. |
Generate impression based on findings. | 15 year old male. Fracture/post-op VIEWS: Right ankle AP, lateral, oblique (3 views) 3/10/2015, 1454 Two surgical screws in place in the tibial epiphysis, without evidence of hardware complication. Alignment is anatomic.No periosteal reaction or callus formation. No joint effusion. | Healed distal tibial fracture without hardware complication. |
Generate impression based on findings. | Pain No acute fracture or malalignment is evident. The ankle mortise is intact. No soft tissue swelling or joint effusion. | No acute fracture is evident. |
Generate impression based on findings. | Pain. Question of dislocated TSA. The humeral component of a left total shoulder arthroplasty device is subluxed superior to the glenoid component. No acute fracture is evident. No evidence of dislocation. | Superior subluxation of the humeral component relative to the glenoid component of a total left shoulder arthroplasty device. |
Generate impression based on findings. | 53-year-old female with history of bilateral breast cysts and multiple bilateral cyst aspirations. No current breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is been further decrease in the size of multiple previously identified bilateral circumscribed masses. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Knee pain. There is no acute fracture or malalignment. The joint spaces are preserved. There is a large joint effusion. | Large joint effusion without acute fracture. If there is concern for internal derangement, MRI may be considered for further evaluation |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral breast reductions. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Asymmetric breast tissue, greater on the left, may be postsurgery in etiology. Scattered benign calcifications in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Hand pain. Evaluate for inflammatory arthritis (RA), gout. Three views of the right hand are provided. No bone erosions are identified. No acute fracture is evident.Three views of the left hand are provided. No bone erosions are identified. No acute fracture is evident. Four views of the right foot are provided. No bone erosions are identified. No acute fracture is evident. Four views of the left foot are provided. No bone erosions are identified. No acute fracture is evident. | No radiographic evidence of erosive changes of the hands or feet. |
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