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Generate impression based on findings. | 36 years, Male. Reason: Assess for obstipation, ileus, obstruction History: 36 y.o. man with periumbilical pain, nausea, vomiting. History of abd pain and constipation Nonobstructive bowel gas pattern with average amount of stool. No dilated loop of bowel is evident. | Nonobstructive bowel gas pattern with average amount of stool. |
Generate impression based on findings. | 63 years, Male. Reason: evaluate for obstruction and for G tube position History: severe pain at Gtube site, constipation x 1 week Free air is evident over the right upper quadrant on a left lateral decubitus view, which may relate to recent G-tube placement, although clinical correlation is recommended. There is a gastrostomy tube in place with two T-tacs in place. There is a nonobstructive bowel gas pattern. | Pneumoperitoneum, likely related to recent gastrostomy tube placement, although clinical correlation is recommended. Further evaluation with a dedicated fluoroscopic gastrostomy tube study can be considered as clinically indicated. |
Generate impression based on findings. | 31-year-old male with history of trauma to the lateral side of the left foot two days ago; continued pain. No evidence of fracture or malalignment. No significant soft tissue swelling. | No acute abnormality. |
Generate impression based on findings. | 32-year-old male with pain and swelling of the right thumb after smashing thumb in a door. Three views of the right hand demonstrate a nondisplaced fracture of the tuft of the first distal phalanx. The remainder of the first digit is in anatomic alignment. There is mild soft tissue swelling. | Nondisplaced fracture through the tuft of the distal phalanx. |
Generate impression based on findings. | Reason: stage 3 non small cell lung cancer, s/p radiation, steroids for pneumonitis History: sob CHEST:LUNGS AND PLEURA: Left upper lobe patchy airspace opacity compatible with radiation reaction, generally similar to the prior CT scan.New small left pleural effusion/pleural thickening in the apical region.Mild focal bronchiectasis and small nodules in the right middle lobe, unchanged.Upper zone predominant centrilobular emphysema.Focal reticular and groundglass opacity in the left lower lobe, slightly less dense than prior and likely post inflammatory.No suspicious nodules.MEDIASTINUM AND HILA: No significant hilar/mediastinal lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.Nonspecific inhomogeneity of the thyroid gland, bilaterally.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material and motion artifact limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Biliary ductal dilatation status post cholecystectomy, unchanged. Multiple hepatic cysts are stable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable appearance of enlarged left adrenal gland, likely benign based on the appearance on previous PET/CT.KIDNEYS, URETERS: Multiple bilateral renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate to severe degenerative disease of the spine.OTHER: No significant abnormality noted. | New small left pleural effusion or thickening, which may be related to radiation reaction.No specific evidence of tumor recurrence. |
Generate impression based on findings. | Male, 84 years old, with history of sinonasal adenocarcinoma status post resection. Evidence of extensive sinonasal surgery is again seen. A partially calcified mass within the sphenoid sinus again shows interval increase in size, now measuring 27 x 23 mm (image 20 series 7), previously 24 x 20 mm. As before, this lesion extends from the floor to the roof of the sphenoid cavity.Progressive opacification of the sphenoid cavity is also seen adjacent to the growing tumor nodule which may reflect accumulated secretions. Progressive nonspecific opacification has also occurred within the residual ethmoid air cells. The sclerotic left maxillary sinus region is somewhat better aerated than before, but the right maxillary sinus demonstrates increased bubbly secretions.No pathologic adenopathy is detected in the neck by size criteria. The salivary glands are unremarkable. The thyroid contains numerous small hypoattenuating lesions similar to prior. Also noted is a large heterogeneous mass within the upper mediastinum which may be contiguous with the posterior right thyroid lobe. This lesion measures up to 45 x 38 mm and has not significantly changed in size when accounting for differences in technique.Emphysema is demonstrated in the lung apices. The cervical vessels enhance with evidence of mild atherosclerotic disease at the carotid bifurcations. No new or concerning osseous lesions are demonstrated in the neck. Multilevel several spondylosis is seen with fusion of several lower cervical vertebral levels. | 1.Continued interval growth of a partially calcified mass centered in the sphenoid cavity.2.Progressive opacification of the paranasal sinuses is also seen in which is felt to be inflammatory in nature.3.No evidence of pathologic adenopathy is detected in the neck.4.A large heterogeneous mediastinal mass, possibly related to the right thyroid lobe, has not significantly changed in size. |
Generate impression based on findings. | History of right breast cyst. Three standard views of both breasts and right spot compression views 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. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. There is a focal asymmetry in the right breast anterior depth that disperses with spot compression. A known cyst in the right outer breast at posterior depth is anything smaller, compatible with interval involution of a cyst. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | History of left lumpectomy for breast cancer in the 1970s. Three standard views of both breasts and right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Area of focal asymmetry in the right breast 6 o'clock position was evaluated with spot compression and partially dispersed. Presumed postsurgical distortion under the left breast scar marker is present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made. The patient filled out paperwork to have her prior mammograms sent here.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 72 year-old female with pain in the left knee, swelling and discoloration of the left tibia/fibula. Two views of the left tibia/fibula are unremarkable. There is no evidence of fracture or malalignment. No significant soft tissue swelling.Four views of the left knee demonstrate marked narrowing of the lateral facet of the patellofemoral joint. There is chondrocalcinosis within the knee joint, compatible with calcium pyrophosphate deposition disease. | Unremarkable views of the tibia/fibula. Evidence of calcium pyrophosphate deposition disease in the knee, including chondrocalcinosis and marked narrowing of the lateral patellofemoral joint. |
Generate impression based on findings. | 75-year-old with history of previous left breast pain. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Bilateral benign calcifications are again noted. Benign morphology masses in left breast 5 o'clock position is unchanged.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. | 65-year-old male status post left total knee arthroplasty, in the recovering room. Two views of the left knee demonstrate total knee arthroplasty in anatomic alignment; no evidence of fracture or dislocation. Surgical clips, surgical drain, and iatrogenic gas are present in the soft tissues. | Total knee arthroplasty in anatomic alignment. |
Generate impression based on findings. | Male, 11 months old. Reflux, evaluate aspiration risk. Feeding DifficultyEXAMINATION: Oropharyngeal motility study 3/11/2015, 0930 Beth Harrison, speech and language therapist, supervised the examination.0:57 seconds of fluoroscopy was used.Delayed pharyngeal swallow trigger, incomplete laryngeal closure, resulting in penetration of 1/2 strength and nectar thick liquids.Aspiration of 1/2 strength nectar via clear rim.Patient tolerated nectar thick liquid via clear rim and sippy cup. | Penetration and aspiration as detailed above.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Head: No acute fracture is evident. There is no evidence for intracranial hemorrhage or acute infarction. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. Calcification of the basal ganglia bilaterally, likely related to age. White matter hypodensity compatible with age indeterminant small vessel disease. The visualized portions of the paranasal sinuses and mastoid air cells are clear. Neck: No acute fracture is evident. Severe multilevel degenerative disk disease cervical spine with vacuum phenomenon. Multilevel neural foraminal compromise without evidence of central canal stenosis. There is step wise spondylolisthesis from C3 to C6 with facet hypertrophy. No paraspinal soft tissue swelling. | 1.No evidence of acute fracture.2.No evidence for acute intracranial abnormality. CT is not sensitive for detection of acute nonhemorrhagic ischemia. If high clinical suspicion of CVA, consider MRI.3.Severe multilevel degenerative disease of the cervical spine without evidence of central canal stenosis. |
Generate impression based on findings. | 11 months old, Male, Reason: Evaluate position of dobhoff, initial placement VIEW: Abdomen AP (one view) 3/11/15 Dobbhoff tube tip in the gastric body. Nonobstructive bowel gas pattern. No free air or pneumatosis. | Dobbhoff tube tip in the gastric body. |
Generate impression based on findings. | 64-year-old female status post left total knee arthroplasty. Two views of the left knee demonstrate total knee arthroplasty in anatomic alignment; no evidence of fracture or dislocation. Surgical clips, surgical drain, and iatrogenic gas are present in the soft tissues. | Total knee arthroplasty in anatomic alignment. |
Generate impression based on findings. | 12 years old, Female, Reason: Evaluate for fracture History: Wrist painVIEWS: Right wrist PA oblique and lateral (3 views) 3/11/15 Cortical irregularity consistent with buckle fracture of the distal radial metaphysis. No other fractures are identified. | Buckle fracture of the distal radial metaphysis. |
Generate impression based on findings. | 51-year-old male with back pain. Images of the thoracic and lumbar spine demonstrate a transcutaneous electrical nerve stimulation unit at the midthoracic spine; the wires appear intact, and the device terminates overlying the sacrum. Interpedicular screws are visualized at L2 through L4 in anatomic alignment. There is a slight compression deformity of L1, involving less than 50% vertebral body height loss. There is no evidence of fracture or malalignment. | 1. Interpedicular screws at L2 through L4, in anatomic alignment.2. Mild compression deformity of the L1 vertebral body.3. TENS unit in the midthoracic spine, terminating over the sacrum.4. No acute fracture of malalignment. |
Generate impression based on findings. | 53-year-old female with new dyspnea on exertion and rib pain. Assess for worsening metastatic disease, including pleural effusion. CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary metastases have increased in size and number. The reference of right upper lobe lesion measures 9 mm (image 25, series 6), previously 6 mm. A large malignant left pleural effusion has increased in size, with near complete collapse of the left lower lobe.MEDIASTINUM AND HILA: Heart size is normal with small to moderate pericardial effusion. Enhancing soft tissue adjacent to the left pericardium likely represents a pericardial extension of tumor, new or increased from the previous exam. Extensive bilateral hilar adenopathy has increased in size, with reference left anterior hilar measurement of 4.0 (series 5, image 42), previously 2.4 cm.CHEST WALL: Increased size of large soft tissue component of a previously described lytic left posterior sixth rib metastasis, measuring 8.0 by 3.6 cm (series 5, image 37), from previously 6.0 x 3.1 cm. Internal mammary chain, cardiophrenic and conglomerate left retrocrural lymphadenopathy has also increased. Multiple lytic thoracic spinal metastases are also new, including new inferior endplate irregularities of T9 and T11.ABDOMEN:LIVER, BILIARY TRACT: Extensive hepatic metastases have grown in size and number as well. The reference left hepatic lobe lesion measures 6.2 x 5.3 cm (series 5, image 75), previously 4.6 x 4.8 cm.SPLEEN: Stable nonspecific hypodense lesion may represent a lymphangioma.PANCREAS: No focal pancreatic lesion is identified.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically. A 3.0-cm left upper pole cyst with rim calcification is redemonstrated, and unchanged. No focal renal lesion is identified.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: The bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: Multiple new lumbar vertebral lytic lesions.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: Lytic spinal lesions, as above. Bilateral metastatic deposits to the ilium.OTHER: No significant abnormality noted. | Progression of disease, evidenced by increased pulmonary, osseus, and hepatic metastases, as described above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 42 year-old female with history of pain in the sacrum since fall in 9 months ago; as well as bilateral arthralgias of the hands. Two views of the sacrum reveal degeneration at the sacroiliac joints with sclerosis of the bilateral iliac margins, consistent with osteitis condensans ilii. There is no evidence of fracture. A probable calcified uterine fibroid is present in the left hemipelvis.Three views of the left hand reveal normal anatomic alignment, without evidence of fracture or significant soft tissue swelling. There are no bony erosions.Three views of the right hand demonstrate normal anatomic alignment, without evidence of fracture or significant soft tissue swelling. There are no bony erosions. | 1. Sacral radiographs reveal evidence of osteitis condensans ilii.2. Radiographs of the hands are unremarkable. |
Generate impression based on findings. | Mesothelioma on observation. CHEST:LUNGS AND PLEURA: Post surgical changes of left nephrectomy and diaphragmatic mesh placement. Left hemithorax pleural thickening and volume loss consistent with mesothelioma. Left hemithorax reference measurements as follows:Level of the aortic arch (3/37) 2 o'clock position 7 mm, unchanged, 7 o'clock position (3/34), 6-7 mm, previously 6-mm.Level of the pulmonary artery (3/45), 3 o'clock position 2-mm unchanged. 7 o'clock position approximately 5 mm, previously 4-mm, unchanged.Level of the left atrium (3/62): 12 o'clock position 12 mm, previously 7-mm. 5 o'clock position 1-2 mm, unchanged.Subjective slight increase in non-index tumor posterior to the aortic arch (3/28) and in the left cardiophrenic angle (3/69).Emphysema. 9mm groundglass density nodule right upper lobe (5/37) unchanged. Scarring and architectural distortion of the lower lobes bilaterally. On the right, there is mild proximal airway stenosis of lower lobe segmental airways.MEDIASTINUM AND HILA: Severe atherosclerotic calcification. Signs of prior CABG. Bilateral mediastinal lymph nodes abnormal in multiplicity. Nonindex anterior mediastinal lymph node (3/41), increased in size with a current short axis measurement of 15 mm, previously 9-mm. Additional nonindex lymphadenopathy on the left about the same. Right hilar soft tissue mass described previously difficult to appreciate without the benefit of IV contrast measures 21 x 17 mm, previously 18 x 16 mm (3/61).Multiple pericardial metastases bilaterally, increased in number since the previous examination. Previously measured focal pericardial lesion anteriorly (3/75) measures 20 x 45 mm, previously 13 x 25-mm.CHEST WALL: Unchanged mildly prominent supraclavicular and axillary region lymph nodes bilaterally. Asymmetry and irregularity of left subscapular soft tissue isoattenuating to the musculature is at least mildly suspicious for intramuscular involvement by tumor, appearing increased in both size and density when comparing back to earlier examinations. This is best appreciated on the sagittal and coronal series, images 114 and 58 respectively.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Exophytic cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches. Distal abdominal aorta is affected by focal areas of short segment dissection/penetrating atherosclerotic ulceration, chronic and unchanged.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. | Left hemithorax mesothelioma with reference measurements as above. Increase in nonindex mediastinal lymph node size and in size and number of pericardial metastases. Equivocal left chest wall mass. |
Generate impression based on findings. | 69-year-old female with profound shock and worsening LFTs. Evaluate for Budd-Chiari syndrome. LIMITED ABDOMENLIVER: Measures 16.2 cm in length. Left hepatic lobe mildly complex cysts are again seen, with the previously referenced cyst now measuring 2.3 cm x 2.1 cm x 1.7 cm, previously measured 2.4 cm x 1.9 cm x 1.9 cm, likely not significantly changed accounting for differences in technique. The cyst contains internal and peripheral echogenic foci which may be related to calcification.BILIARY TRACT: Contracted gallbladder which limits evaluation and likely contains sludge/stones. No intra or extrahepatic biliary ductal dilatation. PANCREAS: Hypoechoic focus in the pancreatic body measures 7 mm x 5 mm x 6 mm. No evidence of pancreatic ductal dilatation. SPLEEN: Spleen measures 9.1 cm in length. RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 11.3 cm in length. No hydronephrosis. OTHER: Increased echogenicity of the left kidney measuring 10.8 cm in length. No hydronephrosis. Large ascites. Bilateral pleural effusions. | 1. Left hepatic mildly complex cysts not significantly. If warranted, these can be definitively characterized with contrast-enhanced cross-sectional imaging. 2. Pancreatic body hypoechoic focus may represent a sidebranch IPMN but is indeterminate on this nondedicated study and may be further characterized with contrast-enhanced cross-sectional imaging. 3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction.4. Large ascites. Bilateral pleural effusions. 5. Contracted gallbladder likely containing sludge/stones. 6. Patent inflow and outflow vasculature of the liver. |
Generate impression based on findings. | Male, 14 years old. Tarsal coalition.VIEWS: Bilateral feet DP, lateral, oblique, right calcaneous view (7 views) 3/11/2015, 0938 Valgus deformity of the right metatarsophalangeal joints, most prominent at the first digit.The osseous structures and joint spaces are otherwise normal. No evidence of tarsal coalition. | Right hallux valgus deformity. No evidence of tarsal coalition.. |
Generate impression based on findings. | Mesothelioma, follow-up one CHEST:CHEST: Unchanged and persistent small areas of extrapleural nodular enhancement . Mild postsurgical pleural thickening and right basilar scarring, unchanged from previous. Reference measurements as follows:Above the level of the aortic arch (image twenty eight series three), the 3 and 7 o'clock measures remain 7 and 5 mm respectively.No definite additional tumor is observed at other levels.Linear opacities in the lower lung, consistent with scarring and moderate right diaphragm elevation. The 5-mm subpleural nodule in the left lower lobe (image 76 series 4) is unchanged and consistent with an intrapulmonary lymph node or granuloma. No new abnormal suspicious nodules or masses. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within limits and unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GIpathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No new findings to support tumor recurrence or interval progression. See reference measurements and descriptions above |
Generate impression based on findings. | Female 75 years old; Reason: Pleural mesothelioma. Please compare to prior exam per RECIST criteria. History: Pleural mesothelioma. ABDOMEN:LUNG BASES: Please see separate same-day CT chest report.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Slight interval increase in pancreatic duct prominence, now measuring 5 mm, most previously 3 mm. however, when compared to CT from 9/24/2014, this is not significantly changed. No obvious mass lesion is seen. Stable 6-mm cystic focus in the pancreatic neck, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference, periaortic lymph node on prior scan is difficult to measure today, as it is not well-defined, and may be related to post therapeutic change. It measures approximately 1.1 x 1.0 cm (7:38) and may be grossly stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or absent.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.Difficulty in accurately measuring the reference right para-aortic lymph node, which may be due to post treatment changes, as described above. |
Generate impression based on findings. | 7 months old, Male, Reason: Feeding dysfunction? History: Coughing decreased gag responseEXAMINATION: Oropharyngeal motility study 3/11/15 Beth Harrison, speech and language therapist, supervised the examination.80 seconds of fluoroscopy was used.Thin, half strength nectar, nectar, honey and stage I purée were used to evaluate the oropharyngeal motility. Oral deficits included inefficient bolus expression, loss of bolus to pyriform sinus resulting in penetration. Improved coordination is present with the nectar thick. Pharyngeal deficits include delayed pharyngeal swallow trigger. Penetration was present with thin and semi-thick liquids without cough. No aspiration. | Penetration without cough with thin and semi-thick. No penetration with nectar thick. No aspiration.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Male 36 years old Reason: Crohn's disease, s/p recent stricturoplasty. partial SBO by MRI. Eval for stricture/adhesions History: Ongoing abdominal pain/diarrhea after surgery Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 45 minutes. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae. The neoterminal ileum was identified in the midline upper pelvis, and was widely patent, measuring up to 2.3 cm. The bowel proximal to the neoterminal ileum is dilated measuring up to proximal mid 3.9 cm in maximal diameter, with associated sacculations. Distortions in the small bowel configuration within the pelvis, suggest possible adhesive disease. No fixed narrowings were evident to suggest stricture formation.TOTAL FLUOROSCOPY TIME 6:25 minutes | 1.Dilatation of the terminal ileum with associated sacculations, with a widely patent neoterminal ileum and no evidence of stricture formation.2.Distortions of the small bowel configuration in the pelvis suggests possible adhesive disease. |
Generate impression based on findings. | 85 years, Male. Reason: improvement in distension? History: distension s/p ngt decompression There is a nasogastric tube with its tip projecting over the proximal stomach. Interval improvement in stomach distention. Nonobstructive bowel gas pattern. | Interval improvement in stomach distention. |
Generate impression based on findings. | Mesothelioma, follow-up LUNGS AND PLEURA: The semisolid and ground glass nodules bilaterally again appear not significantly changed. The reference right upper lobe nodule again measures 1.4 cm in short access, unchanged when measured similarly (image 14, series 6). A more solid component is 7 mm. small to moderate pleural effusions, greater on the right and minimally increasingPleural nodularity and right effusion remains compatible with history of mesothelioma. Reference measurements are as follows:1. At the level of the aortic arch (image 31 series 4), the 6 o'clock and 9 o'clock positions remain unchanged, measuring 6 mm and 0 mm respectively2. At the level of the pulmonary artery (image 41 series 4), the 5 and 11 o'clock measurements remained 3 and 1 mm respectively3. At the level of the SVC/RA junction (image 49 series 4), the 6 and 11 o'clock measurements are difficult to discern given the increased small effusion and focality of the 11 o'clock measurements. The gross measurements remained 2 and 10 mm when measured similarly.MEDIASTINUM AND HILA: Increasing size of the lymph nodes or conglomerate lymph nodes. For reference the subcarinal node or nodal mass currently measures 1.8 cm in short axis (image 40 series 4) from a prior measurement of 1.1-cm. in addition, increasing right hilar lymph node, currently measures 1.0 cm (image 49 series 4).Small to moderate pericardial effusion. Coronary calcifications and remaining cardiac and pericardial changes are similarSmall hiatal hernia and small scattered right hypoattenuating thyroid nodules.CHEST WALL: Right chest port. Persistent and mildly enlarging right mammary lymph node, measuring 5 mm (image 34 series 4) from a prior measurement of 4 mmUPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval increasing lymphadenopathy without significant interval changes of the reference pleural measurements, however the latter is limited due to an increase in the small associated pleural effusion. See measurements provided |
Generate impression based on findings. | Clinical question: intracranial bleed. Signs and Symptoms: on warfarin s/p fall Nonenhanced head CT:No detectable posttraumatic intracranial, calvarial of soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white differentiation. Unremarkable orbits, paranasal sinuses and mastoid air cells. | Unremarkable exam. |
Generate impression based on findings. | 42 year-old female with history of pain in the sacrum since fall in 9 months ago; as well as bilateral arthralgias of the hands. Two views of the sacrum reveal degeneration at the sacroiliac joints with sclerosis of the bilateral iliac margins, consistent with osteitis condensans ilii. There is no evidence of fracture. A probable calcified uterine fibroid is present in the left hemipelvis.Three views of the left hand reveal normal anatomic alignment, without evidence of fracture or significant soft tissue swelling. There are no bony erosions.Three views of the right hand demonstrate normal anatomic alignment, without evidence of fracture or significant soft tissue swelling. There are no bony erosions. | 1. Sacral radiographs reveal evidence of osteitis condensans ilii.2. Radiographs of the hands are unremarkable. |
Generate impression based on findings. | 51 years, Male. Reason: dht placement History: dht placement s/p RYGB and lap band This study is limited due to the pelvis not being in the field of view and the study not centered over the Dobbhoff tube. There is a Dobbhoff tube with its tip projecting over the GE junction. There appears to be an "O-sign" of the lap band, suggestive of slippage. There is a nonobstructive bowel gas pattern. Spinal hardware is noted. | Limited study showing Dobbhoff tube with its tip projecting over the GE junction. Possible slippage of lap band. Consider better evaluation with fluoroscopy. |
Generate impression based on findings. | 69-year-old male patient with metastatic prostate cancer. Evaluate for disease after 3 cycles of investigational therapy. CHEST:LUNGS AND PLEURA: There is elevation of the left hemidiaphragm with overlying compressive atelectasis, new compared to prior exam. No suspicious pulmonary nodules are seen.MEDIASTINUM AND HILA: There is interval decrease in mediastinal lymphadenopathy. Reference anterior mediastinal lesion currently measures 3.2 x 1.9 cm (series 3 image 15), previously 3.6 x 3.1 cm. Low right paratracheal lymph node conglomerate measures 1.7 x 0.9 cm and appear to be two separate lymph nodes (series 3 image 28), previously 2.3 x 1.7 cm.Cardiac size within normal limits without pericardial effusion. Mild to moderate coronary artery calcifications noted.CHEST WALL: Three healing right lateral rib fractures. There appears to be an underlying sclerotic lesion adjacent to the rib fracture on the right 11th rib. There is a sclerotic lesion in the left paracentric manubrium (sagittal series 80271 image 84), enlarged compared to prior exam.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left lower pole renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Portacaval lymph node measures 2.3 x 1.9 cm (series 3 image 94), previously 2.1 x 1.9 cm.There is general interval decrease in extensive retroperitoneal lymphadenopathy. Reference left para-aortic retroperitoneal lymph node currently measures 1.7 x 2.3 cm (series 3 image 117), previously 3.1 x 2.7 cm. Conglomerate right para-aortic lymphadenopathy measures 4.0 x 5.0 cm (series 3 image 140), previously 4.2 x 5.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy again noted with reference common iliac lymph node measuring 4.3 x 2.4 cm (series 3 image 150), previously 3.7 x 3.1 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Overall interval decrease in lymphadenopathy in the thorax, abdomen, and pelvis. Reference measurements as above.2.Enlarging sclerotic osseous lesion in the manubrium and stable right rib lesion. Please refer to nuclear medicine bone scan performed the same day for complete details. |
Generate impression based on findings. | Headaches since two weeks No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. There is global parenchymal and loss, commensurate with age. No hydrocephalus. No extra-axial collections. There is opacification of the left frontal and anterior ethmoid air cells. Mastoid air cells are clear. Calvarium is intact. Bilateral lens replacement. | 1. No intracranial hemorrhage or mass effect. If there is continued suspicion for intracranial mass, MRI would be more sensitive.2. Mild paranasal sinus disease with opacification in the left frontal and anterior ethmoid air cells. |
Generate impression based on findings. | History of adenoid cystic carcinoma. Assess for metastatic lesions. No osseous metastatic lesion is identified in the bilateral femurs. There are mild degenerative changes of the bilateral hips and pubic symphysis.Lytic metastatic lesions pelvic osseous metastases are not included in the field of view on this examination. Please refer to the separate CT chest, abdomen, and pelvis report for additional findings. | No evidence of a metastatic lesion in the bilateral femurs. |
Generate impression based on findings. | Clinical question: Evaluate for possible CSF leak and sinus disease. Signs and symptoms: unilateral rhinorrhea, salty taste, left-sided facial pain and pressure. Headache and dizziness. Unenhanced maxillofacial CT:Examination demonstrates well pneumatized all paranasal sinuses and without evidence of mucosal thickening or air-fluid level.There is significant bony thinning and with resultant nondetectable bony density of the planum sphenoidale ( right greater than left) as well as the floor of the sella turcica and bilateral tegmen tympani in a uniform bilateral fashion. This finding is not associated with any fluid opacification of the mastoid air cells or the middle ear cavities. This appearance is an anatomical variation. There is no detectable CSF leak on this exam however possibly two of intermittent CSF leak due to this appearance cannot be entirely excluded. MRI or contrast CT cisternography while patient has active rhinorrhea would be most helpful for further assessment.Images through the nasal passage demonstrate significant angulation deformity of the septum and unremarkable otherwise.Unremarkable images through the orbits and no detectable soft tissue abnormality of the maxillofacial region. | 1.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized and without evidence of mucosal thickening or fluid levels.2.There is significant bony thinning (normal anatomical variation) with resultant lack of visualization of bony density of the planum sphenoidale; floor of the sella and bilateral tegmen tympani as detailed above. There is no evidence of CSF leak on this exam. However above-mentioned severe bony thinning could conceivably result in intermittent CSF leak. Nuclear medicine, MRI or intrathecal contrast CT cisternography while patient experiencing rhinorrhea would be most helpful for detection of possible leak.3.Significant angulation deformity of the nasal septum and unremarkable images through the nasal passage otherwise |
Generate impression based on findings. | For the purposes of numbering, there are 5 lumbar type vertebral bodies. There is evidence of diffuse osseous metastatic disease with areas of sclerosis and lysis throughout the lumbar spine involving all levels, visualized pelvis, and visualized portion of T11 and T12 ribs. Compared to 2/16/2015, there is increase in size of lytic lesion involving the L2 spinous process with a linear lucency violating the cortical surface compatible with a pathologic fracture without displacement. This multiple areas of linear lucency seen within the lumbar vertebral bodies suggestive of fragmentation/subtle fractures such as right inferior L4 vertebral body (sagittal image 63/129). Vertebral body heights demonstrate no significant loss of height. Alignment is maintained. There is soft tissue component associated with some of these lesions for example at the right L2 level there is lesion involving the right aspect of the vertebral body and paraspinous soft tissues measuring 2 cm x 1.5 cm in the AP and transverse dimensions with subtle enlargement of the paraspinous component compared to 2/16/2015.There is mild neural foraminal narrowing at the L4-L5 level relatively worse on the left. Please note MRI can better assess soft tissue abnormalities including epidural tumor. | Diffuse osseous metastatic disease which appears slightly progressed compared to CT abdomen/pelvis dated 2/16/2015. Notably, there is an enlarging lesion involving the L2 spinous process with new linear lucency violating the cortical surface most compatible with pathologic fracture. Multiple vertebral bodies demonstrate subtle areas of linear lucency compatible with fragmentation/early pathologic fractures. No significant loss of lumbar vertebral body heights however. Please note MRI can better assess for epidural tumor. |
Generate impression based on findings. | Mesothelioma, please follow-up LUNGS AND PLEURA: Nodular pleural thickening in the right lower hemithorax again consistent with known mesothelioma. Reference measurements are as follows:1. At the level of the aortic arch (image 32 series 5), the two o'clock measurement remains 2 mm, unchanged. The 5 o'clock measurement is also unchanged at 6 mm.2. At the level of the main pulmonary artery (image 47 series 5), the 12 o'clock measurement remains 8 mm unchanged3. At the level of the right atrium (9 series 5), the 5 and 7 o'clock measurements remain 2.7 and 1.3 cm unchangedStable appearing nonspecific micronodules in the left lung. No pleural effusions or new intrapulmonary findingsMEDIASTINUM AND HILA: Stable extensive lymphadenopathy. The reference right hilar lymph node (image 48 series 5), remains 2.7 cm. The large subcarinal lymph node or conglomerate node (image 51 series 5) remains unchanged at 3.4 cm. Additional extensive mediastinal and hilar lymphadenopathy appears similar.Moderate coronary calcifications without additional pericardial or cardiac abnormalityCHEST WALL: Unchanged scattered cervical and supraclavicular lymphadenopathy other than a single lymph node in the left lower neck, currently measuring 1.4 cm, previously 1.0 cm (image 7 series 5). This may be partially due to differences in gantry angle and technique.Soft tissue nodule involving the right costovertebral junction at the level of the upper abdomen appears similar and unchanged (image 101 series 5). In addition the right chest wall involvement (image 69 series 5) remains 1.7 cm.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Please correlate results with separately reported CT of the abdomen | Stable mesothelioma disease and involvement. Reference measurements provided |
Generate impression based on findings. | Neutropenia, cell transplant with fever and tachycardia rule out infection. LUNGS AND PLEURA: No pleural fluid or pneumothorax. Mild cylindrical bronchiectasis and scarring in the lower lobes. Prominent subpleural lymph nodes along the right minor and major fissures.8mm subpleural nodular scarring or consolidation along the periphery of the right lower lobe laterally, associated with bronchiectasis. In the right posterior costophrenic angle, bronchiectasis terminates in an area of atelectasis or scarring posteriorly.MEDIASTINUM AND HILA: Retained oral contrast material in the thoracic esophagus. Atherosclerotic calcifications of the aorta and its branches, with severe coronary artery calcification noted. Normal heart size. Hypoattenuating blood pool. No pericardial fluid or lymphadenopathy. Hiatal hernia.CHEST WALL: Severe osteopenia/osteoporosis and innumerable lytic lesions consistent with multiple myeloma. Thoracic kyphosis and numerous old, healed fractures. Expansile lytic lesion involving the the right seventh rib laterally (3/48). Multiple collapsed vertebral bodies in the lower thoracic and lumbar spine with vertebroplasty material in the T10 vertebral body.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Severe atherosclerotic calcification of the abdominal aorta and its branches. Artifact from high density contrast material in the upper abdominal viscera limits assessment for pathology in the upper abdomen.. | No conclusive signs of pneumonia; subpleural consolidation in the right lower lobe is associated with bronchiectasis and has an appearance most suggestive of cryptogenic organizing pneumonia. If the patient remains symptomatic, short-term CT follow-up may be obtained. |
Generate impression based on findings. | Male 56 years old; Reason: metastatic prostate cancer on chemotherapy, evaluate for progression History: metastatic prostate cancer on chemo CHEST:LUNGS AND PLEURA: Unchanged scattered bullae.MEDIASTINUM AND HILA: Multiple prominent mediastinal lymph nodes. Reference mediastinal/left paratracheal lymph node seen and unchanged, measuring 2.2 x 1.1 cm, image 39 series 3. Mild interval decrease in size of reference right retrocrural lymph node, measuring 1.4 x 1.1 cm on image 87 series 3, previously measured 1.5 x 1.4 cm. Unchanged subcentimeter left-sided hypoattenuating thyroid nodule, image 14 series 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple new ill-defined bilobar hepatic lesions, worrisome for metastatic disease. Reference hepatic segment 8/7 lesion, measuring 1.4 x 1.1 cm on image 88 series 3. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Stable appearance of enlarged left adrenal gland, accounting for differences in technique, measuring approximately 3.8 x 2 cm, image 98 series 3.KIDNEYS, URETERS: Subcentimeter renal hypoattenuating foci, stable and too small to characterize, including exophytic focus on coronal image 44.RETROPERITONEUM, LYMPH NODES: Stable to mildly increased prominence of reference paraaortic lymph node, measuring 2.1 x 1.1 cm, image 127 series 3, previously measured 1.9 x 1.1 cm. Interval decrease in size of additional aortocaval (previously described as periaortic) reference lymph node, measuring 1.5 x 1 .3 cm, image 108 series 3, previously measured 2.2 x 1.6 cm. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Small bowel containing 1.5 cm periumbilical hernia. No bowel obstruction.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Innumerable sclerotic osseous lesions, compatible metastatic disease, increased in appearance from prior study, for example T11 vertebral body, coronal image 30. | 1. Findings suspicious for new hepatic metastatic disease.2. Stable left adrenal nodularity, suspicious for metastatic involvement. 3. Additional nodal reference lesion demonstrate mixed response as above.4. Innumerable sclerotic osseous lesions, compatible with metastatic disease, increased in appearance from prior study but please refer to concomitant medicine bone scan from same day, scintigraphic imaging more sensitive for evaluation of osseous neoplastic disease. |
Generate impression based on findings. | Female 50 years old; Reason: Pt with stage IIIC mucinous ovarian cancer s/p 6 cycles of chemotherapy with possible progressive disease in liver. History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Significant worsening of existing multiple hepatic metastasis, the largest measuring 6.0 x 6.1 cm in the posterior right hepatic lobe (3:84). Previously this measured 1.5 x 1.8 cm. Additional new metastatic lesions are also noted. Right portal vein is displaced by this large metastasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post TAHBSO.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Free fluid in the pelvis likely related to port.BONES, SOFT TISSUES: Left pelvic subcutaneous chemotherapy port with tip in the pelvis.OTHER: No significant abnormality noted. | 1.Significant worsening of hepatic metastatic disease. |
Generate impression based on findings. | 76-year-old male with right shoulder pain. Four views of the right shoulder demonstrate subchondral cyst formation and mild joint narrowing of the glenohumeral joint, consistent with osteoarthritis. There is osteophyte formation of the acromioclavicular joint. There is no evidence of fracture or malalignment. | Mild degenerative changes of the right shoulder. No acute abnormalities. |
Generate impression based on findings. | RFO trigger: Organ Transplant Suspected RFO location: abdomenName of suspected RFO: sponges,sharps, instruments Attending Surgeon name/pager: Dr. Renz Two surgical drains project over the right hemiabdomen. There is new pneumoperitoneum in the right upper quadrant, presumably postoperative in etiology. Numerous surgical clips are scattered throughout the abdomen. No unexpected radiopaque foreign object is identified. There is a nasojejunal tube with its tip projecting over the proximal jejunum. | No unexpected radiopaque foreign object identified.These findings were discussed via telephone with Dr. Renz at 12:30 on 3/11/2015. |
Generate impression based on findings. | Cancer follow-up. Currently with cough and shortness of breath CHEST:LUNGS AND PLEURA: Postsurgical and post radiation changes appear similar with a small focal fluid collection adjacent to the surgical clips along the major fissure projects in the left upper lobe. Margins remain discrete and unsuspicious, specifically no discrete soft tissue component to support or suggest discrete recurrence.No additional suspicious nodules or masses in the left lower or right lungs. No pleural effusionsMEDIASTINUM AND HILA: No lymphadenopathyModerate to severe c 6 oronary calcifications without additional pericardial or cardiac abnormality. Mild atherosclerotic changesSmall hiatal herniaCHEST WALL: Scattered degenerative changes without interval new abnormality. Specifically no suspicious lytic or blastic lesions observedABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy without additional hepatic abnormalitySPLEEN: 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. | Postoperative and post radiation changes without additional new abnormality and small adjacent suspected fluid collection |
Generate impression based on findings. | S.O.B., assess progression of lung infiltrates. LUNGS AND PLEURA: Small pleural effusions, unchanged. Mild bronchial wall thickening. Minimal were lung zone septal thickening and subsegmental atelectasis. Mosaic attenuation of lung parenchyma seen on the prior study has resolved. Bronchiectasis and scarring in the posterior right upper lobe, with clearing of the previously seen consolidation in this area.MEDIASTINUM AND HILA: Postsurgical findings of heart transplant. Normal heart size. Mild circumferential pericardial thickening, probably containing areas of calcification. Mild to moderate hilar and interlobar lymphadenopathy, most pronounced in the and interlobar regions, about the same. Mediastinal lipomatosis. Left jugular catheter can be followed to the SVC/RA junction. Calcification in the right atrial appendage. Small right cardiophrenic lymph nodes unchanged. In the left lower lateral aspect of the pericardial fat pad, there is an area of what appears to be fatty necrosis (3/67) which is unchanged over multiple studies.CHEST WALL: Median sternotomy wires and plate/screw fixation devices.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Diffuse fat stranding in the upper abdomen. The stomach is distended with fluid and air. The previously seen pancreatic tail pseudocyst is only seen on the last couple of images and cannot be assessed. | 1. Significant interval improvement in pneumonia. Though not specific, the pattern seen on the prior study may be seen with mycoplasma pneumonia; correlate with labs to exclude acute on chronic pancreatitis.2. Chronic hilar and interlobar lymphadenopathy, bronchiectasis, bronchial wall thickening and bilateral lower lung zone scarring, present since 2012.3. Small pleural effusions and septal thickening consistent with mild residual hypervolemia. |
Generate impression based on findings. | Lung cancer, follow-up CHEST:LUNGS AND PLEURA: The reference soft tissue focus adjacent to the right lower lobe bronchus remains 10 mm when measured similarly (image 63 series 4). The described metastatic lesion also appears unchanged and similar in overall contours with less bulkiness, measuring 3.5 x 1.3 cm (image 71 series 4).The focal ground glass abnormality in the posterior left lung is difficult to discern and measure. Approximately this lesion again remains 10 mm (image 53 series 4). Scattered micronodules without additional suspicious lesions. No effusionsMEDIASTINUM AND HILA: The reference subcarinal lymph node is unmeasurable and should stop be measured. No discrete measurable abnormality is identified. No additional lymphadenopathy.Mild coronary calcifications without additional cardiac abnormalitySmall hiatal herniaCHEST WALL: Scattered moderate degenerative changes without suspicious lytic or blastic lesionsABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered splenic granulomataADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No interval change in stable reference measurements. No new suspicious abnormalities |
Generate impression based on findings. | Female, 59 years old, history of esophageal squamous cell carcinoma. Compare previous. 13-0311 protocol. Head:A rim enhancing lesion within the left superior frontal gyrus has increased in size now measuring 19 x 17 mm, previously 14 x 13 mm. The extent of surrounding vasogenic edema has also increased from the prior exam.No definite evidence of any new intracranial lesion is seen. No significant generalized mass-effect is detected. No evidence intracranial hemorrhage or abnormal extra-axial fluid collection is seen. The ventricles remain normal in size and shape.The osseous structures of the skull are intact and the paranasal sinuses are clear.Neck:Posttreatment findings are redemonstrated including diffuse pharyngeal and supraglottic mucosal thickening appearing similar to the prior exam. Infiltration of the fascial planes bilaterally throughout the neck is unchanged and likely treatment related. No evidence of tumor recurrence or significant cervical lymphadenopathy is detected. Nonspecific sclerotic focus within the right anterior mandible is unchanged and likely benign. The left thyroid is heterogeneous and larger than the right with multiple nodules. Salivary glands are unremarkable. Atherosclerotic calcifications at the carotid bifurcations bilaterally. The inferior aspect of the right internal jugular vein is not opacified, similar to the prior exam. Severe degenerative changes of the cervical spine are redemonstrated. A large right apical metastasis invading the right anterior first rib and chest wall, and a smaller left apical mass, are better assessed on the dedicated chest CT. | 1. Interval increase in the size of an enhancing lesion within the left superior frontal gyrus with associated increasing edema.2. Redemonstration of posttreatment findings in the neck with no evidence to suggest progressive disease.3. Lung metastases are better assessed on dedicated chest imaging. |
Generate impression based on findings. | Head: No acute fracture is evident. There is no evidence for intracranial hemorrhage or acute infarction. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. Calcification of the basal ganglia bilaterally, likely related to age. White matter hypodensity compatible with age indeterminant small vessel disease. The visualized portions of the paranasal sinuses and mastoid air cells are clear. Neck: No acute fracture is evident. Severe multilevel degenerative disk disease cervical spine with vacuum phenomenon. Multilevel neural foraminal compromise without evidence of central canal stenosis. There is step wise spondylosis from C3 to C6 with facet hypertrophy. No paraspinal soft tissue swelling. | 1.No evidence of acute fracture.2.No evidence for acute intracranial abnormality. CTs not sensitive for detection of acute nonhemorrhagic ischemia. If high clinical suspicion of CVA, consider MRI.3.Severe multilevel degenerative disease of the cervical spine without evidence of central canal stenosis. |
Generate impression based on findings. | Male 63 years old; Reason: evaluate for small bowel mass/tumor which may be causing obscure bleeding - no source on EGD, colon, VCE History: anemia ABDOMEN:LUNGS 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: Subcentimeter hypoattenuating focus in the right kidney, attenuation similar to that of fat and may be a small angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant small bowel loops not well distended and collapsed, image 106 series 3, making assessment suboptimal. Within these limitations, no enhancing small bowel mass seen. No evidence of bowel obstruction. Visualized terminal ileum within normal limits. PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate, measuring 5.6 cm in transverse dimension. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. Left lower quadrant small bowel loops not well distended and collapsed, image 106 series 3, making assessment suboptimal. Within these limitations, no enhancing small bowel mass seen. No evidence of bowel obstruction. Visualized terminal ileum within normal limits. |
Generate impression based on findings. | Squamous cell carcinoma of eyebrow. LUNGS AND PLEURA: Minimal scattered scarring without additional discrete acute intrapulmonary abnormalities. Specifically, no suspicious nodules or masses. No effusions. Minimal scattered suspected scarring and emphysematous changes, with minimal atelectasis in both bases. MEDIASTINUM AND HILA: No acute lymphadenopathy, however numerous scattered calcified lymph nodes greater in the right hilar region are observed. Old granulomatous disease exposureModerate to severe coronary an annular calcifications without additional distinct cardiac or pericardial abnormality.Small hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Persistent cystogastrostomy incompletely visualized in the upper abdomen. Scattered calcified granulomata and extensive cyst and atrophy of both kidneys incompletely visualized. Cholelithiasis, overall consider dedicated imaging of the abdomen if further characterization is needed. | No suspicious findings to suggest intrapulmonary metastatic disease. |
Generate impression based on findings. | Lung cancer, follow-up CHEST:LUNGS AND PLEURA: Interval enlarging right pleural effusion with underlying compression atelectasis. No definite distinct superimposed focal new intrapulmonary new nodules or masses this limited evaluation. The right spiculated nodule in the apex again measures 2.5 cm when measured similarly with associated extension to the pleural surface. Enlarging and now moderate to large right pleural effusion.Specifically no contralateral suspicious abnormalities including nodules or or effusion. Marked centrilobular and paraseptal emphysema again observed.MEDIASTINUM AND HILA: Extensive confluent mediastinal and hilar lymphadenopathy greater on the right. Associated tracheal deviation and distortion unchanged. The reference right paratracheal focus again measures 3.1 cm (image 36 series 5) with associated compression of the SVC. Similar right hilar node measurement again 3.1 cm (image 42 series 5).Extensive tumor masses at the level of thoracic inlet are again observed and remain inseparable from the lateral chest wall. Associated mediastinal and esophageal deviation.Moderate coronary calcifications and small pericardial effusion, possibly physiologic), however no additional cardiac or pericardial acute abnormalities. Small hiatal herniaCHEST WALL: Extensive rib involvement throughout the right hemithorax with associated rib destruction. Appearance grossly unchanged along with soft tissue components. Changes include the right third, eighth and ninth ribs.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: New interval mass involving the right adrenal, measuring 4.8 x 2.5 cm (image 106 series 5). Nodularity is now also observed in the left adrenal. Suspected metastatic diseaseKIDNEYS, 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. | Enlarging right pleural effusion yet without underlying thoracic and extensive lymphadenopathy changes, however new metastatic disease observed in both adrenals greater on the right. |
Generate impression based on findings. | Back pain Three views of the thoracic spine are provided. Vertebral body heights are maintained. Alignment is anatomic. No acute fracture is evident.Five views of the lumbar spine are provided. There are posterior stabilization rods extending from L4 to L5. There is a slight anterolisthesis of L5 on S1. No acute fracture is evident. | 1. Postoperative changes of a L4/L5 posterior spinal fusion without evidence of hardware complication.2. Slight anterolisthesis of L5 on S1. |
Generate impression based on findings. | 46 year old female with knee pain status post fall. Four views of the right knee demonstrate a small joint effusion. There is no evidence of fracture or malalignment. Osteophyte formation and mild joint space narrowing suggests osteoarthritis. | Small joint effusion without evidence of acute fracture or malalignment. |
Generate impression based on findings. | Evaluate for fracture. Three views of the right second toe reveal an nondisplaced dorsal fracture of the distal phalanx. This is unchanged from the previous exam of February 20 | fracture of the second distal phalanx unchanged from previous |
Generate impression based on findings. | Postop. Prosthetic assessment. Three views of the right knee reveal a right total knee arthroplasty device in anatomic alignment without evidence of loosening or hardware complication. No acute fracture is evident.AP view of the bilateral knees also demonstrates a left total knee arthroplasty device situated in anatomic alignment without evidence of hardware complication. | Right total knee arthroplasty device without evidence of hardware complication. |
Generate impression based on findings. | Assess fracture Three views of the left ankle reveal a spiral fracture of the distal fibula that extends down to the joint. Fracture is in near-anatomic alignment. In addition, there is a small bone fragment adjacent to the medial malleolus that may represent an avulsion fracture. No change from previous exam of February 20 | Ankle fractures unchanged from previous exam |
Generate impression based on findings. | Status post reverse TSA, latissimus transfer. There is a right shoulder reverse ball and socket arthroplasty device in anatomic alignment. There is no evidence of hardware complication or significant interval change. No acute fracture is evident. Absence of the distal clavicle is presumably postsurgical in nature. A linear radiodensity superior to the distal clavicle is also presumably postsurgical, unchanged. | Postoperative changes of a right total shoulder arthroplasty. |
Generate impression based on findings. | Left shoulder pain. Assess left shoulder for bony causes of left shoulder pain. No acute fracture or dislocation is evident. There is mild osteophyte formation at the acromioclavicular joint. | Minimal acromioclavicular joint osteoarthritis. |
Generate impression based on findings. | Sarcoidosis, sickle cell disease iron overload, chronic liver failure, pulmonary hypertension, hypoxic respiratory failure. LUNGS AND PLEURA: No significant change in sarcoidosis-related interstitial lung disease since the 2011 examination, including a focal area of cystic bronchiectasis containing fluid in the right costophrenic angle (5/67). Although limited by motion artifact, mild peribronchial groundglass distribution opacity in the right lung (5/42), especially within the right middle lobe, is new from the prior study and consistent with an active inflammatory or infectious process.MEDIASTINUM AND HILA: Severe enlargement of the central pulmonary vasculature compatible with pulmonary arterial hypertension. The main pulmonary artery measures 5-cm in transverse dimension (3/36) compared to 4.1-cm on the prior examination. Multichamber cardiomegaly slightly progressed. Mild pericardial thickening, but no pericardial fluid. Right jugular and subclavian catheters terminate at the superior cavoatrial junction. No visible coronary artery calcification.CHEST WALL: Skeletal stigmata of sickle cell disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Hyperattenuation of the hepatic parenchyma compatible with history of iron overload. Autosplenectomy, with calcified splenic remnant the left upper quadrant. The kidneys appear enlarged with transaxial dimensions of 8.2 x 5.4 cm on the left and 5.3 x 6.9 cm on the right, suggestive of solid organ infiltration. | 1. Mild bronchiolitis/pneumonitis pattern in the right lung. Differential diagnosis absent a clinical history of hemoptysis includes follicular bronchiolitis (a rarer but described complication), cellular bronchiolitis from causes such as viral or mycoplasma pneumonia, acute alveolar hemorrhage is considered less likely based on the appearance of the lack of surrounding abnormality. Consider a follow-up HRCT mildly protocol when the patient is better able to breath hold for improved anatomic delineation. Density of these abnormalities is less than what would be seen in alveolar sarcoidosis.2. Progression of pulmonary arterial hypertension since prior examination.3. Hyperattenuation of the liver parenchyma is compatible with iron overload.4. No significant change in fibrocystic pattern of interstitial lung disease compatible with sarcoidosis.5. Suspected renomegaly may be confirmed with ultrasound. |
Generate impression based on findings. | Male 82 years old; Reason: urothelial carcinoma-s/p cystoprostatectomy- ileal conduit urinary diversion on 10/3/14 History: urothelial carcinoma-s/p cystoprostatectomy- ileal conduit urinary diversion on 10/3/14 ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The liver is normal in morphology. No focal hepatic lesions. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal gland nodule measures less than 10 Hounsfield units and is compatible with an adenoma, unchanged.KIDNEYS, URETERS: The right kidney is atrophicLeft kidney enhances homogeneously. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: There are few scattered retroperitoneal lymph nodes.Small nodes also noted adjacent to the crus of the right hemidiaphragm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the bowel. There is a right ileal conduit urinary diversion.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Along the right pelvic sidewall adjacent to the right internal iliac artery there is a partially cystic solid mass that abuts the sigmoid colon measuring 3.7 x 3.5 cm (image 108/series 7). A small cystic lesion is located along the left pelvic sidewall and likely represents a seroma or lymphocele.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings of a soft tissue cystic/solid mass in the right hemipelvis its imaging features are suspicious for a necrotic node. |
Generate impression based on findings. | Pain. Assess prosthesis Four views of the left shoulder reveal a reverse ball and socket arthroplasty in anatomic alignment. No change is seen from the previous exam. There are bullet fragments noted. The gas collection that was seen on the previous exam is no longer present | Reverse total shoulder arthroplasty in anatomic alignment |
Generate impression based on findings. | Female, 16 years old. Reason: eval for fx History: ankle painVIEWS: Right ankle, AP, lateral, oblique (3 views) 3/11/2015, 1209 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Low back pain radiating down right leg. There is no acute fracture. There is mild disk space narrowing and anterior osteophyte formation throughout the lumbar spine. Vertebral body heights are maintained. Partially imaged right hip arthroplasty device. | Degenerative changes as above. |
Generate impression based on findings. | 54-year-old male with concern for rheumatoid arthritis. Three views of the left hand demonstrate normal anatomic alignment. No rheumatologic erosions are identified. There is no significant soft tissue swelling or fracture. Incidental note is made of a nonfused ulnar styloid fragment.Three views of the right hand demonstrate normal anatomic alignment. No rheumatologic erosions are identified. There is no significant soft tissue swelling or fracture. | No radiographic evidence of rheumatoid arthritis. |
Generate impression based on findings. | Right proximal femur replacement for osteosarcoma. Evaluate for hardware complications. Two views of the right femur show a proximal femur resection with hardware components of a right hip hemiarthroplasty and endoprosthetic reconstruction with a long femoral stem. No evidence of hardware complication. Heterotopic ossification is noted about the right hip. | Postoperative changes of right proximal femur resection and endoprosthetic reconstruction without evidence of hardware complication or tumor recurrence. |
Generate impression based on findings. | Prostate cancer. Left-sided rib pain Three views of the ribs reveal patchy widespread sclerosis in the ribs and in the vertebrae. There also areas of sclerosis in the pelvis. The previous bone scan from February 10 reveals widespread osseous metastasis. Incidental note is made of an old right clavicle fracture. | Widespread sclerotic metastases |
Generate impression based on findings. | 6 years old, Male, Reason: evaluate kyphosis History: kyphosisVIEWS: Lumbar spine lateral (one views) 3/11/15 Thoracic kyphosis is minimally improved measuring 50 degrees (previously 56 degrees) from T1 to L1. Mild straightening of the lumbar lordosis is again noted. No fracture or subluxation. Vertebral body heights and disk spaces are maintained. | Minimally improved thoracic kyphosis. |
Generate impression based on findings. | 72-year-old female with bilateral knee and left shin pain. Four views of the right knee demonstrate joint space narrowing, subchondral sclerosis, loose body in the joint and osteophyte formation, consistent with severe tricompartmental osteoarthritis, which has progressed when compared to prior into 2011. No significant joint effusion.Four views of the left knee demonstrate joint space narrowing, subchondral sclerosis, and osteophyte formation, consistent with severe tricompartmental osteoarthritis, which has progressed when compared to prior into 2011. No significant joint effusion.Two views of the left tibia/fibula are unremarkable except for the aforementioned osteoarthritic of the knees. No evidence of fracture or malalignment. No significant soft tissue swelling. | Severe bilateral tricompartmental osteoarthritis, which has progressed when compared to previous study. The left tibia and fibula are unremarkable. |
Generate impression based on findings. | Female, 15 years old. Reason: Evaluate for fracture History: left wrist pain x 1 yearVIEWS: Left wrist AP, lateral, oblique (3 views) 3/11/2015, 1308 The osseous structures are normal.Mild posterior displacement of the ulnar head, a normal variant.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 41-year-old female with right upper quadrant and left upper quadrant tenderness, rising bilirubin, ascites. Evaluate for venoocclusive disease, infectious process. LIMITED ABDOMENLIVER: Normal echogenicity measuring 21.1 cm in length. No focal hepatic lesions. BILIARY TRACT: Gallbladder is normal in echogenicity. Thickened gallbladder wall which is nonspecific in the setting of ascites. No intra or extrahepatic biliary ductal dilatation. PANCREAS: The visualized portions of the pancreas are normal in echogenicity. No evidence of pancreatic ductal dilatation. SPLEEN: Spleen measures 16.3 cm in length. RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 11.9 cm in length. No hydronephrosis. OTHER: Increased echogenicity of the left kidney measuring 13.0 cm in length. No hydronephrosis. Ascites and bilateral pleural effusions are noted. | 1. Hepatic veins are patent with normal directional flow however there is blunting of the waveforms most apparent in the right hepatic vein which may be seen in the setting of venoocclusive disease. 2. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. 3. Hepatosplenomegaly.4. Thickened gallbladder wall which is nonspecific in the setting of ascites. 5. Ascites and bilateral pleural effusions. |
Generate impression based on findings. | Female, 82 years old, history squamous cell carcinoma status post glossectomy. Assess for recurrence. Again seen are postoperative findings related to left hemiglossectomy and flap reconstruction with bilateral neck dissections.Ill-defined, mildly hyperenhancing soft tissue fullness has become more prominent along the base of tongue at the level of the anastomosis of the soft tissue flap with residual right tongue. This fullness extends posteriorly to involve the vallecula and the epiglottis (see image 36 of series 6).Elsewhere, the aerodigestive mucosa is unremarkable. No pathologic adenopathy is detected by size criteria in the neck. The right parotid gland is atrophic relative to the left. The submandibular glands are not clearly present and may have been resected. The thyroid is unremarkable. The cervical vessels enhance normally. Mild scarring in the lung apices is seen.The mandible is mildly sclerotic and there is some bone loss along the alveolar ridge to the right of midline which is similar or at most minimally progressed relative to prior. No new or concerning osseous lesions are seen. Severe right TMJ degeneration is demonstrated. | 1.Ill-defined mildly enhancing soft tissue fullness has progressed at the base of tongue, adjacent to the surgical flap anastomosis, projecting posteriorly to involve the vallecula and epiglottis. The nature of this tissue is uncertain but direct visual inspection is recommended to exclude progressive neoplastic disease.2.No evidence of pathologic adenopathy or any other clear disease progression is seen elsewhere in the neck.3.Sclerosis of the mandible is redemonstrated along with mild bone loss along the alveolar ridge on the right which may be slightly progressed. Findings could represent radiation related bony change. |
Generate impression based on findings. | 36-year-old female with history of systemic sclerosis and known ILD LUNGS AND PLEURA: Diffuse, basilar predominant pulmonary fibrosis with associated paraseptal emphysema. Peripheral honeycombing in the lung bases with traction bronchiectasis. Diffuse ground glass opacities in the spared lung parenchyma with interlobular septal thickening suggestive of diffuse edema, not significantly changed since the prior exam. Calcified granuloma right lower lobe. Interval resolution of right pleural effusion with persistent small left pleural effusion within the major fissure.MEDIASTINUM AND HILA: Multiple hypodense thyroid nodules. The pulmonary artery measures approximately 27 mm, borderline enlarged suggestive of pulmonary hypertension. Moderate cardiomegaly with small pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: The osseous structures are within normal limits. No suspicious osseous lesions. Mildly prominent axillary lymph nodes. No cardiophrenic or retrocrural lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant change in fibrosing NSIP pattern as described above. Overlying pulmonary edema pattern not significantly changed since the prior exam. |
Generate impression based on findings. | Head: There is enlargement of the right foramen rotundum, vidian canal, and foramen ovale with poor delineation of the posterior margin of the right foramen ovale, which is stable from 11/14. Meckel's cave appears symmetric. There is questionable asymmetric enhancement and fullness of the right cavernous sinus, stable also from November. No intraparenchymal lesion or leptomeningeal enhancement is identified. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Neck: Evaluation is significantly limited by motion artifact and streak artifact from dental fillings. Please note that this field of view does not include up to the inferior orbits, as intended.Heterogeneous mass arising from the right submandibular gland measuring 4.5 x 3.0 cm (series 6 image 21), previously also measured 4.5 x 3.0 cm. However, there is decrease in lateral hypodensity as well as increased soft tissue posteromedially. There appears to be more soft tissue extension medially with fullness of the soft tissue along the right floor of the mouth suggested, extending to midline. Subtle effacement of adjacent fat planes is also suggested. Evaluation of mass involvement of the mandible and the floor of the mouth is significantly limited by streak and motion artifacts. There is erosion of the adjacent lingual cortical margin of the right mandibular body and expansion of the right mandibular canal. There is also progressive erosion by infiltrative soft tissue of the lingual cortex of the left mandible with now a wide cortical defect measuring 1.4-cm (series 7 image 13), and the bony left mandibular canal is not well delineated. There is suggestion of some effacement of fat planes medial to the left submandibular gland. Bilateral mental foramen are grossly within normal limits, and fat in the mandibular foramina appears preserved. There is nonspecific asymmetric enhancement of the right anterior belly of the digastric and the right mylohyoid muscle stable from 11/14, which may be prior treatment sequela. There is also slight asymmetric contour of these muscles.Stable appearing level 2A right necrotic lymph node measuring 1.7-cm (series 6 image 19), previously 1.7-cm. Adjacent right level 2A lymph node is increased in size now measuring 1.3 x 1.1 cm (series 6 image 19), previously 0.9 x 0.7 cm. There is an additional enlarged lymph node posteriorly with central coarse calcification measuring 2.1 cm x 1.1 cm (series 6 image 20), previously measured 2.0 x 1.0 cm. Stable scattered small submental and submandibular lymph nodes. There is fatty replacement of the parotid glands. Thyroid gland is surgically absent. Airway is patent.Left vertebral artery originates directly off of the aortic arch, which is a normal variant. Major vessels are patent. There is mild rightward mediastinal shift, likely related to partially visualized large left pleural effusion. There are multiple pulmonary nodular metastases, which are increased in number and size. Please see same day dedicated chest CT report.Interval increase in the size of the lytic C6 vertebral metastatic lesion measuring 1.9 x 1.4 cm (series 7 image 39), previously 1.7 x 1.1 cm. There is new lytic T1 vertebral body lesion measuring 0.8 x 0.5 cm (series 7 image 49) and lytic T4 vertebral body lesion measuring 1.0 x 1.4 cm (series 7 image 67). No evidence of compression fracture. | 1.Interval progression of left mandibular destruction now with wide lingual cortical defect by soft tissue invasion, presumably from the left submandibular gland as surrounding fat planes are somewhat effaced, versus metastatic disease. Floor of mouth is difficult to evaluate for extension of tumor across midline from the right due to artifact. Similar size of previously described heterogeneous right submandibular mass with interval slight change in internal appearance and similar mandibular involvement, within limitations of artifact.2.Enlargement of the right foramen rotundum, foramen ovale, and vidian canal, which appears stable from November study, concerning for perineural spread of tumor. Questioned stable slight asymmetric prominence of right cavernous sinus. MR would be more sensitive.3.Interval increase in the size of the pathologic right level 2A lymph node, and increased size of an additional adjacent 2A node.4.Interval development of T1 and T4 vertebral body metastatic lesions and increase in the size of the known C6 vertebral metastatic lesion. No evidence of compression fracture.5.Partially visualized large left pleural effusion. Multiple pulmonary nodular metastases which have increased in size and number. Please see same day dedicated chest CT report. |
Generate impression based on findings. | 3 years old, Female, hip subluxationVIEW: Pelvis AP and frog leg (one view) 3/1115 Overlying material obscures fine bone detail portions of the pelvis. Femoral heads are round and smooth and well directed into a normally formed acetabula. The acetabular coverage is greater than 60% of the femoral head. | No subluxation. |
Generate impression based on findings. | 57-year-old male with history of peritoneal mesothelioma, signs of left-sided sciatica. Two views of the lumbar spine demonstrate normal anatomic alignment, without evidence of fracture. Sclerosis of multiple lumbar facet joints as consistent with degenerative disease. A sclerotic focus in the T12 vertebral body likely represents a small bone island. | Degenerative lumbar facet joints without evidence of acute abnormality or malalignment. |
Generate impression based on findings. | Assess for fracture. Snuffbox tenderness Five views of the left wrist are unremarkable. No radiographic bodies. No fractures. | Negative left wrist examination |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in her maternal grandmother at age 70. Family history of ovarian carcinoma in her paternal aunt in her 80s. Two standard digital views of both breasts were performed, with tomosynthesis, and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Patient with HIV and concern for PCP pneumonia. History dyspnea LUNGS AND PLEURA: Exam with marked limitation secondary to motion.No distinct focal area of consolidation or air space abnormality, however multiple small areas largely the both bases are suspected with additional atelectasis. Two distinct focal and subcentimeter nodules are observed in the right upper lobe (image 52 and 51, series 4) measuring approximate 6 mm. The multiplicity and appearance given the relayed history raise concern for infection , however the overall appearance is also nonspecific. Serial imaging may be indicatedNo additional distinct superimposed effusions or specific findings to support pneumocystis pneumoniaMEDIASTINUM AND HILA: No lymphadenopathyMild coronary calcifications without additional distinct cardiac or pericardial abnormality.CHEST WALL: No gross abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted within this severely limited evaluation given motion described above. | Questionable nonspecific interpulmonary changes including small nodules in the right upper lobe within limitations outlined above. Concern for infection and possible serial follow-up imaging is indicated to confirm |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of a stable asymmetry within the left lateral breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. Normal morphology lymph nodes are present within both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 76-year-old female status post total knee arthroplasty, postop follow-up. Three views of the right knee demonstrate the hardware components of a right total knee arthroplasty device in near-anatomic alignment, without evidence of hardware complication, similar to prior exam. There is no evidence of acute fracture or malalignment. | Bilateral total knee arthroplasty in anatomic alignment. |
Generate impression based on findings. | History of T1N2b SCC R tonsil p16+ , Post chemoradiation. Again seen are post-treatment findings including soft tissue thickening along the fascial planes and fat-stranding in the right neck. No measurable tumor in the right tonsillar fossa. There is no significant lymphadenopathy in the neck. For example, the right level 2 lymph node is unchanged in size, measuring 6 mm in short axis, previously also 6 mm. There is effacement of the right vallecula and piriform sinus likely related to secretions and treatment change without apparent underlying mass. The thyroid and major salivary glands are unchanged. The major cervical vessels are patent. The osseous structures are unchanged. The airways are patent. There is minimal mucosal thickening in the maxillary sinuses. The imaged portions of the lungs are clear. Please see separate report for findings in the chest. | Post-treatment findings in the neck without evidence of recurrent tumor. No significant lymphadenopathy in the neck. |
Generate impression based on findings. | Non-small cell lung cancer. CHEST:LUNGS AND PLEURA: Left upper lobe proper is largely collapsed by paramediastinal radiation fibrosis. Unchanged appearance. No new or suspicious nodules. Small left pleural effusion, minimally larger.MEDIASTINUM AND HILA: Mild rightward mediastinal shift. Loculated pericardial fluid collection, probably a pericardial cyst, unchanged. Severe coronary artery calcifications. No lymphadenopathy. Atherosclerotic calcification of the left proximal subclavian artery.CHEST WALL: Osteopenia.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small exophytic cysts, incompletely characterized.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches. Unchanged small retroperitoneal lymph nodes.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Mesenteric fat stranding in the left upper quadrant is chronic and unchanged suggestive of chronic mesenteric panniculitis. Suspected small polyp in the mid transverse colon (coronal image 79, axial series image 100).BONES, SOFT TISSUES: Osteopenia. Osteophytes.OTHER: Correlation of the left hemidiaphragm consistent with phrenic nerve paralysis | 1. Unchanged exam, no specific evidence of recurrent or metastatic disease. 2. Suspected small transverse colon polyp.3. Severe coronary artery calcifications. |
Generate impression based on findings. | 36 years, Female. Reason: sbo? constipation? History: RLQ pain Dense calcifications of the bilateral renal arteries. There is a nonobstructive bowel gas pattern. A peritoneal dialysis catheter has been removed. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Female 81 years old; Reason: 81 y/o female with colon ca on Xeloda. pls compare to prior History: see above CHEST:LUNGS AND PLEURA: Spiculated left upper lobe nodule not significantly changed, measuring 9 x 7 mm (series 4, image 25) from previously 8 x 8 mm. Stable scattered bilateral micronodules. No focal consolidation or pleural effusion is present.MEDIASTINUM AND HILA: Severe coronary calcifications are present. Mild aortic arch atherosclerotic calcifications are additionally noted. Mild cardiomegaly. Multiple hypoattenuating bilateral thyroid nodules are redemonstrated. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary, subpectoral, or internal mammary lymphadenopathy. No suspicious focal osseous lesion. Moderate degenerative changes affect the visualized spine.ABDOMEN:LIVER, BILIARY TRACT: Increased size and number of hepatic metastases. A large central, centrally necrotic metastasis measures 7.4 x 5.4 cm (series 3 image 93), from previously 6.7 x 4.3 cm. At least 5 new hypodense lesions are evident in the left hepatic lobe.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Two right renal cysts and other bilateral renal subcentimeter hypodensities, too small to further characterize. Three nonobstructing left renal punctate calculi.RETROPERITONEUM, LYMPH NODES: Moderate calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes affect the visualized spine. L1 vertebral body hemangioma. No suspicious focal osseous lesion.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: Multiple intraluminal colonic fat attenuating round lesions for example in the distal sigmoid colon, which may represent intraluminal lipomas versus ingested material.BONES, SOFT TISSUES: Moderate degenerative changes affect the visualized spine. No suspicious focal osseous lesion. | 1.Increased size and number of hepatic metastases.2.Unchanged spiculated left upper lobe pulmonary nodule, remains suspicious neoplasm particularly primary lung malignancy. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast carcinoma in her mother. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Circumscribed masses are present in both breasts, likely benign etiology however correlation with prior mammogram would be helpful. Clustered masses are present within the upper outer right breast, with a single punctate associated calcification. Focal asymmetry in the left central breast. | Bilateral masses and left focal asymmetry for which comparison to prior studies is needed. If those are not submitted, then the clustered masses and left focal asymmetry will require additional work up. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Right shoulder pain. Evaluate for osteoarthritis. Three views of the right shoulder reveal no acute fracture or dislocation. An approximately 3 x 2 cm well ossification inferior to the acromion may represent heterotopic ossification. There is osteophyte formation at the inferior glenohumeral joint. | Moderate osteoarthritis of the glenohumeral joint. |
Generate impression based on findings. | Shortness of breath LUNGS AND PLEURA: Focal pleural soft tissue density along the lateral aspect of the left upper lung (image 24 series 4) measures under 2 cm. Hounsfield counts straddle water density with questionable fat. The benign appearance remains unchanged, including overall size and tissue characteristics when compared to prior outside imaging dating back to 6/25/14The remainder of the lungs are otherwise significant for mild centrilobular emphysema and scattered micronodules without suspicious additional focal lesions. No masses or effusions.Numerous scattered tracheal nodules are observed with less involvement of distally in the main bronchi or subsequent secondary branching. Overall appearance is also similar to prior exams yet limited given only axial imaging provided from prior outside imagingMEDIASTINUM AND HILA: No lymphadenopathyModerate coronary calcifications without additional discrete cardiac or pericardial abnormalityModerate hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Numerous and incompletely visualized renal cysts given lack of contrast and incomplete imaging of the kidneys bilaterally. The remainder of the upper abdomen is otherwise grossly unremarkable within this limited evaluation | Numerous grossly stable small tracheal soft tissue nodular abnormality grossly unchanged since 6/25/14. Appearance remains compatible with patient's history of tracheal papillomas without immediate additional complication. |
Generate impression based on findings. | 67 years, Male. Reason: 67 yo M with h/o c.diff infection, with ileus, eval recurrent ileus History: AMS, There is a nonobstructive bowel gas pattern. There is a Dobbhoff tube with its tip projecting over the antrum of the stomach. Cardiomegaly unchanged. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her maternal grandmother and aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 43 years, Female. Reason: assess for constipation History: 43 y.o. woman with history of gas/bloating abd distension There is a average stool burden distributed throughout the colon. There is a nonobstructive bowel gas pattern. | Average stool burden distributed throughout the colon. |
Generate impression based on findings. | Male 72 years old Reason: esoph cancer s/p chemorads ck response History: none. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.A single contrast evaluation of the esophagus and gastric cardia/fundus showed a focal segment of smooth centric esophageal narrowing just above the GE junction, measuring approximately 5 mm in diameter at maximal distention. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. There is a small sliding hiatal hernia. No secondary lesions are identified. Limited evaluation of the stomach and proximal small bowel was unremarkable.Fluoroscopic evaluation of esophageal peristalsis demonstrated abruption of the primary peristaltic wave just proximal to the aortic arch with proximal escape to the level of the thoracic inlet, which then passed through with secondary peristaltic wave about 15 seconds later.TOTAL FLUOROSCOPY TIME: 4:32 minutes | Focal segment of smooth centric esophageal narrowing just above the GE junction, with sliding hiatal hernia. |
Generate impression based on findings. | Clinical question: Renal cell carcinoma, please provide measurements. Signs and symptoms: Renal cell carcinoma. Unenhanced head CT:Examination demonstrate no areas of abnormal density or enhancement of the brain parenchyma or leptomeninges to suggest metastases disease. Calvarium also is negative for lytic or sclerotic metastatic lesions. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- matter white matter initiation.Portable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. Images through the nasal passage demonstrate mild leftward nasal septum deviation and a bony septal spur which is in contact and deforms the mucosa of the left inferior turbinate. | 1.Negative pre-and post enhanced brain MRI and in particular no evidence of metastases.2.Nasal septum deviation to the left and a left ward projecting bony septal spur resulting in deformity of the left inferior turbinate mucosa. |
Generate impression based on findings. | 86-year-old male status post fall with new back pain, concern for fracture. Two views of the thoracic and two views lumbar spine demonstrate compression fracture of T12, which is stable when compared to remote exam in 2009. There is multilevel degenerative changes and anterior bridging osteophyte formation. Bilateral nephroureteral tubes are in the expected location. There is no evidence of acute fracture or malalignment. There is no significant soft tissue swelling. | Chronic compression fracture of T12, stable in appearance from 2009. No evidence of acute fracture or malalignment. |
Generate impression based on findings. | 55-year-old male with histoplasmosis now with cough, shortness of breath, fevers, evaluate for changes after treatment LUNGS AND PLEURA: Innumerable pulmonary nodules are noted diffusely throughout both lungs not significantly changed since the prior exam.. A majority of the nodules are subcentimeter in size. There is slight interval increase in a right lower lobe nodule now measuring 6 mm (series 6, image 53) that was not seen on the previous exam. Previously noted consolidation in the left lung base has significantly improved since prior exam with persistent focal opacity. Right basilar atelectasis appears improved since exam. No pneumothorax or pleural effusion.MEDIASTINUM AND HILA: Reference right paratracheal lymph node appears similar in size since prior exam now measuring 9 mm, previously 10 mm (series 4, image 24). Additional scattered subcentimeter mediastinal lymph nodes. No significant hilar lymphadenopathy.CHEST WALL: Minimal degenerative changes affect the thoracic spine. No suspicious osseous lesions are identified.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Probable gastric diverticulum is seen posteriorly, unchanged. Scattered subcentimeter retroperitoneal lymph nodes. | 1.Innumerable bilateral pulmonary nodules with slight interval increase in a right lower lobe nodule now measuring 6 mm. Further attention on subsequent studies can be given. 2.Near complete resolution of bilateral lower lobe consolidation. Persistent left lower lobe focal opacity. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, with additional bilateral CC and MLO views, were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications are present. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 11 years old, Male, Reason: rule out free air History: abdominal pain s/p EGDVIEW: Chest AP and Abdomen AP (two view) 3/11/15 Chest: The aortic arch, cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No focal lung opacities. No pneumomediastinum. No pleural effusion or pneumothorax.Abdomen: No pneumoperitoneum. Nonobstructive bowel gas pattern. | Normal chest and abdomen. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, with additional left CC and bilateral MLO views, were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 52-year-old female with concern for hallux valgus. There is mild hallux valgus deformity. No evidence of acute fracture or malalignment. No significant soft tissue swelling. | Mild hallux valgus deformity. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast carcinoma in her maternal grandmother. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Focal asymmetry in the left upper outer breast. No suspicious microcalcifications or areas of architectural distortion are present. | Left focal asymmetry for which comparison to prior studies is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Male 32 years old evaluate for radiopaque foreign object. There is no radiopaque foreign object seen on this examination.Superficial skin staples. There is a right-sided pigtail catheter with its tip projecting over the epigastric region. Right upper quadrant surgical clips, compatible with cholecystectomy, are noted. There are pigtail catheters in the left quadrant. Nonobstructive bowel gas pattern. | No radiopaque foreign object is identified.These findings were discussed by telephone with Dr. Stephan Wyers, the attending surgeon, on 3/11/2015 at 12:45 pm. |
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