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Generate impression based on findings. | Pain. Evaluate for fracture status post fall 4 weeks ago. Two views of the right knee reveal a right total knee arthroplasty device in anatomic alignment without evidence of hardware complication. There is heterotopic bone superior to the patella and along the posterior knee joint. No acute fracture is evident. There is a small to moderate joint effusion. | Right total knee arthroplasty without evidence of hardware complication. |
Generate impression based on findings. | Female, 28 years old, with severe headache. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. No parenchymal edema, mass effect or loss of gray-white distinction is detected.Low lying cerebellar tonsils are demonstrated similar to the prior examination. Brain morphology is otherwise unremarkable. The caliber of the ventricular system is small but unchanged.The osseous structures of the skull are intact and the paranasal sinuses are clear. | 1. No definite acute intracranial abnormality is detected.2. Redemonstration of low lying cerebellar tonsils similar to the prior exam. |
Generate impression based on findings. | 66 year old female with intraoperative imaging. Single view of the pelvis demonstrates intraoperative construction of a total right hip arthroplasty in anatomic alignment. There is iatrogenic gas present in the soft tissues. Severe degenerative disease is present in the left hip. | Hardware components of a total right hip arthroplasty in anatomic alignment. |
Generate impression based on findings. | Postop. Prosthetic assessment. Three views of the left knee with weight-bearing reveal a left total knee arthroplasty device in anatomic alignment without evidence of hardware complication. No acute fracture is evident. | Left total knee arthroplasty without evidence of hardware complication. |
Generate impression based on findings. | 62 year-old female with history of left knee pain. Four views of the left knee demonstrate severe osteoarthritis affecting the left knee, including significant joint space narrowing, particularly in the medial tibiofemoral compartment. There is no evidence of joint effusion. No acute fracture or evidence of malalignment. No acute abnormality. | Severe osteoarthritis of the left knee. |
Generate impression based on findings. | Question of healed osteotomy. Two views of the left forearm reveal two side plate and screw devices affixing a mid ulnar osteotomy. The osteotomy line is indistinct suggestive of healing. There is deformity of the proximal radius likely from prior fracture.Three views of the left reveal absence of the scaphoid and trapezium. There are 4 metacarpal bones with the lateral most metacarpal appearing to articulate distally with the phalanx of the thumb but proximally with the trapezoid. There is mild deformity of the lunate, which is situated proximal to the hamate bone. The triquetrum is largely situated medial to the hamate. There is possible fusion of the hamate, capitate, and triquetrum. | Healing osteotomy of the mid-ulna. |
Generate impression based on findings. | 28 years, Female. Reason: eval LP shunt History: severe HA Lumboperitoneal shunt catheter again seen, entering the spinal canal at the L3-4 level with the distal tip extending superiorly out of the field-of-view and the proximal tip in the left lower quadrant. No evidence of kinking or fracture is identified within the radiopaque portions of the tubing. Codman Hakim valve set at the 4 o'clock position. Surgical clips present in the right upper quadrant. | Lumboperitoneal shunt catheter without evidence of kinking or fracture. |
Generate impression based on findings. | 66 showed female status post total right hip arthroplasty. Single view of the right hip demonstrates hardware components of a total hip arthroplasty in near-anatomic alignment; no evidence of fracture or dislocation. Surgical clips, surgical drain, and iatrogenic gas are present in the soft tissues.Single view of the pelvis demonstrate the aforementioned total right knee arthroplasty. There is severe degenerative disease of the left hip. No other acute abnormality. | Hardware components related to recent total right hip arthroplasty in near-anatomic alignment. |
Generate impression based on findings. | 60 year-old female patient with history of mild transaminitis status post cholecystectomy with persistent abdominal pain. Recent ERCP with concern for retroperitoneal perforation. Exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: Mild right middle lobe and lingula atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy. Common bile duct stent extends from the porta hepatis into the duodenum. Foci of air along the posterior and lateral portions of the liver noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are foci of air in the right retroperitoneum, raising concern for perforation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric feeding tube tip is in the gastric antrum. There is flow of enteric contrast into the duodenum and proximal small bowel. No evidence of active enteric contrast leak. There are foci of gas external to the first, second, and third portions of the duodenum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Foci of air in the intraperitoneal and retroperitoneal spaces are suggestive of perforation. There is no active enteric contrast leak or fluid collection. |
Generate impression based on findings. | Status post lumbar fusion with pelvic fixation. Three views of the pelvis reveal screws within the pedicles of L2, L4, L5, and S1 bilaterally along with the right ilium with posterior stabilization rods and interposed disk spacers. No acute fracture is evident.An IVC filter is noted. | Postoperative changes of posterior lumbosacral spinal fusion. |
Generate impression based on findings. | Foot pain. Preop evaluation Four views of the right foot are unremarkable. No radiographic abnormalities. | Negative right foot examination |
Generate impression based on findings. | Evaluate fracture Three views of the left foot reveal a nondisplaced fracture of the base of the fifth metatarsal that appears to be extra-articular. No change in the exam | Nondisplaced fracture base of fifth metatarsal |
Generate impression based on findings. | 57 years old Female. Reason: seizure localization. History: seizures. ii The noncontrast CT portion of the brain is not remarkable. There is a low attenuation lesion in the left frontal bone. The FDG PET imaging demonstrates a large area of decreased metabolic activity in the right temporal lobe. Decrease metabolic activity is also seen in the posterior parietal lobe and the right occipital lobe. There is no increased FDG uptake in the low attenuation lesion in the left frontal bone. | Hypometabolism in the right temporal lobe, right posterior parietal lobe and right occipital lobe. |
Generate impression based on findings. | 51 female with morbid obesity, diabetes mellitus, hepatitis B. Limited exam due to patient positioning, could not evaluate in decubitus position.LIVER: Increased echogenicity of the liver measuring 19.6 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Pancreas is not well assessed.RIGHT KIDNEY: Measures 11.1 cm in length. No hydronephrosis.OTHER: Spleen measures 9.6 cm in length. Left kidney measures 11.6 cm in length. No hydronephrosis. | Stable mild hepatomegaly and increased echotexture suggestive of parenchymal dysfunction/fatty infiltration. |
Generate impression based on findings. | Female; 62 years old. Reason: tachycardia, doe, decreased mobility. Assess for PE. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. Perfusion images show a nonsegmental area of decreased perfusion in the right upper lung, probably artifact. The perfusion images otherwise show a physiologic distribution of pulmonary perfusion. | Low probability of pulmonary embolism. |
Generate impression based on findings. | 70 year-old female with rheumatoid arthritis and left upper lobe NSCLC status post recent completion of radiation therapy CHEST:LUNGS AND PLEURA: Severe upper lobe predominant central and paraseptal emphysema is again noted. There is honeycombing at the lung bases with fibrosis and traction bronchiectasis.Pleural based mass (series 7, image 43) measures 3.3 x 1.6 cm, previously 3.7 x 1.7 cm.Right subpleural nodule (series 7, image 76) measures 17 mm, previously 17 mm. The reference smaller adjacent subpleural nodule appears flat on the current examination, favoring organizing pneumonia over malignancy.Unchanged, right middle lobe nodule likely represent a lymph node (series 7, image 72).No new nodules or masses are evident.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. The heart size is normal without pericardial effusion. Severe coronary artery calcifications. Moderately enlarged pulmonary artery suggestive of pulmonary artery hypertension.CHEST WALL: No suspicious osseous lesions. No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Severe degenerative disease affects the thoracolumbar spine with unchanged compression fracture of T11. Prior vertebroplasty of T8 and T9 with compression fractures, unchanged. Additional compression fractures of T12, L1 and superior endplate depression of L2. Disk space narrowing at L4-L5 and L5-S1. No suspicious osseous lesions are identified.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous hypodense hepatic lesions some of which are too small to further characterize presumably representing benign cysts are unchanged since prior exam. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is within normal limits.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: Atherosclerotic calcification of the aorta and branch vessels without aneurysmal dilatation.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative disease affects the thoracolumbar spine with unchanged compression fracture of T11. Prior vertebroplasty of T8 and T9 with compression fractures, unchanged. Additional compression fractures of T12, L1 and superior endplate depression of L2. Disk space narrowing at L4-L5 and L5-S1. No suspicious osseous lesions are identified.OTHER: Low lying IVC filter is noted, unchanged in position compared to CT 7/8/12. The filter struts extend into the surrounding fat with one strut appearing to penetrate what appears to the be right gonadal vein. | 1.Slight interval decrease in size of the left upper lobe mass highly compatible with patient's primary NSCLC.2.Unchanged right lower lobe subpleural nodule.3.Unchanged severe combined pulmonary fibrosis and emphysema. |
Generate impression based on findings. | Male, 17 months old. Reason: physical abuse with elevated liver enzymes, eval for internal injuries History: deformed arm, multiple bruises all over body ABDOMEN:LUNG BASES: No focal consolidation or pleural effusions.No evidence of traumatic injury involving the visualized ribs.LIVER, BILIARY TRACT: No focal lesions or evidence of traumatic injury.No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No focal lesions or evidence of traumatic injury.OTHER: No free air or free fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No free air or free fluid. | No evidence of solid organ or hollow viscus injury. No other posttraumatic findings. |
Generate impression based on findings. | 55 years old Male. Reason: Myeloma relapse with known extramedullary disease; bone disease re-evaluation - Baseline prior to chemotherapy. History: Myeloma relapse with known extramedullary disease; bone disease re-evaluation. RADIOPHARMACEUTICAL: 15.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 159 mg/dL. Today's CT portion grossly demonstrates numerous stable lytic lesions throughout the axial skeleton. Healing rib fractures are also present. Cholecystectomy clips are seen.Today's PET examination demonstrates diffuse and uniform increased metabolic activity seen in the axial and proximal appendicular skeleton, significantly decreased as compared with the prior study. There is no FDG PET contrast between the lytic lesions and normal bone marrow seen on CT.Several new hypermetabolic normal-sized lymph nodes are seen in the neck. There is a focus of increased activity in the left proximal tibia.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Several new mildly hypermetabolic lymph nodes in the neck, which can be due to tumor or inflammatory change.2.Interval increased and uniform bone marrow activity in the visualized axial and proximal appendicular skeleton can be due to bone marrow reconversion. However, this finding makes detection of the osseous lesion in the PET impossible.3.Focus of increased activity in the left tibia, which can be due to tumor or bone marrow reconversion. |
Generate impression based on findings. | Salivary gland adenoid cystic cancer with mets to lung. Dyspnea. CHEST:LUNGS AND PLEURA: Bilateral pulmonary nodules and masses compatible with metastases. Largest lesion occurs in the right upper lobe measuring 2 x 1.7 cm (5/33).Large loculated right pleural effusion with nodular pleural enhancement compatible with visceral and parietal pleural metastatic disease. For reference, the greatest pleural thickness in the right posterior costophrenic angle measures 2-cm (4/85).MEDIASTINUM AND HILA: No pericardial fluid. Upper normal heart size. Mediastinal pleural tumor on the right compresses the right atrium focally, but there is no conclusive invasion. Soft tissue nodules in the right cardiophrenic fat are compatible with nodal metastases (4/70).Subcarinal lymph node measures 1.9-cm (4/43). Mild left low paratracheal (4/34) lymph node enlargement. Mild bilateral hilar lymph node prominence.CHEST WALL: Small right internal mammary chain lymph nodes are not normally visible..ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Tumor extends deep into the pleural recesses adjacent the liver and along the diaphragmatic pleural surface, but no hepatic lesions are appreciated.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: Scattered small lymph nodes in the upper abdomen are nonspecific, correlate with same day PET scan.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. | Bilateral pulmonary and right pleural metastases. Nodal metastases to the mediastinum and hila as well as the right internal mammary chain. |
Generate impression based on findings. | 59 year old male with h/o metastatic lung adenocarcinoma with bone pain on R ribs, bilateral ASIS, r/o bony mets History: pain over R 11-12 ribs, bilateral pain over ASIS. Focal increased uptake in the left lateral skull base is likely secondary to mastoid inflammation given findings on recent MRI. No abnormal osseous foci are identified to indicate metastatic disease. Symmetric increased uptake in the shoulders, knees, and hips is compatible with degenerative disease. | No evidence of bone metastases. |
Generate impression based on findings. | 34-year-old female patient status post robotic hysterectomy, BSO for serous borderline tumor of the ovary with vaginal cuff abscess requiring vaginal drain placement. Recheck size of vaginal cuff abscess. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Postsurgical changes from hysterectomy and BSO. There is a complex fluid collection containing air with a vaginal drain that measures 1.6 x 4.9 cm (coronal series 80240 image 37). There is a large amount of surrounding induration and obscures evaluation of the adjacent soft tissues.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. | Complex fluid collection with vaginal drain as described above. Surrounding soft tissues are mildly obscured by induration. |
Generate impression based on findings. | Shoulder dislocation Four views of the right humerus reveal deformity of the humeral head consistent with a Hill-Sachs deformity. Small fragments are seen displaced laterally. In addition there are bone fragments seen in the axillary pouch most likely from a Bankart lesion. | Changes in the humeral head glenoid consistent with anterior dislocation |
Generate impression based on findings. | Surveillance imaging. Evaluate stability of spine for c-collar clearance. Four views of the cervical spine redemonstrates an oblique fracture through the spinous process of C2. There is no widening of the atlantodental interval with flexion and extension imaging. Alignment is anatomic. | Redemonstration of a C2 spinous process fracture without definite evidence of atlantoaxial instability. |
Generate impression based on findings. | 63 or female status post fall on heparin. Single view of the pelvis demonstrates normal anatomic alignment of the hips without evidence of acute fracture. There is no significant soft tissue swelling. Radiopaque material in the bowel likely relates to recent contrast examination, and partially obscures the pelvis. | No evidence of acute fracture or malalignment. |
Generate impression based on findings. | Female 65 years old; Reason: kidney stone History: stone ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 4 millimeter obstructing stone in the proximal/mid left ureter with the proximal hydronephrosis, periureteral and perinephric stranding. A couple other small punctate hyperdensities could represent small stones floating in the renal pelvis. Postsurgical changes of the right kidney may be related to prior catheter placement.RETROPERITONEUM, LYMPH NODES: Mild calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Dense metallic artifact seen in a loop of transverse colon could be polypectomy. Correlate clinically.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic/not well visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes.OTHER: No significant abnormality noted. | 1.4-mm obstructing stone in the left ureter with proximal moderate hydronephrosis and hydroureter. Findings discussed with Dr. Blake Alberts at 4:35pm on 3/11/2015. |
Generate impression based on findings. | Male; 14 months old. Reason: Intermediate risk neuroblastoma; received 8 cycles of chemotherapy; assess for response to therapy. Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. There is no abnormal focus of activity to indicate current MIBG avid tumor. | No MIBG avid tumor. |
Generate impression based on findings. | 71 year-old female with right foot pain. Four views of the left foot demonstrate severe hallux valgus deformity, as well as hammertoe deformity of the second through fifth digits. No acute fracture is identified. There is no significant soft tissue swelling. | Severe hallux valgus deformity; no evidence of acute fracture. |
Generate impression based on findings. | 2 years old, Female, Reason: Multiple skin bruises, evaluate for occult injury EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 3/11/15 No evidence of acute or healing fractures identified. The skull is normal in appearance. Adenoid hypertrophy is identified on the lateral cervical spine radiograph. No prevertebral soft tissue swelling. Aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No focal pulmonary opacities are identified. No pleural effusion or pneumothorax. | No evidence of acute or healing fractures. Adenoid hypertrophy. |
Generate impression based on findings. | Measuring TT-TG. Assessment of trochea for dysplasia. Right knee pain. The TT-TG distance measures approximately 28 mm. The trochlear depth is approximately 2 mm. There is a wiberg type 1 patella. No acute fracture is evident. There is a small knee joint effusion. | Findings consistent with trochlear dysplasia. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial abnormality. |
Generate impression based on findings. | Postoperative changes are again seen from right frontal parietal craniotomy and underlying tumor resection from the posterior right frontal lobe. There has been no significant change in size or configuration resection cavity and associated encephalomalacia. There is persistent scattered susceptibility in the area resection. There is a stable extent of T2/FLAIR hyperintensity along the margins of the resection cavity extending medially into the centrum semiovale and corona radiata. Mild thin gyriform T1 hyperintensity is also seen along the surgical margins. There is no definite masslike enhancement. However, there is an interval delineation of nodular enhancement seen in the anterior right temporal lobe on 1201/39-40, each measuring 4-5 mm. There is subtle corresponding FLAIR hyperintensity seen associated with the more medial finding.Evaluating for hyperperfusion is likely limited secondary to the size of these foci of nodular enhancement, although there is equivocal suggestion of corresponding foci of elevated rCBV, although the lateral finding is limited by adjacent vasculature.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Incidental note is made of likely a chronic blowout fracture of the inferomedial left orbital floor with herniation of orbital fat through the fracture defect. | 1. Interval delineation of tiny nodular foci of enhancement in the anterior right temporal lobe with equivocal perfusion findings, as evaluation is limited given small size of the findings. This is concerning for tumor progression versus post-treatment change, although continued follow-up is recommended.2. Otherwise, stable postoperative and post treatment changes. |
Generate impression based on findings. | Female, 80 years old, with history of recurrent esophageal squamous cell carcinoma. Since the prior examination, soft tissue thickening involving the upper cervical esophagus and adjacent tracheoesophageal groove has increased, now measuring up to 20 mm in thickness on sagittal imaging (image 42 series 80381), previously 13 mm. An esophageal stent has been placed beginning just below the level of thickening. Generalized infiltration of the soft tissues surrounding the stent is seen.No pathologic adenopathy is detected in the neck by size criteria. The salivary glands and thyroid are unremarkable. The cervical vessels enhance with evidence of severe atherosclerotic calcification of the right carotid bifurcation. Reticular opacities and mild emphysema are noted in the lung apices. No concerning or destructive osseous lesions are demonstrated.Evidence of age indeterminate microvascular ischemic disease is seen on limited views of the brain. | 1.Progressive thickening of the upper cervical esophagus and adjacent soft tissues is noted which could represent tumor growth or a treatment related effect.2.Interval placement of an esophageal stent. Progressive ill-defined infiltration of the soft tissues surrounding the stent is of uncertain significance but may be reactive.3.No pathologic adenopathy is detected by size criteria. |
Generate impression based on findings. | Female; 69 years old. Reason: flank pain History: solitary pulmonary nodule, lung cancer, abdominal mass, PET for cancer staging. . RADIOPHARMACEUTICAL: 13.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 122 mg/dL. Today's CT portion grossly demonstrates the previously identified cavitary right upper lobe nodule with irregular borders and partial solid component. Scattered calcified lung granulomas and dense coronary artery calcifications are also noted. Left pelvic soft tissue mass is present, also described previously. Please refer to recent CT chest/abdomen/pelvis report for other pertinent anatomical findings and lesion measurements. Today's PET examination demonstrates significantly increased FDG uptake within the solid component of the right upper lobe nodule (mean SUV 21), as well as within the left pelvic mass seen on CT (mean SUV 22.7). No additional FDG-avid lesions are identified. | 1.Solid component of right upper lobe lung nodule is hypermetabolic on PET and suspicious for primary lung neoplasm. 2.Additional hypermetabolic soft tissue mass in the left pelvis is suspicious for associated metastatic disease. |
Generate impression based on findings. | Chest wall sarcoma CHEST:LUNGS AND PLEURA: Interval mildly enlarging yet small right pleural effusion. No discrete superimposed focal air space abnormality other than scattered dependent atelectasis. Specifically no suspicious nodules or masses. Mild centrilobular emphysemaMEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within limits.Small hiatal herniaCHEST WALL: Incomplete visualization of the right chest wall due to cut off the field-of-view. Within this limitation however overall increased heterogeneity and decreased size in volume of the large mass, in what previously measured 9 x 10 cm, currently measures approximately 7 x 6 cm (image 32 series 3). The mass continues to abut the chest wall without evidence of osseous destruction. Soft tissue interposed between ribs cannot be excluded. Suspected biopsy clip inferiorly and persistent overlying stranding of the fat and visualized skin, again incompletely observed.No new underlying osseous abnormalities. Left chest wall portABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Scattered calcified granulomataADRENAL GLANDS: Persistent mild nodularity of the right adrenal gland unchanged KIDNEYS, URETERS: Scattered simple renal cysts bilaterallyPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in the large right chest and axillary mass see detail and reference measurements provided. No evidence of intrapulmonary disease, however a small new right effusion is of uncertain significance |
Generate impression based on findings. | Thyroid cancer LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No lymphadenopathy.Cardiac and pericardium are within limitsNo residual thyroid is observed, presumably postsurgical or treatmentCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Focal nonspecific hypodensity within the spleen, consider dedicated imaging if of concern and further characterization is needed clinically. Specifically no evidence of enhancement | No findings to support metastatic disease |
Generate impression based on findings. | Chest wall mass LUNGS AND PLEURA: A focal right apical spiculated large nodule two small masses observed anteriorly this focus measures 2.0 x 1.7 cm (image 12 series 5) and abuts the anterior wall with mild thickening. Questionable small satellite nodular densities are also observed inferiorly as wells and associated small effusion. Nodularities also observed along both the major and minor fissures.Left lung appears clearMEDIASTINUM AND HILA: Scattered borderline to mildly enlarged lymphadenopathy. Subcarinal lymph node measures 1.4 cm in short axis (image 35 series 3). No discrete hilar lymph nodesModerate coronary with more pronounced annular and aortic calcifications yet without additional cardiac or pericardial abnormalities.Small hiatal herniaCHEST WALL: No discrete chest wall mass is observed. In light of the patient's history, if specific location was identified this would increase or sensitivityUPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Suspicious right upper lobe focal mass with associated satellite nodules, effusion and pleural/fissural nodularity concerning for a primary malignancy with focal spread. Follow-up evaluation comparing with prior outside imaging if available might be helpful or more likely a PET scan given the lesions size and potential need for initial workup.Pager 9599 was paged and voice mailed |
Generate impression based on findings. | 67 year old female with h/o NSCLC s/p SBRT. Noted to have new spine metastases. Re-staging PET/CT to evaluate current extent of metastatic disease burden.RADIOPHARMACEUTICAL: 12.112 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates upper lobe predominant emphysema and near-complete resolution of the previously described right upper lobe nodule, with only residual patchy opacities seen in the right upper lung. Basilar lung scarring, stable liver cysts, and extensive degenerative disease involving the cervical spine are also noted. The sclerotic T7 vertebral body lesion seen on prior CT is not visualized. Today's PET examination demonstrates very little residual FDG activity in the right upper lobe nodule (mean SUV 0.8, previously 8.4). New mildly increased FDG activity in the adjacent chest wall (mean SUV 2.6) is nonspecific and may represent prior trauma or post-treatment changes. Mild symmetric increased activity in the regions of the bilateral axillary lymph nodes (mean SUV 2.5) is also nonspecific and may reflect an underlying inflammatory process. No new FDG avid lesions are identified. | 1.Significant interval decrease in size and metabolic activity of right upper lobe pulmonary lesion. 2.Mild nonspecific increased activity in the right chest wall and bilateral axillary regions as described above, but no definite evidence of metastatic disease. |
Generate impression based on findings. | Male, 65 years old, with history of TIA. Non-angiographic findings:Precontrast images of the head show no evidence of parenchymal edema, mass effect or loss of gray-white distinction. At most, there may be very minimal patchy subcortical white matter hypo-attenuation which is nonspecific. No intracranial hemorrhage or any abnormal extra-axial collection is detected. The ventricular system is normal in size. The osseous structures of skull are intact and the paranasal sinuses are clear.Angiographic findings:The left vertebral artery arises from the aortic arch. Otherwise, aortic branching is unremarkable. Mild atherosclerotic disease is evident at the carotid bifurcations, not significant by NASCET criteria. The left vertebral artery is uniformly smaller than the right, likely congenital given the smaller size of the foramina transversaria.Intracranially, no significant vascular stenosis or occlusion is detected. No aneurysms are seen. A small ACOM artery is present. Moderately sized right and small left PCOM arteries are seen. | No evidence of significant vascular stenosis or occlusion in the head or neck. |
Generate impression based on findings. | Male; 77 years old. Reason: rule out pulmonary embolism History: RV strain on echo. The comparison chest radiograph performed on 2/11/2015 demonstrates cardiomegaly, small right pleural effusion, and nonspecific focal right lung base opacity. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show small scattered perfusion defects but no moderate or large defects. | Low probability of pulmonary embolism. |
Generate impression based on findings. | 37 year old female with history of Lisfranc injury status post orthopedic fixation. Orthopedic screws affix the medial cuneiform to the first metatarsal; the head of the second metatarsal to the medial cuneiform; the middle cuneiform to the second metatarsal; and the third metatarsal to the lateral cuneiform. There is a calcaneal defect at the site of a prior orthopedic alignment device which has been removed. Overall alignment is anatomic, and there is no evidence of hardware complication or loosening. | Orthopedic fixation as described above, without evidence of hardware complication or significant interval change. |
Generate impression based on findings. | Female; 31 years old. Reason: metastatic breast cancer - baseline prior to starting new treatment History: Recent PET shows metastatic disease in the sternum. Punctate focus of increased tracer uptake in the lateral right jaw likely reflects dental disease. No abnormal osseous foci are identified to indicate metastatic disease. | No evidence of bone metastases. |
Generate impression based on findings. | Movement disorder, including unsteady gait, falls, retropulsion. Evaluate for Parkinson's disease versus essential tremor. Normal symmetric activity is seen in the basal ganglia. | Normal examination. No evidence of nigrostriatal dopaminergic dysfunction. Given the history, these findings are suggestive of essential tremor. |
Generate impression based on findings. | 89 years old Male. Reason: Evaluate for PE History: dyspnea, active malignancy, leg swelling. The comparison chest radiograph performed on 03/11/2015 demonstrates no pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is minimal abnormal Xe-133 retention in the lower lungs during the wash-out phase. The perfusion images show large areas decreased perfusion in the left lingular lobe and lateral basal segment. Decreased perfusion is also seen in the right middle lobe and anterobasal segment. The perfusion defects are substantially larger on the more severe as compared with ventilation anonymities. Non-segmental area of decreased perfusion is also seen in the right apex. | High probability for PE. |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage. Signs and symptoms: Seizure-like activity. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Mild periventricular and subcortical low attenuation of white matter although nonspecific considering patient's stated age of 77 likely representing microvascular age indeterminate small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: ESRD on HD with complicated hospital care, gradual mental status decline and lethargy, found on floor. Signs and symptoms: Evaluate for intracranial process. Unenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is mild prominence of cortical sulci and supratentorial ventricular system for patient's stated age of 63 however is stable since prior exam. Mild periventricular low attenuation of white matter is suspected for age indeterminant small vessel ischemic strokes. Unremarkable cerebral cortex, CSF spaces, calvarium, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes is suspected. |
Generate impression based on findings. | Clinical question: Rule out acute process. signs and symptoms: Headache Nonenhanced head CT:No acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Small focus of encephalomalacia in the right frontal lobe in the distribution of the right MCA is highly suggestive of a chronic ischemic stroke. There is mild ex vacuo dilatation of the adjacent right lateral ventricle.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF and spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Right frontal lobe chronic ischemic stroke.3.Unremarkable exam otherwise. |
Generate impression based on findings. | Clinical question: ICB. Signs and symptoms: Severe headache 4 days with no relief, blurred vision. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for any ischemic changes, hemorrhage or mass. Signs and symptoms: Right temporal headache and blurry vision. Nonenhanced head CT:There is no evidence of an acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic stroke.Slight prominence of cortical sulci and the supratentorial ventricles likely within normal range for patient stated age of 82.No evidence of intracranial mass, mass effect, midline shift or hydrocephalus. Bilateral internal carotid and a lesser degree vertebral artery calcification.Unremarkable images through the orbits.Mild chronic sinus disease and well pneumatized mastoid air cells. | 1.Unremarkable exam for age.2.Mild chronic sinus disease. |
Generate impression based on findings. | Clinical question : Hydrocephalus? Signs and symptoms: Incontinence and psychiatric symptoms. Nonenhanced head CT:Detectable acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic strokes.Slight prominence of cortical sulci, cerebellar and vermian folia and ventricular system for patient's stated age without significant change since prior study from 2014.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Slight prominence of cortical sulci, cerebellar and vermian folia for age without significant change since prior exam. |
Generate impression based on findings. | Clinical question: Evaluate intracranial hemorrhage. Signs and symptoms: Leg weakness, dysphasia and cranial nerve palsy. Nonenhanced head CT:No evidence of an acute intracranial process. CT however it is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Diffuse periventricular and subcortical low attenuation of white matter is a nonspecific finding. Correlate with history since this appearance could represent advanced age indeterminate small vessel ischemic strokes, postradiation change. There is a left anterior temporal -- frontal craniotomy with underlying left anterior temporal encephalomalacia. No prior exams for comparison. There is a focus of low-attenuation in the left occipital lobe of unknown etiology. Correlate with history and consider MRI for further assessment. If there are old exams available and provided to radiology department an addendum to this report was resubmitted after comparison.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No evidence of an acute intracranial process.2.Post operative changes of left anterior frontal and temporal craniotomy with subtle underlying encephalomalacia.3.Focus of low-attenuation in the white matter of left occipital lobe without mass effect or parenchymal volume loss is not a specific. Correlate with history and consider MRI for further assessment. |
Generate impression based on findings. | Clinical question: Aphasia. Signs and symptoms: Aphasia. Nonenhanced head CT:New since prior exam is a focus of acute hemorrhage in the operculum a left anterior frontal lobe measuring at 31 x 38-mm increments axial dimensions. There is no significant surrounding edema however mild regional mass-effect is noted. Slight prominence of lateral ventricles without deviation of midline is similar to prior studies.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise. A small lytic and calcific lesion of right paramedian parietal bone is identified and with a heavily calcified extraosseous component extending through the inner table of the skull. The finding measures approximately 11 mm in size. This lesion appears benign and could represent a small calvarial hemangioma or less likely a meningioma however follow-up with an MRI exam is recommended to entirely exclude metastatic disease. This findings retrospectively is present on prior head CT however it was not mentioned in the report. Evident MRI exam is recommended for further assessment.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.Acute hemorrhage in the operculum and left anterior frontal lobe measuring at 3.8 times 3-cm with subtle regional mass-effect.2.Tiny lytic/calcific lesion of right parietal bone with a small heavily calcified extraosseous/epidural component appears benign however follow-up with MRI is recommended for further assessment. |
Generate impression based on findings. | Clinical question: ICH. Signs and symptoms: ICH. Nonenhanced head CT:Examination demonstrates slight interval increased size of a left frontal operculum parenchymal hemorrhage. On sagittal image 11 the finding measures approximately 41 mm in AP and 31-mm in cc compared to prior study measurements of 37 x 25. The mass effect is still remains in general and without evidence of herniation of midline.Stable exam otherwise. | 1.Interval increased size of left frontal operculum parenchymal hematoma measuring to 41 x 31 on sagittal images compared to prior study measurement of 37 x 25mm and stable exam otherwise.2.Lytic and calcific right parietal calvarial lesion likely representing a hemangioma and less likely meningioma similar to prior study. Cannot MRI is recommended to entirely exclude malignancy. |
Generate impression based on findings. | known hemorrhagic metastasis, follow up, headaches Multifocal hemorrhagic metastatic lesions are again seen. However, the maximum diameter of each lesions on the left frontal, left parietal, right parietal and bilateral occipital lobes appear to be increased since prior exam.In addition, there is evidence of intraventricular hemorrhage especially in the left lateral ventricle. There is a lesion on the falx, which does not show any interval changes.The osseous structures are unremarkable. The mastoid air cells are clear. The right maxillary sinus shows retention cyst. | Interval aggravation of known hemorrhagic metastasis lesions with new development of intraventricular hemorrhage. |
Generate impression based on findings. | Male, 36 days old. Reason: ? occult fracture History: sibling with injuryEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 3/11/2015, 1612 Bowing deformity of the left ulna, with a periosteal reaction, compatible with a fracture.No other acute or healing fractures identified.The skull is normal in appearance. No prevertebral soft tissue swelling. Aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No focal pulmonary opacities are identified. No pleural effusion or pneumothorax. | Bowing fracture of the left ulna. No additional acute or healing fractures identified. |
Generate impression based on findings. | 35-year-old male patient with decreased appetite and decreased output from ileostomy. Evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: Trace basilar atelectasis.LIVER, BILIARY TRACT: Diffuse fatty infiltration. No intra-or extrahepatic biliary ductal dilatation. No cholelithiasis or CT evidence of cholecystitis.SPLEEN: Subscapular splenic cyst noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating lesion in the midpole of the left kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen are postsurgical changes from J-pouch formation and diverting loop ileostomy in the left hemiabdomen. No evidence of small bowel obstruction. There is focal dilatation of the loop of small bowel in the left lower quadrant and measures up to 3.6 cm. Submucosal fat in the distal small bowel is compatible with chronic inflammation.Nonobstructive ventral abdominal hernia containing small bowel and mesenteric fat is again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is interval resolution of fluid collection posterior to the J-pouch.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of small bowel obstruction. Focal dilatation of a loop of small bowel in the left hemiabdomen may represent adhesive disease versus postsurgical changes. |
Generate impression based on findings. | 13-year-old female with sickle cell disease and desaturation and crackles on exam.VIEW: Chest AP (one view) 3/11/15 Cardiomegaly is present. Triangular opacity silhouettes the medial portion of the left hemidiaphragm which could represent atelectasis or pneumonia. Evidence of vascular engorgement. Bone changes from sickle cell anemia are noted. | Triangular opacity silhouettes the medial left hemidiaphragm which could represent atelectasis or pneumonia.Findings discussed with Dr. Kim at 0850 on 3/12/15 |
Generate impression based on findings. | Female 85 years old Reason: r/o acute process History: syncope, elevated LFTs. ABDOMEN:LUNG BASES: Left lower lobe consolidation with associated bronchiectasis, unchanged. Other micronodules stable. LIVER, BILIARY TRACT: Diffuse intrahepatic biliary dilatation and dilatation of the common hepatic duct with obstruction secondary to the pancreatic mass at the level of the suprapancreatic common duct.No focal liver lesions.Evidence of portal or hepatic vein thrombus.SPLEEN: Granulomata.PANCREAS: Homogeneously hypoattenuating mass in the pancreatic head measures 2.6 x 2.1 cm, series 3 image 47. Mass obstructs pancreatic duct which is dilated to 5.5 mm in the region of the proximal body. No calcifications. No cystic components. A hypoattenuating component extends to but the superior mesenteric vein over approximately 180 degrees and tracks along the dorsal aspect of the superior mesenteric vein to the level of the first jejunal branch seen on series 2 image 54.No evidence of involvement of the celiac axis, trifurcation or superior mesenteric artery. The mass also obstructs the common bile duct. Common hepatic duct is dilated to 1.5-cm (coronal image 49).Normal arterial and venous anatomic branching with no variants.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Some areas of scarring.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease aorta branch vessels. No evidence of aneurysm. No pathologic size nodes.BOWEL, MESENTERY: Left-sided colostomy. Descending colon and jejunal loops seen in the left-sided abdominal wall parastomal hernia, non-obstructive. No evidence of ascites or carcinomatosis. Postsurgical changes anterior abdominal wall.Diverticulosis right colon.BONES, SOFT TISSUES: Left lateral abdominal wall stomal hernia containing bowel and omentum.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Surgically absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse mild wall thickening involving most of the loops within the pelvis, etiology uncertain. No intramural or free air. No ascites or carcinomatosis. Some distortion of bowel loops consistent with adhesions. There is a surgical anastomosis of small bowel the left lower quadrant series 2 image 116. Rectum and sigmoid colon surgically absent.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New pancreatic mass and possible involvement of the superior mesenteric vein and shows jejunal branch. No arterial encasement or abutment. Intrahepatic biliary dilatation.Stable left abdominal wall stomal hernia.New finding of diffuse wall thickening suggestive of some mucosal edema involving small bowel loops in the pelvis. Correlate for infection or ischemia. |
Generate impression based on findings. | Male 17 years old Reason: eval for fx History: knee pain sportsVIEWS: Bilateral knee AP, and PA weight bearing, lateral and sunrise 3/11/15 (5 views) Possible right knee joint effusion with no evidence of fracture or malalignment. | Question of right knee joint effusion. |
Generate impression based on findings. | 17 year-old female with abdominal pain, concern for obstruction.VIEW: Abdomen upright AP (one view) 3/11/15 The cardiac apex and stomach are left-sided. Nonobstructive bowel gas pattern. No pneumatosis, portal venous gas or free air. | Normal examination. |
Generate impression based on findings. | Male, 17 months old. Reason: history of child abuse ? fractures History: multiple bruises/swellingsEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (23 views) 3/11/2015, 2257 Metaphyseal lesions involving both proximal humeri, with periosteal reaction, fraying, and corner fractures identified. The fractures appear to be of varying ages, with greater periosteal reaction on the left. Right humerus fracture is visualized on separate right upper extremity images.There is a possible small corner fracture of the distal right radial metaphysis.The skull is normal in appearance. No prevertebral soft tissue swelling. Aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No focal pulmonary opacities are identified. No pleural effusion or pneumothorax. | Multiple fractures of varying ages involving the proximal humeral metaphyses and possibly the distal right radial metaphysis. Findings suspicious for nonaccidental trauma.Findings were discussed by the on call resident with Dr Orozco-Kellermeier in the ER on 3/11/2015 at 1:00 AM. |
Generate impression based on findings. | 68 male patient with recent CABG outside hospital and CT with pancreatic mass. Evaluate for tumor/metastatic disease. CHEST:LUNGS AND PLEURA: Left apical scarring noted. Moderate centrilobular emphysema. Nonspecific scattered micronodules.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes. Severe coronary artery calcifications and valvular calcifications noted. Surgical changes from CABG.CHEST WALL: Median sternotomy hardware noted.ABDOMEN:LIVER, BILIARY TRACT: There are numerous hypoattenuating lesions in both lobes of liver. A reference lesion measures 3.1 x 2.9 cm (series 3 image 92).SPLEEN: Subcentimeter hypoattenuating lesion in the spleen is too small to characterize.PANCREAS: There is a hypoattenuating lesion in the body of the pancreas that measures approximately 4.0 x 4.1 cm (series 3 image 114). There is associated distal pancreas atrophy and pancreatic ductal dilatation. The mass is inseparable from the left adrenal gland. There are numerous adjacent enlarged lymph nodes. There is infiltration of the superior mesenteric artery and obliteration of the splenic vein.ADRENAL GLANDS: Left adrenal gland involvement by tumor as described above.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate to severe coronary artery calcifications and thrombus formation involving the abdomen aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T11 Schmorl's node and nonspecific linear lucency in the T4 vertebral body.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Status post right hip arthroplasty and left femoral intramedullary rod and pin. There is associated streak artifact, limiting evaluation of the adjacent structures.OTHER: No significant abnormality noted. | Findings compatible with primary pancreatic tumor with bilobar liver metastases and direct extension into the left adrenal gland. |
Generate impression based on findings. | known hemorrhagic metastatic lesions follow up. No significant interval change of bihemispheric hemorrhagic metastasis since prior exam.Intraventricular hemorrhage appears to be not changed since prior exam.There is no midline shift.The osseous structures are unremarkable. The mastoid air cells are clear. | No significant interval change since prior exam. |
Generate impression based on findings. | Male, 17 months old. Evaluate for fracture History: upper arm deformityVIEWS: Right elbow AP, lateral, oblique (3 views) 3/11/2015, 1701 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | No acute fracture or malalignment of the right elbow. See same day osseous survey and humeral radiographs for additional findings. |
Generate impression based on findings. | Male, 17 months old. Evaluate for fracture. History: arm deformityVIEWS: right humerus. AP, lateral (2 views) 3/11/2015, 1700 Metaphyseal lesions involving the proximal humeri, with periosteal reaction, fraying, and corner fractures identified. There is greater periosteal reaction on the left, which is seen on additional osseous survey images.Soft tissue swelling in the region of the right shoulder. | Right humerus proximal metaphyseal fracture. Combined with additional findings on osseous survey, this is suspicious for nonaccidental trauma, however the possibility of osteomyelitis cannot be totally excluded. See same day osseous survey for additional details. |
Generate impression based on findings. | Male, 8 years old. Suspected sepsis. Evaluate LungsVIEW: Chest AP (one view) 3/11/2015, 1717 Mediastinal clips are unchanged in position. Left PICC tip at the junction of the brachiocephalic veins.The cardiothymic silhouette is normal.Postoperative changes in the right chest are again seen. Loculated pneumothorax and dilation of the upper esophagus appear similar to the prior exam.Contrast material again seen within the right pleural space. No focal left-sided pulmonary opacities. | Unchanged appearance of the chest. |
Generate impression based on findings. | 64-year-old male with head and neck cancer status post chemoradiation CHEST:LUNGS AND PLEURA: Biapical scarring/fibrotic changes related to radiation are unchanged.Debris is noted in the right central line lobe low bronchi appearing similar to the prior exam.There is increased subpleural consolidation with increase in tree in bud opacities predominantly in the right lower lobe and new nodular ground glass opacities in the right middle lobe compatible with aspiration.Scattered groundglass nodular opacities in the left lung base the also represent aspiration.No suspicious nodules or masses are identified.MEDIASTINUM AND HILA: Stable prominent precarinal lymph node (series 4, image 39) measures 11 mm.Prominent right paratracheal lymph nodes is slightly increased in size since the prior exam, may be reactive.Heart size is normal. No pericardial effusion. Severe coronary artery calcification.CHEST WALL: Prominent 11 mm retrocrural lymph node is increased in size since prior exam (series 4, image 95). No significant cardiophrenic, subpectoral, or axillary lymphadenopathy.Degenerative changes affect the thoracic spine. No suspicious osseous lesions are identified.Bilateral Bochdalek hernias are 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: Nonobstructive right renal stone.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube is again noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increased subpleural consolidation and increased tree in bud opacities in the right middle and lower as well as the left lower lobe compatible with aspiration.2.Mild interval increase in size of right paratracheal and retrocrural lymph nodes as described above. These may be reactive in etiology but continued follow-up is recommended.3.Patient had contrast extravasation as described in the technique section above. |
Generate impression based on findings. | Clinical question: Rule out ICH, skull fracture. Signs and symptoms: Fall with head injury and vomiting. Unenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp. Unremarkable and well pneumatized bilateral mastoid air cells and middle ear cavities.Unremarkable images through the orbits. Acute on chronic pansinusitis with air fluid levels within bilateral maxillary sinuses. | 1.No acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.2.Acute on chronic pansinusitis. |
Generate impression based on findings. | 21-year-old female with periumbilical pain and right lower quadrant pain ABDOMEN:LUNG BASES: No significant abnormality noted. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix measures 1 cm in diameter with mild wall thickening and fluid and fat stranding adjacent to the cecum. The small bowel is normal in caliber. No evidence of abscess or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right corpus luteum cyst cyst.BLADDER: Moderately distended and otherwise normal.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix measures 1 cm in diameter with mild wall thickening with fluid and stranding adjacent to the cecum. The small bowel is normal in caliber. No evidence of abscess or perforation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic fluid is likely physiologic given the patient's age. | Findings suggestive of early acute appendicitis without evidence of perforation or abscess. |
Generate impression based on findings. | 69 years, Female. Reason: 69 y/o with pseudoobstruction, s/p NG tube placement History: abdominal distention There is a nasogastric tube with its tip projecting over the body of the stomach and the side-port at the level of GE junction. There is marked gaseous distention of multiple loops of large bowel as well as several loops of small bowel, most consistent with colonic ileus, although distal obstruction is possible. There is a moderate stool burden predominantly within the rectosigmoid colon. | 1.Diffuse gaseous distention of multiple loops of large bowel and several loops of small bowel, most consistent with colonic (given apparent colonic predilection) or diffuse ileus, although distal colonic obstruction is possible.2.NG tube with tip in the body of the stomach and side-port at the level of GE junction, advancement is recommended. |
Generate impression based on findings. | 36-year-old male patient with history of escalating periumbilical abdominal pain radiating to both lower quadrants. Evaluate for appendicitis and diverticulitis. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenule 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: There is a small umbilical hernia containing fat with associated mild fat stranding.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Small umbilical hernia containing fat with mild associated fat stranding is noted. Recommend correlation with physical examination and point tenderness. Otherwise, no findings to account for patient's symptoms. |
Generate impression based on findings. | 68-year-old female with history of spinal stenosis/ scoliosis status post L-15 XLIF complicated by bowel injury status post repair now with leukocytosis and SOB PULMONARY ARTERIES: Adequate pulmonary artery opacification without evidence of pulmonary embolism. The main pulmonary artery caliber is within normal limits.LUNGS AND PLEURA: Moderate pleural effusions bilaterally with adjacent atelectasis. Severe apical predominant centrilobular emphysema. Patchy opacity in the posterior segment of the right upper lobe (series 14, image 150) is suspicious for aspiration. Groundglass opacity in the anterior right upper lobe is nonspecific and may also reflect aspiration or infection (series 14, image 131).MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. Moderate coronary artery calcification. No significant mediastinal or hilar lymphadenopathy. Small amount of debris is noted within the right mainstem bronchus.CHEST WALL: Spinal fixation hardware noted at T10 and below. Severe degenerative disease affects the visualized lower thoracolumbar spine. Mild rightward curvature of the thoracolumbar spine. No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. Probable calcified fibroadenoma in the right breast. Scattered small foci of air is seen within the left breast and may be related to recent surgery.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism. 2.Moderate bilateral pleural effusions.3.Patchy opacity in the posterior segment of the right lobe most suspicious for aspiration/infection. Resolving edema is a consideration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male, 6 years old. Pain after a fall. Evaluate for fractureVIEWS: Left elbow AP, lateral, oblique (3 views) 3/11/2015, 1816 Elevation of the posterior and anterior fat pads, compatible with a joint effusion.No acute fracture or malalignment is identified. | Elbow joint effusion without acute fracture or dislocation identified. Occult fracture cannot be excluded. |
Generate impression based on findings. | 69 years, Female. Reason: Resolution of distension? There is a nasogastric tube with its tip projecting over the body of the stomach and the side-port at the level of GE junction. There is marked gaseous distention of multiple loops of large bowel as well as several loops of small bowel, slightly improved from the prior examination, most consistent with colonic ileus, although distal obstruction is possible. There is a moderate stool burden predominantly within the rectosigmoid colon. | 1.Diffuse gaseous distention of multiple loops of large bowel and several loops of small bowel, slightly improved improved from the prior examination, most consistent with colonic ileus, although distal obstruction is possible.2.NG tube with tip in the body of the stomach and side-port at the level of GE junction, advancement is recommended. |
Generate impression based on findings. | Increased work of breathing and desaturation. Klebsiella urinary tract infection. History of chronic lung disease.VIEW: Chest AP (one view) 03/11/15, 1823 Tracheostomy tube tip is below thoracic inlet. Feeding tube tip is distal to GE junction and not included on the image. Lower extremity PICC tip is in intrahepatic IVC.Soft tissue edema persists.Cardiac silhouette size is mildly enlarged. Lung volumes are increased with hemidiaphragm is at the 12th posterior ribs. Streaky opacities are present bilaterally. | Large lung volumes and streaky opacities. Enlarged cardiac silhouette most likely due to pulmonary hypertension. |
Generate impression based on findings. | 34-year-old female with history of neuroblastoma with new onset of cough.VIEWS: Chest AP/lateral (two views) 3/11/15 Left upper extremity PICC with tip at the cavoatrial junction. Right central line tip in the right atrium. Upper abdominal surgical clips are again seen.Cardiac silhouette is mildly enlarged. Mild peribronchial thickening is present. No focal lung opacities are present. No pneumothorax or pleural effusion. | No pneumonia. |
Generate impression based on findings. | Male 5 years old Reason: position of ET tube History: respiratory failure, nephrotic syndrome.VIEW: Chest AP (one view) 3/11/15 at 1735 hrs. Central line tip is at the right atrium. ET tube terminates below thoracic inlet. Interval NG tube removal. Cardiac silhouette size is enlarged. Interval worsening in multifocal patchy opacities, either related to fluid overload and edema and or infection. | Multifocal opacities as described. |
Generate impression based on findings. | 69 years, Female. Reason: assess for worsening ileus or obstruction History: 60 y.o. woman with history of pseudoobstruction and increased abdominal distension, pain, acidosis There is marked gaseous distention of multiple loops of large bowel as well as several loops of small bowel, most consistent with colonic ileus, although distal obstruction is possible, increased in the prior exam. There is a moderate stool burden predominantly within the rectosigmoid colon. | Diffuse gaseous distention of multiple loops of large bowel and several loops of small bowel, increased from the prior exam, most consistent with colonic ileus, although distal obstruction is possible. |
Generate impression based on findings. | 58 year-old female with knee and pelvic pain on the left status post fall from standing today. Single view of the pelvis demonstrates normal anatomic alignment. Chronic parasymphyseal and medial acetabular fractures are unchanged. There is no evidence of acute fracture. Stable appearance of metallic device projecting over the right distal lumbar spine and sacrum.Two views of the left femur demonstrates aforementioned healed pelvic fractures, as well as marked left knee osteoarthritis and a moderate joint effusion. There is no evidence of acute fracture or malalignment. No significant soft tissue swelling. | Moderate left knee joint effusion. No acute fracture or malalignment is evident. Severe left knee osteoarthritis. |
Generate impression based on findings. | RFO trigger: Surgery length greater than 8 hours RFO trigger: Multiple surgical teams Suspected RFO location: Abdomen Name of suspected RFO: Unknown Attending Surgeon name/pager: Dr. Choi Body Mass Index (BMI): 21.37 Surgical drains are present in the left and right upper quadrant. There is a nasogastric tube with its tip projecting over the fundus of the stomach. Skin staple line projects in the midline abdomen. Suture material is seen in the abdomen. There is a surgical drain within the pelvis. A rectal temperature probe is in place. Pneumoperitoneum along the right flank is presumably postoperative in etiology. No unexpected radiopaque foreign object identified. | Postsurgical changes but no unexpected radiopaque foreign object identified.These findings were discussed via telephone with Dr. Choi by the radiology resident on call at 19:00 on 3/11/2015. |
Generate impression based on findings. | Male, 6 years old. Fall, pain. Evaluate for fracture.VIEWS: Left humerus AP, lateral (2 views) 3/11/2015, 1814 No acute fracture or dislocation.Elbow joint effusion. | Elbow joint effusion without acute fracture or dislocation. See same day elbow radiograph for additional details. |
Generate impression based on findings. | RFO trigger: R/O RFO Suspected RFO location: Abdomen Name of suspected RFO: surgical needle Attending Surgeon name/pager: room 15- tel 69415 Body Mass Index (BMI): 24.96 Catheter tubing is seen looped in the right lower quadrant. A sponge projects over the very right lateral field on the first image, but was removed on the subsequent image provided. Additionally, towel clips suggested in lower right thoracic area and over the right hip on final image. | No unexpected radiopaque foreign object identified.These findings were relayed to Dr. Umansky at 20:57/11/2015. |
Generate impression based on findings. | 49-year-old female with persistent nausea and vomiting after LOA ABDOMEN:LUNG BASES: Mild basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating renal lesions likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of gastric bypass. Interval resolution of bowel obstruction. Mild stranding in the mesentery and small amount of fluid in the paracolic gutter may be postoperative in etiology.BONES, SOFT TISSUES: Postoperative of the abdominal wall from laproscopic ports.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval resolution of bowel obstruction. Mild stranding in the mesentery and small amount of fluid in the paracolic gutter may be postoperative in etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval resolution of bowel obstruction without specific findings to account for the patient's symptoms. |
Generate impression based on findings. | 78-year-old male with history of metastatic small cell lung carcinoma with brain mets admitted for falls and altered mental status. New opacity on chest radiograph. LUNGS AND PLEURA: Small right pleural effusion has increased in size when compared to prior. There are dense airspace opacities with air bronchograms within the right middle and lower lobes which are new when compared to prior. There is a considerable amount of debris/tumor within the right mainstem and bronchus intermedius resulting in complete obstruction of the bronchus intermedius. Nodular and irregular interlobular septal thickening has increased likely the result of lymphangitic carcinomatosis. Diffuse bronchial wall thickening and centrilobular emphysema both lungs.MEDIASTINUM AND HILA: Please note that lack of intravenous contrast makes accurate tumor measurements in the mediastinum difficult. Large confluent tumor and lymphadenopathy along the right hilum involving the right pulmonary artery, pericardium, SVC, and right mainstem bronchus has increased in size now measuring 7.7 x 7.5 cm. The tumor causes complete obstruction of the bronchus intermedius and seems to narrow the SVC and right pulmonary artery, however without intravenous contrast, luminal dimensions of the vasculature are difficult to assess.Right paramediastinal mass measures 2.6 x 2.8 cm (image 43 series 4). Reference right paratracheal lymph node cannot be accurately measured without intravenous contrast, however subjectively, mediastinal lymphadenopathy has increased in size and number.Overall, the mediastinum is slightly shifted to the right, likely as a result of post-obstructive atelectasis. Heart size normal. Small pericardial effusion. Moderate coronary artery calcifications. Hypoattenuating blood pool compatible with anemia.CHEST WALL: Right cardiophrenic lymph node measures 11 mm, previously 8 mm (image 74 series 4). Sclerotic lesion along the posterior aspect of the L1 vertebral body is stable compared to prior.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered atherosclerotic calcifications of the abdominal aorta and its branches. Small splenule. | 1. Complete obstruction of the bronchus intermedius by tumor/debris with resultant right middle and lower lobe dense airspace opacities likely representing postobstructive atelectasis and pneumonia. Small to moderate right pleural effusion.2. Overall increase in tumor burden with measurements as above.3. Unchanged L1 vertebral body metastatic lesion. |
Generate impression based on findings. | 74 years, Female. Reason: evaluate Dobbhoff History: s/p TEE Limited study as pelvis is not included. There is a Dobbhoff tube with its tip projecting over the distal duodenum. There is a paucity of bowel gas which is unchanged from the prior exam. Surgical staples partially visualized and other postsurgical sequela unchanged from prior exam. Please refer to concomitant chest radiograph for full thoracic report. | Dobbhoff tube with its tip projected over the distal duodenum. |
Generate impression based on findings. | Clinical question: Evaluate for sinusitis. Signs and symptoms: Pancytopenia. Nonenhanced maxillofacial CT:Paranasal sinuses are well pneumatized. Examination demonstrate tiny foci of mucosal thickening along the medial aspect of left maxillary sinus and unremarkable exam otherwise. Patent bilateral ostiomeatal units of maxillary sinuses and bilateral sphenoethmoidal recesses of the sphenoid.Unremarkable images through the nasal passage.Well pneumatized bilateral mastoid air cells and middle ear cavities.Unremarkable images through the orbits. | No sinusitis. |
Generate impression based on findings. | 20 years, Female. Reason: abdominal pain, vomiting, IBD There is a nonobstructive bowel gas pattern. Average stool burden. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 47 years, Female. Reason: abdominal pain, evaluate for ileus History: abdominal pain There is a nonobstructive bowel gas pattern. Streaky left basilar opacity suggestive of atelectasis. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | known hemorrhagic metastatic lesions follow up. No significant interval change of bihemispheric hemorrhagic metastasis since prior exam.Intraventricular hemorrhage appears to be not changed since prior exam.There is no midline shift.The osseous structures are unremarkable. The mastoid air cells are clear. | No significant interval change of multifocal hemorrhagic metastasis with IVH since prior exam. |
Generate impression based on findings. | Female, 13 years old. Pain and swelling. Inversion ankle injury to leftVIEWS: left ankle, AP, lateral, oblique (3 views) 3/11/2015, 1806 Small joint effusion. Mild soft tissue swelling over the lateral aspect of the ankle. No acute fracture or dislocation. | Small joint effusion with no acute fracture or dislocation. |
Generate impression based on findings. | Respiratory distress syndrome. 2-year-old former 24 week gestational age patient.VIEW: Chest AP (one view) 03/12/15, 0540 Endotracheal tube tip is below thoracic inlet. Gastrostomy tube is present. Left upper extremity PICC has its tip in superior vena cava. Surgical clips are noted at the level of the GE junction.Cardiothymic silhouette is normal. Patchy bilateral lung opacities continue. Lung volumes are large. | Continued bilateral lung opacities. |
Generate impression based on findings. | Male, 16 years old. Status Post-Op Cardiac SurgeryVIEW: Chest AP (one view) 3/11/2015, 1843 Status post interval median sternotomy. Surgical clips in the mediastinum. ET tube below the level of the thoracic inlet and above the carina. Enteric tube with distal sideport above the level of the GE junction. New right chest tube in place.Cervical spine fixation hardware.The cardiothymic silhouette is normal.Streaky perihilar opacities may relate to increased pulmonary blood flow. No pleural effusions. Very small right apical pneumothorax. | Postoperative changes in the right hemithorax and mediastinum without acute complication. |
Generate impression based on findings. | 44-year-old female with buttock pain, rectal abscess ABDOMEN:LUNG BASES: Mild atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcifications likely representing granulomas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Slight prominence of the ureters and collecting system likely due to distended bladder. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The small bowel is normal in caliber. The colon is filled with fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Markedly distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The small bowel is normal in caliber. The colon is filled with fluid. Slight perianal stranding and gas extending towards the buttock abscess raises the question of an associated anal fistula.BONES, SOFT TISSUES: 12.5 x 8.0 cm gas and fluid collection in the posterior right buttock with slight extension into the left medial gluteal fold. There is no evidence of osseous involvement or overlying skin defect.OTHER: No significant abnormality noted | Large buttock abscess without osseous involvement as well as findings raising the question of associated anal fistula. MRI is recommended for further evaluation. |
Generate impression based on findings. | 16 year old female with abdominal pain, concern for fecal impaction.VIEW: Abdomen upright AP (one view) 3/12/15 Nonobstructive bowel gas pattern. No pneumatosis, portal venous gas, or free air. Moderate formed stool burden is present. | Normal examination. |
Generate impression based on findings. | 38 years, Male. Reason: Crohn's disease, evaluate for obstruction History: abdominal pain, bloating Nonobstructive bowel gas pattern with a greater than average amount of stool burden, most pronounced in the ascending colon. | Nonobstructive bowel gas pattern with a greater than average amount of stool burden, most pronounced in the ascending colon. |
Generate impression based on findings. | Male, 16 years old. post op cardiac; evaluate for internal changes. HypotensionVIEW: Chest AP (one view) 3/11/2015, 2105 Status post median sternotomy. Surgical clips in the mediastinum. Percutaneous atrial lines.ET tube below the level of the thoracic inlet. Enteric tube now with distal sideport below the level of the GE junction. Right chest tube in place. Cervical spine fixation hardware.The cardiothymic silhouette is normal.No focal pulmonary opacities. No pleural effusions.Very small right apical pneumothorax, unchanged. | Unchanged cardiopulmonary appearance. |
Generate impression based on findings. | 9 months old male. Assess ETT placement, assess for infiltrate Former 21 week gestation with tracheostomyVIEW: Chest AP (one view) 3/12/15 Tracheostomy tube tip is below the thoracic inlet. Feeding tube tip is distal to the GE junction, however is not included on this image. Lower extremity PICC tip is in the intrahepatic IVC.Soft tissue edema is again noted and not significantly changed. Cardiac silhouette is mildly enlarged, unchanged. Increased lung volumes unchanged. Bilateral streaky opacities appear mildly increased. Costal periosteal reaction is present likely secondary to chronic soft tissue edema. This periosteal reaction was not present on 2/9/15. | Chronic lung disease with increased bilateral streaky pulmonary opacities. |
Generate impression based on findings. | 34-year-old male with history of pain and swelling of the left hand after injury at work on 3/9/15. Three views of the left hand demonstrate a subacute transverse fracture through the mid diaphysis of the second metacarpal with mild ulnar deviation of the distal fracture fragment. There is moderate associated soft tissue swelling. | Subacute transverse fracture of the second metacarpal mid-diaphysis with mild ulnar deviation of the distal fracture fragment. |
Generate impression based on findings. | Call back from screening mammogram for right breast distortion. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. A distortion in question at outer quadrant in the right breast disperses into normal glandular tissue with spot compression. Focused ultrasound did not detect any abnormalities in the right lateral breast. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 66-year-old female with a prior CT raising question of right pulmonary infarct, assess for pulmonary embolism PULMONARY ARTERIES: Pulmonary artery opacification without evidence of pulmonary embolism to the segmental arterial level. The main pulmonary artery measures 2.2 cm, within normal limits.LUNGS AND PLEURA: Nonspecific peripheral wedge-shaped airspace opacity in the right upper lobe appears slightly decreased since the prior exam. Scattered nonspecific micronodules. No new focal opacities, nodules, or masses. Mild bibasilar dependent atelectasis. Unchanged subpleural nodule in the right upper lobe (series 10, image 131). No pneumothorax or pleural effusion. MEDIASTINUM AND HILA: Heart size is top normal. Mild coronary artery calcification. Mildly prominent 11-mm right hilar lymph node is again noted (series 9, image 97). No significant mediastinal lymphadenopathy.CHEST WALL: Biopsy clip is noted in the left breast. No significant axillary, subpectoral, retrocrural, or cardiophrenic lymphadenopathy. Right chest port tip at the superior cavoatrial junction. Small foci of air surrounds the chest port hub reflects recent placement. Mild degenerative changes affect the osseous structures. No suspicious osseous lesions are identified.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized subcentimeter hypodense lesion in the left kidney is unchanged. Mildly enlarged left adrenal gland with slightly nodular contour is unchanged. | 1.No evidence of pulmonary embolism.2.Slight interval decrease in size of right upper lobe peripheral opacity. This may represent a resolving infarct or may be infectious in etiology.3.Stable indeterminate 6 mm right subpleural nodule. Continued follow up is recommended.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 85-year-old male with history of G-tube placed in colon, eval for abscess ABDOMEN:LUNG BASES: Basilar atelectasis and consolidation. Small pleural effusions. Cardiomegaly.LIVER, BILIARY TRACT: Hypoattenuating hepatic lesions likely represent cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypoattenuating renal lesions likely represent cysts.RETROPERITONEUM, LYMPH NODES: IVC filter. Scattered atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: G-tube tip adjacent to and communicating with the transverse colon. NG tube tip in the stomach.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: Diffuse abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Distended with foci of gas, correlate for recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube tip adjacent to and communicating with the transverse colon. NG tube tip in the stomach.BONES, SOFT TISSUES: Moderate degenerative changes of the lumbar spine.OTHER: Diffuse ascites. | 1. G-tube tip adjacent to and communicating with the transverse colon as seen on recent IR study. No evidence of abscess.2. Pleural effusions with basilar atelectasis and consolidation which may represent aspirate or infection.3. Diffuse abdominal and pelvic ascites. |
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