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Generate impression based on findings. | 44-year-old male patient with left lower quadrant pain. Evaluate for infection. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a small hypoattenuating lesion in segment 6 of the liver. There is an additional hyperattenuating lesion in the inferior portion of segment 5 that measures 1.4 x 1.7 cm (series 3 image 45). Both of these lesions are incompletely characterized. Intraluminal focus of hyperattenuation along the gallbladder wall may represent a gallstone versus adenomyomatosis.SPLEEN: Multiple small peripherally enhancing lesions in the spleen are favored to be benign in etiology, such as hemangiomas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Incidental note is made a right adrenal nodule that measures 1.1 x 1.0 cm (series 3 image 30).KIDNEYS, URETERS: Subcentimeter hypoattenuating right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well-visualized and is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal abnormalities to account for patient's symptoms.2.Incidental liver lesions are incompletely characterized and are favored to be benign in etiology, such as hemangiomas or focal nodular hyperplasia.3.Right adrenal nodule is incompletely evaluated.4.Splenic lesions are favored to be benign, such as hemangiomas. |
Generate impression based on findings. | Trauma to right maxillary area 6 wks ago with persistent swelling. There is extensive mucosal thickening and fluid within the paranasal sinuses diffusely with relative sparing of the frontal sinuses. The nasal septum is deviated slightly to the right. There is mild stranding in the right cheek subcutaneous tissues. The maxillofacial skeleton and temporomandibular joints appear to be intact. The nasopharynx, orbits, and imaged intracranial structures appear to be unremarkable. There is a carious tooth # 30 with periodontal lucency. There is torus mandibularis. The mastoid air cells are clear. | 1. Extensive paranasal sinus inflammatory changes with signs of acute sinusitis.2. Carious tooth # 30 with periodontal disease.3. Apparent residue of a right cheek contusion, but no evidence of maxillofacial fractures. |
Generate impression based on findings. | 67-year-old female with ascites, jaundice and history of cholangiocarcinoma. Evaluate blood flow in liver LIMITED ABDOMENLIVER: Coarse echogenicity of the liver measuring 16.3 cm in length. No focal hepatic lesions.BILIARY TRACT: Gallbladder wall opacification of thickening unchanged. No pericholecystic fluid. Sonographic Murphy's sign is negative. Mild to moderate intrahepatic bilobar biliary ductal dilatation unchanged.PANCREAS: The visualized pancreas is normal in echogenicity.SPLEEN: Enlarged spleen measuring 16.4 cm in length and is normal in echogenicity. RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 10.6 cm in length. No hydronephrosis or shadowing calculi are noted.Moderate ascites.Biliary stent is noted. | 1. Coarse echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration.2. Gallbladder wall thickening and calcification unchanged. 3. Stable mild to moderate bilobar intrahepatic biliary ductal dilatation. 4. Splenomegaly. 5. Patent inflow and outflow hepatic vasculature. |
Generate impression based on findings. | Male 15 months old Reason: pulmonary edema/ pleural effusion History: Status post cardiac surgeryVIEW: Chest AP (one view) 3/12/15 at 1621 hrs. Central line, mediastinal clips, epicardial pacer leads and right-sided chest tube unchanged. Cardiac silhouette size is top normal but stable. Subsegmental atelectasis of the right upper lobe. No effusions or pneumothorax. | Segmental atelectasis of the right upper lobe. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (11/10/14), ultrasound images of left breast (11/10/14), ultrasound images of both breasts (11/25/14), ultrasound images for both breasts (2/18/15) performed at Good Shepherd Hospital. For comparison, digital mammographic images (8/15/13, 5/21/12) are available. DIGITAL MAMMOGRAPHIC IMAGES (11/10/14):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A retropectoral saline implants are unchanged in position and contour.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF LEFT BREAST (11/10/14):There are no abnormal findings in the provided images.ULTRASOUND IMAGES OF BOTH BREASTS (11/25/14):There is a circumscribed, oval, benign appearing hypoechoic mass (9 x 3 mm) at 9 o'clock position in the right breast and a circumscribed, oval, benign appearing hypoechoic mass (11 x 2 mm) at 11 o'clock position in the left breast. Both appear to be intramammary lymph nodes. ULTRASOUND IMAGES OF BOTH BREASTS (2/18/15):The benign appearing hypoechoic mass at 9 o'clock position in the right breast and a benign appearing hypoechoic mass at 11 o'clock position in the left breast appear unchanged in shape and size. | No mammographic or sonographic evidence for malignancy. Annual mammogram and possible whole breast ultrasound study is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | T3N2b squamous cell carcinoma of the right tonsil (HPV+), status post induction chemotherapy and then concurrent chemoradiation. There is a new heterogeneous mass within the left cerebellar hemisphere that measures up to approximately 25 mm with surrounding edema and partial effacement of the fourth ventricle. Otherwise, there are stable post-treatment findings in the right tonsillar fossa. There is no evidence of measurable mass lesions or significant lymphadenopathy in the neck. The thyroid and major salivary glands are unchanged. There is mild low attenuation plaque in the bilateral carotid bifurcation regions. The osseous structures are unchanged. The airways are patent. The pituitary lesion is better depicted on the prior MRI, but appears grossly unchanged. The imaged paranasal sinuses and mastoid air cells are clear. There are partially imaged bilateral pleural effusions. | 1. A new heterogeneous mass within the left cerebellar hemisphere that measures up to approximately 25 mm with surrounding edema and partial effacement of the fourth ventricle likely represents a metastasis. A brain MRI with contrast is recommended for further evaluation.2. Post-treatment findings without evidence of measurable locoregional tumor recurrence or significant lymphadenopathy in the neck.3. Grossly unchanged pituitary lesion |
Generate impression based on findings. | 53-year-old male with pleural mesothelioma right bidimensional measurements per RECIST1.1 criteria and compare to prior exam. CHEST:LUNGS AND PLEURA: Postsurgical changes of a right thoracotomy are noted. Right pleural nodularity is not significantly changed since the prior exam. Reference measurements as follows:At the level of the great vessel origins (image 27): Three o'clock position measures 27 mm, previously 26 mm. Six o'clock position measures 28 mm, previously 27 mm.At the level of the aortic arch (image 29): Three o'clock position measures 25 mm, previously 25 mm. Six o'clock position measures 21 mm, previously 22 mm.At the level of the left ventricle (image 66): Five o'clock position lesion is confluent with adjacent anterior disease. When measured in a similar fashion to 12/2/2014, this lesion measures 51 mm, previously remeasured at 49 mm.Pulmonary metastases have increased in size.. No definitive contralateral pleural or parenchymal disease.MEDIASTINUM AND HILA: Reference right high paratracheal lymph node measures 14 mm, previously 15 mm (series 3, image 20). Additional subcentimeter, prominent mediastinal lymph nodes are not significantly changed since prior exam.Heart size is normal. No pericardial effusion. Minimal coronary artery calcification. Again noted is tumor abutting the right heart and involving pericardium and superior mediastinum attenuation of the azygos vein. Tumor abuts the distal thoracic esophagus, unchanged from the prior exam.Tracheal debris.CHEST WALL: Mildly prominent retrocrural lymph node is not significantly changed since prior exam. No cardiophrenic lymphadenopathy. No significant axillary lymphadenopathy. No subpleural or supraclavicular lymphadenopathy.Again noted is tumor extending along the right paravertebral space abutting the vertebral bodies on multiple levels without definitive osseous erosions to suggest involvement. Posterior extension of tumor in between the 11th and 12th rib is slightly increased since the prior exam (series 3, image 89).ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slight interval increase in right pleural reference measurements and chest wall tumor. Enlargement of pulmonary nodules. |
Generate impression based on findings. | 67-year-old female with right wrist pain. Three views of the right wrist demonstrate calcification of the triangular fibrocartilage complex as well as the scapholunate ligament, suggestive of calcium pyrophosphate deposition disease. There is positive ulnar variance and sclerosis of the proximal pole of the lunate, suggestive of ulnar abutment syndrome. There is significant soft tissue swelling. No discrete fracture is identified. | Findings suggestive of moderate osteoarthritis, CPPD, and ulnar abutment syndrome. Significant soft tissue swelling, without discrete fracture identified. |
Generate impression based on findings. | 42 year old female with a history of hyperlipidemia presented to the ED for chest pain radiating to the jaw and left arm. CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is mild diffuse mixed plaque in the mid-LAD, without significant stenoses.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the LCx.RCA: The right coronary artery is large and arises normally from the right Sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is mild diffuse mixed plaque in the mid-RCA, without significant stenoses.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 125 ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not included in the field of view. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Lungs: Limited coverage of the lungs due to limited scan acquisition. Left dependant reticulations favor atelectasis.Tiffany, the resident caring for the patient, was called by phone with the results at approximately 1pm, at time of image interpretation. | There are no significant coronary artery stenoses present. Mild, diffuse mixed plaques of the mid-LAD and mid-RCA. |
Generate impression based on findings. | 33 year old female with abdominal pain, elevated lipase. Evaluate for acute cholecystitis or pancreatitis LIVER: Normal echogenicity of the liver measuring 17.6 cm in length. No focal hepatic lesions.GALLBLADDER, BILIARY TRACT: Shadowing calculi are noted within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: Right kidney measures 11.0 cm in length. No hydronephrosis or shadowing calculi are noted. OTHER: Left kidney measures 13.0 cm in length. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 9.5 cm in length. | Cholelithiasis without evidence of cholecystitis. |
Generate impression based on findings. | Bilateral knee pain. History of right knee posterior horn medial meniscal tear. Assess for arthritis. Three views of the right knee reveal moderate to severe medial compartment joint space narrowing and tricompartmental osteophyte formation. A small joint effusion is noted. No acute fracture is evident.Three views of the left knee reveal mild osteophyte formation. No acute fracture is evident. | 1. Moderate to severe right knee osteoarthritis.2. Mild left knee osteoarthritis. |
Generate impression based on findings. | Postoperative findings are seen with scattered surgical clips and scarring. PHARYNX/LARYNX: Oropharyngeal, hypopharyngeal and laryngeal mucosal thickening persists. There is further slight increased density within the paraglottic fat, although without discrete mass. The degree of mucosal enhancement appears somewhat decreased. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is diminutive in size but unchanged.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental hardware.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is atherosclerotic calcification at the carotid bifurcations there is mild narrowing bilaterally of the proximal internal carotid arteries. There is prominent noncalcified plaque along the left common carotid artery just distal to its origin, with moderate narrowing. Majority of the left internal jugular vein is not visualized, but unchanged. Emphysema is demonstrated in the lung apices. | Redemonstration of post treatment changes without evidence of cervical lymphadenopathy or recurrent disease. |
Generate impression based on findings. | 44 year old male with mitral valve prolapse, referred for cardiac CT to evaluate aorta and coronary arteries. Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.Ramus intermedius: DiminutiveLAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The second diagonal branch is dominant which trifurcates; no significant stenoses of the diagonals are noted.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to one dominant obtuse marginal branch. There are no significant stenoses in the LCx.The LAD and Cx distal vessels demonstrate marked tortuosity which can be seen in the presence of systemic hypertension.RCA: The right coronary artery is large and arises normally from the right Sinus of Valsalva. It is the dominant coronary artery supplying an early branching posterior descending artery, an inferoseptal branch and a posterolateral branch. There are no significant stenoses in the right coronary artery and branches.Left Ventricle: The left ventricular late diastolic volume is normal (LV volume 154 ml).Right Ventricle: Visually the right ventricular late diastolic volume is within normal limits.Left Atrium: Visually, the left atrial volume appears to be normal in size. There are three right and two left pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves. There is apparent prolapse of the mitral valve at end systole with mild thickening of the leaflets.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.CHEST:LUNGS AND PLEURA: Small non-calcified nodule in the peripheral right upper lobe measuring 3mm in diameter. There is also a small calcified granuloma in the inferior aspect of the peripheral right upper lobe. If the patient is at high risk, such as having a history of malignancy or is/ has been a smoker, recommend one year follow up with dedicated thoracic CT. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: There is gynecomastia with asymmetric left lateral nodularity of the left breast, which should be correlated to physical exam and possibly a mammogram. 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: 3 right exophytic renal cysts. Small cortical cysts on the left.RETROPERITONEUM, LYMPH NODES: Several small gastrohepatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral fat-filled inguinal hernias.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No significant coronary artery stenoses are present.2.Small, non-calcified nodule in the peripheral right upper lobe measuring 3mm in diameter. 3.Mild gynecomastia with asymmetric nodularity of the left breast, please see above.4.Vascular dimensions will be reported later in an addendum to this report. |
Generate impression based on findings. | 59-year-old male with right knee pain. Two views of the right knee demonstrate a healed proximal fibular fracture. There is mild osteoarthritis and a small joint effusion. There is no acute fracture or malalignment. | Mild osteoarthritis and a small joint effusion. |
Generate impression based on findings. | Female 68 years old Reason: fracture, History: swelling, pain Bone mineralization is decreased. There is severe right osteoarthritis there is a small joint effusion. No acute fracture is evident. | Severe right knee osteoarthritis. |
Generate impression based on findings. | Female 64 years old Reason: right knee pain History: right knee pain Moderate osteoarthritis affects the right knee with moderate medial compartment joint space narrowing and tricompartmental osteophytes. There is a small joint effusion. No acute fracture or malalignment. | Moderate right knee osteoarthritis |
Generate impression based on findings. | History of knee surgery. Now with recurrent knee pain. Moderate osteoarthritis affects the knee, particularly the patellofemoral joint, that appears to have progressed slightly since the prior study. There is a small to moderate sized joint effusion. There is a small well corticated ossicle along the tip of fibular styloid, of doubtful current clinical significance. | Moderate osteoarthritis and joint effusion. |
Generate impression based on findings. | Male 59 years old Reason: Assess shoulder for arthritis, signs of impringement History: Left shoulder pain Bone mineralization is normal. Alignment is anatomic. The joint space is normal.Mild osteoarthritis affects the AC joint. | Mild osteoarthritis of the AC joint. |
Generate impression based on findings. | Female 63 years old Reason: pre-op History: pain Moderate to severe osteoarthritis affects the right knee with tricompartmental osteophytes. There is a small joint effusion. No acute fracture or malalignment.Mechanical axis right knee is 3 degrees of valgus. | Osteoarthritis of the right knee and mechanical axis as detailed above. |
Generate impression based on findings. | Status post MVA with right hip pain. Question of dislocation, fracture, or other acute abnormalities. Two views of the right hip reveal no acute fracture. There is abnormal offset of the right femoral head/neck junction compatible with a CAM type deformity. | CAM type deformity of the right femur; correlate for hip impingement. |
Generate impression based on findings. | Heel ulcer. Elevated CRP. Rule-out osteomyelitis. There is a soft tissue defect along the plantar aspect of the heel compatible with the known ulcer. The underlying calcaneus appears intact, without radiographic evidence of osteomyelitis. There is diffuse soft tissue swelling. Mild osteoarthritis affects the ankle joint. | Soft tissue ulcer without radiographic evidence of osteomyelitis. If there is strong clinical concern for osteomyelitis, MRI may be considered. |
Generate impression based on findings. | Female 44 years old Reason: S/p Rt THA History: S/p Rt THA Components of a total right hip arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Joint drain and soft tissue gas are present.AP view of the pelvis shows the aforementioned right hip arthroplasty. There is a port type device projecting over the left ilium.Mild osteoarthritis affects the left hip partially imaged. | Right arthroplasty device as detailed above. |
Generate impression based on findings. | Fall on Saturday, bruising on anterior chest, pain with deep breathing, patient reports feeling movement in the rib area. Evaluate for rib fracture. Markers were placed along the left rib cage presumably denoting the site of the patient's pain. I see no fracture or other findings to account for the patient's rib pain. The lungs are underinflated but appear clear. | No fracture or other findings to account for the patient's pain. |
Generate impression based on findings. | Male 59 years old Reason: eval fracture History: pain There are healing medial and lateral malleoli fractures with callus formation. The fracture lines remain visible. Alignment is unchanged.No significant joint effusion.The bones are demineralized. The swelling has slightly improved | Healing medial and lateral malleoli fractures. |
Generate impression based on findings. | Pain after hitting chest wall. Rule out rib fracture. I see no fracture or other findings to account for the patient's rib pain. | No fracture or other findings to account for the patient's rib pain are evident. |
Generate impression based on findings. | Male 63 years old; Reason: Preop eval shoulder and glenoid prior to total shoulder arthroplasty History: above There is severe osteonecrosis of the left humeral head with a subchondral fracture and collapse. This fragmentation of the subchondral fracture.Moderate to severe osteoarthritis affects the left glenohumeral joint. There is no significant remodeling of the glenoid. There is a small fragment of bone noted in the subcoracoid space.Mild osteoarthritis affects the AC joint. There is some anterior spurring of the acromial process.There is no significant muscle atrophy.Mild emphysematous changes are noted in the left lung. | 1.Osteonecrosis of the left humeral head and moderate osteoarthritis of the left shoulder joint. |
Generate impression based on findings. | Male 44 years old Reason: knee pain, ankle pain History: same Right lower extremity: There is diffuse soft tissue swelling. The underlyingtibia and fibula are intact. No evidence of osteomyelitis or acute fracture.Right ankle: There is moderate midfoot osteoarthritis. The joint space the ankle isnormal. No acute fracture or malalignment. Is soft tissue swelling.Note is made of an Achilles tendon insertion enthesophyte. | Soft tissue swelling without underlying fracture. |
Generate impression based on findings. | Pain in the hip status post fall. Rule out fracture. Again seen is deformity of the femoral head and acetabulum compatible with hip dysplasia. I see no fracture. | Findings compatible with developmental dysplasia of the hip without acute fracture. |
Generate impression based on findings. | Status post posterior L4 -- 5 arthrodesis/decompression with TLIF and posterior instrumentation. Evaluate arthrodesis at L4 -- 5. There are posterior rods with screws entering the L4 and L5 vertebrae. I see no hardware complications. An Intervertebral spacer device is noted at L4 -- 5 containing faint density presumably representing bone graft. Mottled gas density in the posterior soft tissues presumably reflects recent surgery. Moderate degenerative disk disease affects L5/S1. Mild degenerative disk disease affects L3/4. | Postoperative changes of lower lumbar fusion and degenerative disk disease as above. |
Generate impression based on findings. | 79-year-old man with history of head and neck cancer status post chemotherapy and radiation, now with right mandible draining cutaneous fistula with bone exposure. Evaluate for osteomyelitis. Again seen is a plate and screw device spanning a large defect of the right mandibular body. There is scalloping along the alveolar ridge of the remainder of the right mandibular body that appears more prominent on the current study than on the prior study; however I cannot tell if this represents true progression of erosion or simply slight differences of technique/positioning. The orientation of the third most medial screw has changed, and it no longer appears to reside within the bone. The mandibular angle and lateral screws appear similar to those seen on the prior study. The patient is edentulous. | Scalloping of the alveolar ridge of the remainder of the right mandibular body along with change in orientation of one of the screws may reflect osteomyelitis, but this is equivocal. This could be further evaluated with CT, if clinically warranted. |
Generate impression based on findings. | Fracture of left foot Orthopedic screws affix the first, second, and third tarsometatarsal joints in near anatomic alignment. Gas density within the adjacent soft tissues reflects recent surgery. There is a bipartite medial sesamoid bone, likely a normal variant. | Orthopedic fixation of the Lisfranc joint as above. |
Generate impression based on findings. | Bilateral hand numbness. Lumbar pain. Hip pain. Rule out disk impingement, disk herniation, osteoarthritis. Six views of the cervical spine are provided. There is severe degenerative disk disease throughout the cervical spine. There is also moderate multilevel facet joint osteoarthritis and neuroforaminal narrowing bilaterally. Alignment is within normal limits.Five views of the lumbar spine are provided. There are 4 non-rib bearing lumbar type vertebrae which for the purposes of this study will be designated L1 through L4. Severe degenerative disk disease affects L4/S1. Moderate to severe facet joint osteoarthritis affects the lower lumbar spine. There is a grade 1 anterolisthesis of L3 and a grade 1 retrolisthesis of L4. Vertebral body heights are preserved. Mild degenerative disk disease affects the visualized lower thoracic spine.Two views of the right hip are provided. Mild osteoarthritis affects the hip. Arterial calcifications are noted in the soft tissues. | Degenerative arthritis of the spine and hip as described above. |
Generate impression based on findings. | Reason: 77M with shortness of breath History: Dry cough, possibly infectious vs oncologic PULMONARY ARTERIES: The examination is adequate for the evaluation of pulmonary embolism. No pulmonary embolus is present. There is mild narrowing at the level of the pulmonic valve which may be due to external compression from surrounding fluid.LUNGS AND PLEURA: Respiratory motion artifact. Moderate to large, loculated left pleural effusion, increased from prior with associated compressive atelectasis. Small right pleural effusion which is decreased compared to prior. Basilar interstitial edema. Peripheral nodular focus right middle lobe (9/79), and not present on prior exam. This can be followed when the patient's acute issues have been resolved.MEDIASTINUM AND HILA: Moderate pericardial effusion which appears chronic. Mild cardiac enlargement from left atrial dilation. Extensive coronary artery and mitral annular calcification. There is fat stranding within the pericardial fat. No interval mediastinal adenopathyCHEST WALL: There has been prior sternotomy. Gynecomastia unchanged. Ectasia of the left brachiocephalic vein partially included in this field of view. Deformities of multiple left-sided ribs from callus of prior fracture.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Hepatic granulomata. Several nodular foci of various densities are noted in expected location at the superior pole right kidney which is not included in the field-of-view. Morgagni hernia. | No pulmonary embolus. Partially loculated moderate to large left pleural effusion, small right pleural effusion. Chronic pericardial effusion. Mild basilar edema. Nodule lateral right middle lobe which can be followed after resolution of the patient's acute medical issues.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | New diagnosis of acute leukemia. Infectious process? Several teeth are absent, and note is made of multiple dental fillings and bridges. I see no focal lucencies to suggest bony infection. | No findings to suggest bony infection. If further imaging evaluation is clinically warranted, dedicated dental radiographs may be considered. |
Generate impression based on findings. | 50-year-old recall from screening for a focal asymmetry in the right breast. An ML view and spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The area of focal asymmetry largely disperses with spot compression. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Foul-smelling discharge from wound. Evaluate for osteomyelitis. Since the prior study, the first and second toes have been amputated. There is a large soft tissue defect distal to the heads of the first and second metatarsals. There is scalloping of the distal aspect of the head of the first metatarsal and mild flattening of the 2nd metatarsal head, but I cannot tell if this is due to osteomyelitis or prior surgery. Mild deformities of the base of the fifth metatarsal and distal fibula likely represent old healed fractures. Note is made of arterial calcifications in the soft tissues. | Postoperative changes of first and second toe amputation with a large wound distal to the first and second metatarsal heads. Scalloping of the first metatarsal head and mild flattening of the 2nd metatarsal head may simply represent additional postoperative changes although I cannot exclude the possibility of osteomyelitis. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Reason: shortness of breath, tachycardia, diagnosed with DVT History: shortness of breath, tachycardia PULMONARY ARTERIES: Examination is technically adequate for the evaluation of pulmonary embolism. No pulmonary embolus is present.LUNGS AND PLEURA: Centrilobular emphysema dependent opacities compatible with atelectasis and possible aspirated secretions at the bases. Chronic basilar pleural thickening and left lower lobe bronchiolectasis raising the question of chronic aspiration.MEDIASTINUM AND HILA: There is a patulous structure right of midline in the expected location of the esophagus which is most compatible of a colonic interposition filled with gas and air to the cervical esophagus. Small mediastinal nodes. Heart size is normal. No pericardial effusion. Extensive coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Low density lesion with associated high density foci incompletely imaged. When compared to outside CTs abdomen pelvis 12/18/14 and 8/22/14, this has not significantly changed. Multiple clips are noted in the left upper abdomen | No pulmonary embolus.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Ms. Stone is a 61 year old female with biopsy proven IDC in the right breast. She presents today for needle localization prior to surgery. Targeted right breast ultrasound was performed to re-identify the biopsy proven malignancy in the right lateral breast. However, no sonographic correlate was seen corresponding to the known malignancy. As a result, a decision to proceed with wire localization using mammographic guidance was made.WIRE LOCALIZATION USING MAMMOGRAPHIC GUIDANCE: On review of the prior studies, a spiculated asymmetry is present in the right lateral breast, along with a percutaneously placed ribbon clip. This will be the target for today's needle localization via mammographic guidance. Target spiculated asymmetry is located in the right breast in the outer region located posteriorly at 9 o’clock. The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 7 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Sheth performed the procedure under direct supervision of Dr. Schacht, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed distortion, the clip, the mass and spring wire to be within the specimen. Spiculation extending peripherally were discussed with Dr. Jasowiak and felt to potentially represent fibrosis, given that the mass is central in the specimen. | Successful needle localization of the right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | History of rheumatoid arthritis. Neck and shoulder pain. The cervicothoracic junction is partially obscured on the lateral views due to overlying anatomy. There is perhaps mild facet joint osteoarthritis affecting the lower cervical spine, and perhaps a minimal retrolisthesis of C4, but vertebral body heights and intervertebral disk spaces are within normal limits. The neuroforamina appear patent. | Possible minimal facet joint osteoarthritis, but otherwise normal-appearing spine. |
Generate impression based on findings. | 55 year old female with epigastric pain, right upper quadrant pain, elevated alkaline phosphatase LIVER: Liver measures 15.6 cm in length. There is some lobulation along the margins of the liver. No focal hepatic lesions. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Several mobile shadowing stones within layering sludge present within the gallbladder. Mild asymmetric gallbladder wall thickening along the fundus which may represent adenomyomatosis. No pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation. PANCREAS: The visualized pancreas appears slightly hypoechoic. No peripancreatic fluid or pancreatic ductal dilatation.RIGHT KIDNEY: Not visualized.OTHER: Normal echogenicity of the spleen measuring 9.0 cm in length. Normal echogenicity of the left kidney measuring 12.3 cm in length. | 1. Cholelithiasis and sludge with no evidence of cholecystitis. Suggestion of adenomyomatosis along the fundus of the gallbladder. 2. Slight hypoechogenicity of the visualized pancreas which is nonspecific and can be seen in pancreatitis although no peripancreatic fluid or pancreatic ductal dilatation is noted. Clinical correlation is recommended. 3. Lobulation along the margins of the liver. Correlate clinically and with lab values for possible cirrhosis. |
Generate impression based on findings. | 59-year-old female patient with epigastric, right upper quadrant pain, and nausea. Evaluate for pancreatitis. ABDOMEN:LUNG BASES: Trace basilar atelectasis.LIVER, BILIARY TRACT: Status post cholecystectomy. Subcentimeter hypoattenuating lesion in the right lobe of liver is too small to characterize and likely represents a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No abnormal pancreatic enhancement are peripancreatic inflammation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction or significant bowel wall thickening.BONES, SOFT TISSUES: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well visualized and filled with enteric contrast. Sigmoid diverticulosis.BONES, SOFT TISSUES: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: Small amount of free fluid in the pelvis. | No acute intra-abdominal abnormality to account for patient's symptoms. Small amount of fluid in the pelvis is abnormal in postmenopausal women. Recommend correlation with menopausal status. |
Generate impression based on findings. | Pain after fall. Evaluate for fracture. The bones appear slightly demineralized, perhaps reflecting osteopenia. I see no fracture or dislocation. There is a slight lateral downsloping of the acromion process and perhaps minimal osteoarthritis of the AC joint, of questionable clinical significance. Mild degenerative arthritic changes affect the visualized spine. | No fracture or other acute findings to account for the patient's pain are evident. |
Generate impression based on findings. | Pain. Fracture? There is a comminuted fracture of the proximal half of the distal phalanx of the great toe with extension to the articular surface. There is mild dorsal displacement of a couple of the fracture fragments at the base of the phalanx. | Great toe fracture as above. |
Generate impression based on findings. | Generalized pain. Three views left hand reveal no acute fracture. There is joint space narrowing and osteophyte formation of the first interphalangeal joint, and the DIP joints of the remaining digits, most predominantly the second and fourth digits. Moderate osteoarthritis affects the first metacarpophalangeal joint. There is mild soft tissue swelling of the fifth digit. | 1. Soft tissue swelling of the fifth digit without acute fracture evident.2. Degenerative changes as above. |
Generate impression based on findings. | Fall. Right ankle pain. Right hip pain. Three views of the right ankle are provided. There is mild soft tissue swelling, but I see no acute fracture. A well corticated ossicle distal to the medial malleolus likely reflects old trauma, and was present on the prior study. Small tibiotalar joint osteophytes suggest mild osteoarthritis. There are small plantar and posterior calcaneal spurs.Two views of the right hip are provided. Mild osteoarthritis affects the hip, but I see no fracture. | Mild osteoarthritis without acute fracture evident. |
Generate impression based on findings. | 62-year-old male patient status post Frey procedure with RUQ abscess presents with fever and diarrhea. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with overlying atelectasis/consolidation. Moderate to severe coronary artery calcifications are again noted.LIVER, BILIARY TRACT: Posterior changes from cholecystectomy and hepatic segment 5 partial resection. No intrahepatic or extra hepatic biliary ductal dilatation. Interval placement of right infrahepatic drain with minimal fluid surrounding the catheter tip. There is interval decrease in perihepatic fluid collection and slight interval decrease in gallbladder fossa fluid collection. Foci of air in the gallbladder fossa collection is again noted. SPLEEN: No significant abnormality noted.PANCREAS: Postsurgical changes from Frey procedure including pancreaticojejunostomy. Jejunal Roux limb is mildly prominent, unchanged compared to prior.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes. Moderate atherosclerotic changes affect the abdominal aorta and its branches.BOWEL, MESENTERY: Posterior changes of pancreaticojejunostomy. Roux limb formation with jejunojejunal anastomosis in the left midabdomen. No evidence of bowel obstruction.BONES, SOFT TISSUES: Post surgical changes noted in the anterior abdominal wall. Mild diffuse anasarca. Moderate multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Air in the bladder is likely iatrogenic.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: As above.BONES, SOFT TISSUES: Moderate multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted | Interval placement of infrahepatic drain with minimal fluid surrounding catheter tip. Mild interval decrease in gallbladder fossa fluid collection and perihepatic fluid. |
Generate impression based on findings. | 70 years, Male. Reason: evaluate Dobbhoff tube placement History: new Dobbhoff tube placement There is a Dobbhoff tube with its tip projecting over the body of the stomach. The pelvis is excluded from the field of view. The pelvis is excluded from the field of view. Retrocardiac opacity suggest atelectasis/consolidation. There small bilateral pleural effusions. There are marked degenerative changes of the lower lumbar spine. There is new embolization coil material in the right upper quadrant and an IVC filter has been placed. | Dobbhoff tube with its tip projecting over the body of the stomach. |
Generate impression based on findings. | Rule-out ICH, Cerebral edema. Status post lung transplant, hepatic failure, ECMO There is diffuse loss of gray-white differentiation throughout the brain parenchyma and diffuse sulcal effacement. There is also diffuse effacement of the basilar cisterns indicative of downward herniation. Ventricular system appears small likely related to mass effect. . Cerebellum appears relatively hyperdense. No intracranial hemorrhage is identified. No midline shift.Endotracheal tube and NG tube are in place. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | Diffuse cerebral edema and evidence of downward herniation. Global hypoxic ischemic injury is not excluded. |
Generate impression based on findings. | Female, 12 years old. Evaluate for fracture History: medial swelling with increased pain and inability to bear weightVIEWS: Right ankle, AP, lateral, oblique (3 views) 3/12/2015, 2007 The osseous structures and joint spaces are normal.Mild soft tissue swelling about the ankle. No significant joint effusion. | Soft tissue swelling with no acute fracture or dislocation. |
Generate impression based on findings. | RFO trigger: Surgery length greater than 8 hours Suspected RFO location: Abdomen and /or pelvis Name of suspected RFO: Instruments, sponges, needles per protocol Surgery length > 8 hours Attending Surgeon name/pager: Yamada- ROOM 20-Tel 69420 Body Mass Index (BMI): 23.63 There is a nasogastric tube with its tip extending out of the field-of-view the left. Skin staples are present in the midline abdomen. There is a JP drain in the right lower quadrant. There is a nonobstructive bowel gas pattern. Pneumoperitoneum is presumably postoperative in etiology. Two surgical clips are seen in the left hemipelvis and several surgical clips project over the left upper quadrant. No unexpected radiopaque foreign object identified. | No unexpected radiopaque foreign object identified.These findings were discussed via telephone with Dr. Yamada, the attending surgeon at 20:00 on 3/12/2015 by the radiology resident on call |
Generate impression based on findings. | 68 years, Female. Reason: assess for obstipation History: 68 y.o. woman with a history of abd gas/bloating and excessive gas. Rectal exam suggestive of rectal prolapse with copious st ool in vault Nonobstructive bowel gas pattern with a greater than average stool burden. Levoscoliosis of the lower lumbar spine. | Greater than average stool burden. |
Generate impression based on findings. | Male, 4 months old. History of Trisomy 21 and history of mild pulmonary hypertension p/w resp distress/increased WOB.VIEW: Chest AP (one view) 3/12/2015, 2105 The cardiothymic silhouette is normal.Peribronchial thickening and increased lung volumes. Streaky bibasilar and right upper lobe opacities, compatible with atelectasis, are similar to the prior exam. No new focal opacities. No pleural effusion or pneumothorax. | Bronchiolitis pattern without significant interval change. |
Generate impression based on findings. | 33 years, Male. Reason: Pt is a 32 yo M with h/o ureteroplasty with stent placement in the Left kidney, now presented with abdominal pain, constipation and rectal bleeding. Please assess stool burden and or obstructive disease. . History: abdominal pain and constipation Nonobstructive bowel gas pattern. No subdiaphragmatic free air. Visualized lung bases are unremarkable. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 13-year-old male with foreign object in left foot.VIEWS: Left foot AP, oblique and lateral (3 views) 3/13/15 A 1 cm triangular radiodensity is present in the dorsal soft tissues overlying the second metatarsal. No fracture is identified. | 1 cm triangular radiodense foreign object is present in the dorsal soft tissues overlying the second metatarsal. |
Generate impression based on findings. | Reason: PE History: CP PULMONARY ARTERIES: This examination is technically adequate for the evaluation of pulmonary embolism. No pulmonary embolus is present.LUNGS AND PLEURA: There is respiratory motion artifact with the acquisition obtained in exhalation. Trace pleural effusions. Diffuse bronchial wall thickening, greatest at the bases, suggestive of recurrent aspiration. There is a pulmonary nodule the right lower lobe measuring 7 x 9 mm (7/90). Additional pulmonary micronodules are smaller and nonspecific. Atelectasis is noted at the bases.MEDIASTINUM AND HILA: Moderate aortopulmonary and bilateral hilar lymphadenopathy.The overall heart size is within limits of normal. Moderate to severe aortic valvular calcification. No significant coronary artery calcification. No pericardial effusion.CHEST WALL: Significant retropectoral and bilateral axillary adenopathy. Several low densities within the thyroid gland compatible with cysts. At the base of the neck, there is soft tissue fullness which may represent lymphadenopathy; this is difficult to ascertain at the edge of the superior field of view. Consider obtaining CT of the neck for further evaluation. Multiple mildly enlarged supraclavicular lymph nodes.Degenerative changes of the thoracic spine and glenohumeral joints.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypodensity at the dome of the liver which may represent a cyst or hemangioma. There is loss of fat plane in the expected location of the porta porta hepatis and mesenteric vessels, raising a question of lymphadenopathy. Splenomegaly is incompletely imaged. Further imaging with a dedicated abdominal CT is recommended. | No pulmonary embolus.Extensive subpectoral, bilateral axillary, hilar and mediastinal lymphadenopathy. Soft tissue fullness noted the base of the neck with mildly enlarged supraclavicular lymph nodes. Fat planes are lost at the porta hepatis, suspicious for intraperitoneal lymphadenopathy. Multiple pulmonary micronodules in addition to right lower lobe nodule measuring 7 x 9 mm. The constellation of findings suspicious for malignancy, such as lymphoma or possibly metastatic disease. If outside imaging examination has been performed, comparison is recommended. Otherwise, additional imaging with a dedicated abdominal and pelvic CT, possibly neck CT recommended.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 51 years, Male. Reason: new dht History: please comment on position relative to lap band (hx rygb + lap band w/ erosion) There is a Dobbhoff tube with its tip projecting over the proximal body of the stomach, just distal to the gastric band. Gastric band seen partially en face suggesting possible slippage, further evaluation with an upper GI study can be considered as clinically indicated. Spinal fixation hardware unchanged. Previously seen oral contrast within the colon has cleared. | Dobbhoff tube with its tip projecting over the proximal body of the stomach, just distal to the gastric band.Findings suggestive of possible slipped gastric band, further evaluation with upper GI can be considered as clinically indicated. |
Generate impression based on findings. | Female; 20 years old. Reason: eval for abd pathology History: s/p chole and appy; h/o biliary stent ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild dilation of the common bile measuring up to 8 mm with no evidence of distal obstructing lesion; this is likely a normal finding in this patient who is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal lower pole hypoattenuating lesion is too small to characterize but likely a benign cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid, likely physiologic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic free fluid, likely physiologic. | No acute abdominopelvic abnormality. Mild dilation of the common bile duct is likely a normal finding in this patient who is status post cholecystectomy. |
Generate impression based on findings. | 70 year-old male with shortness of breath, hypoxia. History of esophageal adenocarcinoma. LUNGS AND PLEURA: Decrease in small right pleural effusion with increase in adjacent atelectasis. Interval increase in left pleural effusion with adjacent atelectasis. No pneumothorax.Diffuse, upper lobe predominant patchy groundglass opacities with scattered areas of focal consolidation mainly in the periphery are significantly increased. No change in pleural-based focal opacity likely scar from prior chest tube placement.Calcified granuloma in the right middle lobe.MEDIASTINUM AND HILA: Post surgical changes of a gastric pull-up are again noted with fluid in the neoesophagus.Previously to subcarinal lymph node conglomerate is unchanged measuring 12 mm (series 3, image 47), previously 12 mm.High right tracheoesophageal lymph node measures 8 mm (series 3, image 12), previously 9 mm. Small left hilar lymph nodes cannot be adequately assessed due to lack of IV contrast.Heart size is normal. No pericardial effusion. Moderate coronary artery calcification. Calcification of the aortic valve.Right chest port tip is at the superior vena cava.CHEST WALL: No significant axillary, retrocrural or cardiophrenic lymphadenopathy is identified. Healing right fifth rib fracture and 6 rib postsurgical deformity. No suspicious osseous lesions are identified.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Abdominal ascites is increased from prior exam. Central biliary dilatation appears unchanged. Pancreatic head cannot be visualized with certainty on the current exam. Right hydronephrosis. Bilateral nephroureterostomy tubes are in place. Enteric contrast from a prior exam. Left para-aortic adenopathy is not well delineated and better visualized on the prior study. | 1.Diffuse, upper lobe predominant patchy groundglass opacities with scattered areas of focal consolidation may represent aspiration and/or atypical infection. 2.Overall increase in pleural effusions and atelectasis. 3.Increasing abdominal ascites. No significant change in central biliary dilatation. 4.New right hydronephrosis with interval placement of bilateral nephroureterostomy tubes. |
Generate impression based on findings. | 31-year-old female with chest pain, elevated d-dimer PULMONARY ARTERIES: Adequate pulmonary artery opacification without evidence of pulmonary embolism.LUNGS AND PLEURA: No pleural effusion or pneumothorax. No focal pulmonary opacities. No suspicious nodules or masses are identified.MEDIASTINUM AND HILA: Mildly prominent right hilar lymph node. Additional scattered subcentimeter mediastinal and hilar lymph nodes. The heart size is normal. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: No significant axillary, retrocrural or cardiophrenic lymphadenopathy. No subpectoral or supraclavicular lymphadenopathy. The osseous structures are within normal limits. No suspicious osseous lesions are identified.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple gallstones are identified. Diffuse thickening of the stomach wall may be accentuated underdistention. | 1.No evidence of pulmonary embolism.2.Contrast extravasation as described above in the technique section.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female, 8 years old. Reason: Please assess for fracture. History: medial rt foot contusion, trauma, difficulty ambulating.VIEWS: Right foot, AP, lateral, oblique (3 views) 3/12/2015, 2130 A small bone fragment medial to the physis of the distal phalanx of the great toe may represent a Salter-Harris II fracture or a secondary ossification center.Otherwise, the osseous structures and joint spaces are normal. | Possible Salter-Harris II fracture of the medial aspect of the distal phalanx of the great toe. Correlate with the point of maximum tenderness. |
Generate impression based on findings. | Male 12 years old Reason: ETT position History: Cerebral palsy with respiratory insufficiency.VIEW: Chest AP (one view) 3/13/15 at 522 hours. ET tube tip is at the thoracic inlet. Right upper extremity PICC terminates at the right subclavian vein. Thoracolumbar dextroscoliosis unchanged. Cardiac silhouette size is normal. No change in angulation, persistent subsegmental atelectasis/scarring of the left upper lobe. | ET tube positioning as described. |
Generate impression based on findings. | Persistent headache, assess ventricular size No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Mild cerebellar tonsillar ectopia again seen. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of acute intracranial hemorrhage or mass effect. Ventricles are within normal limits without evidence of hydrocephalus.2. Mild cerebellar tonsillar ectopia as seen on prior MRI. |
Generate impression based on findings. | 61-year-old male patient with history of narrowing and tumor since with fever and right upper quadrant pain. ABDOMEN:LUNG BASES: Numerous new right lung base micronodules (series 4 image 12).LIVER, BILIARY TRACT: Again seen is extensive tumor involvement throughout the liver with confluent mass involving the central portion of the liver, caudate lobe, and porta hepatis. There is significant mass effect and compression of the hepatic and portal venous vasculature. There is also compression posteriorly of the inferior vena cava. Associated compression of the biliary tree with increased mild intrahepatic biliary ductal dilatation in the right and left lobes. Lymphadenopathy is noted at the porta hepatis.Reference lesions are as follows:Small lesion in the posterior segment of the right lobe measures 2.5 x 2.6 cm (series 3 image 33), previously 2.0 x 1.8 cm.Second index lesion in the lateral segment of the left lobe measures 4.1 x 2.5 cm (series 3 image 33) previously 3.5 x 2.1 cm.Lesion along the posterior capsule of the right lobe is not significantly changed from prior examination given differences in technique and likely resents an extrahepatic peritoneal implant.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: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: TURP defect in the prostate.BLADDER: No significant abnormality noted.LYMPH NODES: As below.BOWEL, MESENTERY: There is interval increase in size and number of soft tissue densities in the distribution of the omentum/mesentery in the pelvis, compatible with carcinomatosis. Reference soft tissue lesion in the right lower quadrant measures 3.1 x 2.8 cm (series 3 image 91), previously 2.7 x 1.9 cm.New small amount of ascites.BONES, SOFT TISSUES: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted. | 1.Overall interval increase in size of hepatic metastases with associated compression of the hepatic vasculature and increased compression of the biliary tree with mild intrahepatic biliary ductal dilatation.2.Interval increase in size and number of peritoneal implants compatible with carcinomatosis. Additionally, there is new ascites.3.New micronodules in the right lung base. |
Generate impression based on findings. | Male 15 months old Reason: Status-post VSD repair.VIEW: Chest AP (one view) 3/13/15 at 558 hours Central line tip is at the right atrium. Epicardial pacer leads, right-sided chest tube and mediastinal clips again noted. Cardiac silhouette size is large but stable. Persistent right upper lobe atelectases. No effusions or pneumothorax. | Persistent right upper lobe atelectasis. |
Generate impression based on findings. | 44 years, Female. Reason: Check Dobbhoff placement History: Check Dobbhoff placement There is a Dobbhoff tube, which is looped upon itself with its tip projecting over the proximal body of the stomach. There is a nonobstructive bowel gas pattern. The pelvis is excluded from the field of view. Streaky retrocardiac opacity suggests atelectasis. | Dobbhoff tube looped upon itself with its tip projecting over the proximal body of the stomach. |
Generate impression based on findings. | Male, 11 years old. Pain. Evaluate for fracture.VIEWS: Left great toe, AP, lateral (2 views) 3/12/2015, 2142 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | No acute fracture or dislocation. |
Generate impression based on findings. | Female 6 months old Reason: 6 mo F HIE, CP/DD, reintubated for hypercarbic respiratory failure. Evaluate lung fields and ETT position. History: Respiratory insufficiency.VIEW: Chest AP (one view) 3/13/15 at 528 hours. ET tube terminates at the carina. Gastrostomy tube again noted. Cardiac silhouette size is normal. Large lung volumes and left lower lobe opacity, likely atelectasis unchanged. | ET tube terminates at the carina.Persistent left retrocardiac atelectasis a large lung volumes. |
Generate impression based on findings. | Female; 59 years old. Reason: abdominal or pelvis hemorrhage or hematoma History: acute drop in hgb ABDOMEN:LUNG BASES: Mild bibasilar dependent subsegmental atelectasis. Small calcified granuloma right lower lobe.LIVER, BILIARY TRACT: Cholelithiasis.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: Enteric tube tip in first portion of the duodenum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Calcified uterine fibroid.BLADDER: Small amount of air within the decompressed bladder due to Foley catheter being in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No hemorrhage or other acute abdominopelvic abnormality. |
Generate impression based on findings. | 12 year-old male with facial trauma and bruisingVIEWS: Facial bones PA, lateral (two views) 3/13/15 Nasal bone appears intact. The sinuses are clear and there are no air-fluid levels present. No displaced skull fractures are seen on this exam. Please note that facial bone radiographs are insensitive for the detection of small fractures. | No fracture is identified. If there is strong clinical concern for fracture a CT is recommended. |
Generate impression based on findings. | 29-year-old male status post reduction of anterior shoulder dislocation. Previously seen glenohumeral dislocation has been reduced, in near anatomic alignment. Again seen is a Hill-Sachs deformity. Small bony fragments along the inferior aspect of the glenoid and medial aspect of the humeral neck are noted, likely representing chronic fracture fragments. No acute fracture is identified. | Reduction of glenohumeral dislocation as above. |
Generate impression based on findings. | Male 0 days old Reason: where is ETT? History: INITIAL XR - increasing respiratory distress; increasing O2 requirementVIEW: Chest and abdomen AP (two views) 3/13/15 at 449 hours. ET tube terminates at the carina. UAC tip is at the RA/SVC junction. UVC terminates at T8. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Diffuse lung haziness consistent with TTN versus RDS. No focal lung opacities. No effusions or pneumothorax.Disorganized, likely age related and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | ET tube and umbilical line positioning as described.Bilateral diffuse lung haziness consistent with TTN versus RDS.Disorganized, likely age related and nonspecific abdominal gas pattern. |
Generate impression based on findings. | Kidney stones ABDOMEN: The exam is not sensitive for detecting lesions in the bowel or solid organs due to lack of oral or intravenous contrast.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis in a collapsed gallbladder unchanged. No obvious biliary dilatation. Previously described cyst in the left lobe has increased in size and currently measures 5.8 cm in diameter.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral, nonobstructive renal calculi. Single stone on the right measures 4 mm and is located at the lower pole. Right kidney remains scarred in appearance as described previously with probable cysts. Enlarging nonobstructive stones on the left (approximately 5 total) with the largest measuring 7 mm and located at the upper pole.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications. No aneurysm.BOWEL, MESENTERY: Scattered colonic diverticulosis redemonstrated.BONES, SOFT TISSUES: Left hip replacement. 2.2-cm low-density nodule in the subcutaneous tissues of the back (image 24; series 3).OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Status post hysterectomy. Most of these do the pelvis are obscured by the left hip replacement. Previously described hypodense left adnexal nodule is much smaller now. This could be better evaluated by gynecologic ultrasound if desired clinicallyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral renal calculi, nonobstructive. Cholelithiasis. Diverticulosis. |
Generate impression based on findings. | Compare bleed Again seen is a large intraparenchymal hematoma measuring 4.8 x 3.7 x 3.2 cm previously 3.4 x 3.2 x 3.3 cm centered at the left insula and frontoparietal operculum. Again seen is hematocrit effect which may be related to active bleeding and/or coagulopathy. There is mild surrounding edema and mass effect with mild effacement of the left lateral ventricle, slightly worse since prior. No significant midline shift. No uncal herniation. No hydrocephalus. No other focus of hemorrhage is seen.There is a small lytic lesion involving the right parietal calvarium with punctate foci of hyperdensity and extra-axial extension with calcifications. Lytic lucency in the left frontal bone is favored to represent a hemangioma, with additional lucencies at the vertex bilaterally at the vertex compatible with arachnoid granulations. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. | 1. Interval enlargement of intraparenchymal hematoma centered at the left frontal operculum. There is mild increase in local mass effect without significant midline shift or uncal herniation.2. Right parietal lytic calvarial lesion with extra-axial extension and calcification is favored to represent a benign etiology such as hemangioma or meningioma and unchanged since 2/10/2015. Comparison with more remote prior studies would be helpful if available. |
Generate impression based on findings. | Tonsillar exudate with neck pain. There is diffuse enlargement of the Waldeyer ring structures with associated airway narrowing. There are multiple mildly enlarged cervical lymph nodes. For example, a right level 2 lymph node measures 12 x 18 mm. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. There is a carious tooth# 31. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. Diffuse enlargement of the Waldeyer ring structures with associated airway narrowing with likely reactive cervical lymphadenopathy likely represents adenotonsillitis without evidence of abscess formation. Nevertheless, an underlying neoplastic process cannot be entirely excluded on the basis of imaging.2. Carious tooth# 31. |
Generate impression based on findings. | Malignant neoplasm of uterus. Please note that lack of IV contrast limits evaluation for solid organ pathology and lymphadenopathy. Within this limitation, the following observations can be made:CHEST:LUNGS AND PLEURA: Scattered subcentimeter ground-glass and sub solid nodules in both lungs, unchanged since the prior exam and nonspecific in appearance. Mild centrilobular emphysema.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions are identified on this noncontrast exam.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild nodularity of the left adrenal gland, stable.KIDNEYS, URETERS: Right pelvic kidney, unchanged.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches, mild. Multiple prominent, none pathologically enlarged retroperitoneal lymph nodes are again noted.BOWEL, MESENTERY: Multiple omental and mesenteric nodules have decreased in size. The reference greater omental lesion currently measures 1.5 x 1.1 cm (image 124; series 3). There is no evidence of small bowel obstruction.BONES, SOFT TISSUES: There is a lucent lesion at the L1 vertebral body measuring approximately 2.2 x 1.3 cm (image 79; series 3). This was not present on a prior CT exam done at University Chicago (6/30/2014) but was present on a MR and CT examination done elsewhere in the interim. It has relatively well corticated margins but is new and has increased slightly in size. Correlation with repeat spine MRI may be beneficial as clinically indicated. No definite evidence of cord compression.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status-post hysterectomy.BLADDER: The bladder is partially collapsed. A non-reference soft tissue nodule in the perivesicular fat continued to decrease in size on the left lateral aspect of the bladder.LYMPH NODES: The previously referenced left external iliac lymph node currently measures 1.0 x 0.7 cm (image 145; series 3).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Reference lesions have all decreased in size however there is a new lucent lesion in the L1 vertebral body as discussed above. Findings discussed with Dr. Lee at the time of dictation. |
Generate impression based on findings. | 74 years, Male. Reason: patient with emesis with tube feeds, need to r/o obstruction History: nausea/emesis Nonobstructive bowel gas pattern. No significant abnormality is seen. Partially imaged pacemaker leads unchanged in position. G-tube valve seen en face view, but tubing is not well visualized. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 67 years, Female. Reason: NG History: NG Exclusion of pelvis in field of view. There is a Dobbhoff tube with its tip projecting over the antrum of the stomach. There are bilateral nephroureteral stents, two on the left and two on the right. Nonobstructive bowel gas pattern. | Dobhoff tube with its tip projecting over the antrum of the stomach. |
Generate impression based on findings. | Reason: r/o acute intracranial process History: head trauma, nausa, vomiting The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Facial trauma, maxillary point tenderness. There are comminuted fractures of the nasal skeleton with mild displacement and angulation of the fracture fragments. There is overlying subcutaneous swelling and stranding. There is effacement of the left nasal vestibule. There is mild S-shaped deviation of the nasal septum with a small spur directed towards the right. There is minimal scattered paranasal sinus opacification. The orbits area unremarkable. The temporomandibular joints and dentition appear to be grossly intact. The imaged intracranial structures are unremarkable. | Comminuted and displaced fractures of the nasal skeleton with overlying soft tissue contusion. |
Generate impression based on findings. | 63-year-old male patient with head and neck cancer, new gastrostomy tube placed 3/9/2015 presents with fever. Evaluate for source of infection. CHEST:LUNGS AND PLEURA: New small bilateral pleural effusions and overlying atelectasis/consolidation. Anterior bilateral upper lobe subpleural groundglass opacities are also noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiac size within normal limits without pericardial effusion. Minimal coronary artery calcifications.CHEST WALL: Left-sided chest port with catheter tip at the cavoatrial junction. No axillary lymphadenopathy.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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Partially thrombosed right common iliac artery aneurysm measures 2.5 cm in maximal diameter, unchanged compared to prior.BOWEL, MESENTERY: Interval placement of percutaneous gastrostomy tube with balloon in the gastric body. There is a small amount of free fluid superior to the gastrostomy site. There is a moderate amount of pneumoperitoneum, greater than expected for the prior gastrostomy placement. Note that there is no extravasation of enteric contrast.BONES, SOFT TISSUES: Mild to moderate multilevel degenerative changes affect the thoracolumbar spine.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: Mild to moderate multilevel degenerative changes affect the thoracolumbar spine. Dextroscoliosis affects the lumbar spine.OTHER: No significant abnormality noted. | 1.Percutaneous gastrostomy tube tip within the stomach without enteric contrast leak. However, there is greater than expected pneumoperitoneum. Correlate with clinical symptoms of peritonitis.2.New pleural effusions with overlying atelectasis/consolidation and subpleural ground glass opacities may represent infection or inflammatory changes. Correlate with aspiration history.3.Right common iliac artery aneurysm measures 2.5 cm in maximal diameter. |
Generate impression based on findings. | Reason: r/o acute intracranial process History: head trauma, nausa, vomiting The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | malaise and fatigue No evidence of acute ischemic or hemorrhagic lesion.Patchy low attenuation on bilateral periventricular white matter indicate minimal to mild non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | Reason: r/o intracranial process History: slurred speech There is ventriculomegaly present associated with periventricular hypodensities of a moderate degree. The biventricular diameter on the prior exam was a 41 mm and is similar on the current exam. Third ventricular diameter is 7 mm and previously was the same.The visualized portions of the paranasal sinuses demonstrates an air-fluid level in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Punctate lesion is present in the right and left basal ganglia. These remain stable when compared to the prior examAtherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.There is ventriculomegaly present which is stable compared to the prior exam4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Punctate lesions in the globus pallidus and are present which are stable since prior exam. These are likely vascular related. |
Generate impression based on findings. | Reason: r/o bleed History: fall, head laceration on aspirin The CSF spaces are appropriate for the patient's stated age with no midline shift. Atherosclerotic calcifications are present along the scalp vasculature . These calcifications could be related to renal failure or diabetes. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. There are calcifications present at the the globus pallidi bilaterally.Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Left post auricular swelling and erythema. Left: There is mild stranding of the subcutaneous tissues in the postauricular region, but no evidence of drainable fluid collection. There is opacification of the inferior mastoid air cells with intact bony septations. The middle ear is well-pneumatized and clear. The external auditory canal is patent. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There is partially-imaged paranasal sinus mucosal thickening. | 1. Findings suggestive of left mastoiditis and overlying postauricular cellulitis without evidence of associated abscess.2. Findings suggestive of sinusitis. |
Generate impression based on findings. | 67 year old male with history of thyroid cancer status post thyroidectomy. Evaluate for adenopathy or recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No residual thyroid tissue is seen. LEFT LOBE: No residual thyroid tissue is seen. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left neck level 4 lymph node is again seen measuring 1.1 cm x 0.6 cm x 1.4 cm, similar in size to previous study although appears different in echotexture with development of internal echogenic foci within the lymph node. Right neck level three benign appearing lymph node measures 5 mm x 6 mm x 1.0 cm. OTHER: No significant abnormality noted. | Left neck level 4 lymph node is again seen and although similar in size, appears different on today's exam with internal echogenic foci which could be related to sequelae of prior biopsy, although could also represent developing calcifications. Additional benign appearing lymph node in the right neck. |
Generate impression based on findings. | 43-year-old male with history of lymphoma. Evaluate for disease. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Reference right thoracic inlet lymph node has resolved. Reference right upper paratracheal lymph node measures 1.6 x 1.1 cm (image 17; series 3), decreased in size. Cardiac size is normal. No hilar lymphadenopathy.CHEST WALL: Reference left axillary lymph node measures 4.1 x 2.9 cm (image 21; series 3), increased in size. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left lower pole renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy with reference left paraaortic lymph node measuring 3.8 x 4.0 cm (image 122; series 3), larger.BOWEL, MESENTERY: Hazy/Misty mesentery with multiple mesenteric lymph nodes is again noted. Reference mesenteric lymph node measures 2.0 x 1.8 cm (image 107; series 3) unchanged. Reference mesenteric lymph node adjacent to the inferior spleen measures 2.4 x 2.0 cm (image 106; series 3), increased in size.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference right inguinal lymph node measures 2.5 x 1.5 cm (image 197; series 3). BOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mixed response with most of the adenopathy increasing in size. |
Generate impression based on findings. | 46 year old with history of left lumpectomy in 2002 for infiltrating ductal carcinoma followed by radiation and chemotherapy. No new breast complaints. 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 elements, unchanged in pattern and distribution. Stable postsurgical volume loss, increased density and architectural distortion are present in the left upper outer quadrant. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | known multiple hemorrhagic metastasis No significant interval change of multifocal hemorrhage metastatic lesions on bilateral hemisphere.There is no new evidence of midline shift or significant mass effect comparing to prior scan.The ventricles, sulci, and cisterns are symmetric and unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No interval change of multifocal hemorrhagic metastasis since prior exam. |
Generate impression based on findings. | Female 48 years old Reason: hyperthyroid History: low TSH Small focal area of decreased scintigraphic activity only appreciated on RAO, but not on other projections, likely artifact. The remainder of the gland is homogenous in appearance, with normal size and configuration. The 4-hour radioactive iodine uptake is 20.4% and the 24-hour uptake is 36.2% (normal range 10-30% at 24-hours). | Mildly increased 24 hour radioactive iodine uptake, consistent with hyperthyroid state. |
Generate impression based on findings. | 27-year-old female patient with right lower quadrant pain and fever. Evaluate for appendicitis. ABDOMEN:LUNG BASES: Trace dependent atelectasis.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: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well-visualized and is within normal limits. There is questionable bowel wall thickening of a loop of distal ileum in the pelvis (coronal series 80236 image 58), however, this is equivocal.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Equivocal bowel wall thickening in a portion of the distal ileum is nonspecific and may represent inflammation or edema. Otherwise, no definitive findings to account for patient's symptoms. |
Generate impression based on findings. | 72-year-old male with history of right ankle fracture, follow-up exam. Again seen is a spiral/oblique fracture the distal fibula, with fracture fragments in near anatomic alignment. Callus formation along the fracture is indicative of early healing. A vertically oriented lucency, partially traversing the posterior aspect of the distal tibia, may represent a nondisplaced "posterior malleolar" fracture, but this is equivocal. A pes planus deformity is present. There are degenerative arthritic changes of the midfoot. Note is made of a plantar heel spur. | Healing of distal fibular fracture as above. |
Generate impression based on findings. | headache No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | 47-year-old male with history of uncontrolled HIV now with shortness of breath and hypoxia LUNGS AND PLEURA: Severe upper lobe predominant paraseptal emphysema with large right apical bullae is again noted without significant interval change.Bilateral bronchiectasis appears worsened compared to the prior exam. Right lower lobe dense consolidation is again noted. New right middle lobe consolidation with bronchiectasis is present. Focal and tree-in-bud opacities are also noted in the right upper and left lower lobe, similar to the prior exam. Bronchial wall thickening is unchanged.The cavitary lesion with solid component in the inferior aspect noted in the left lung apex is not significantly changed measuring 3.5 x 1.8 cm (series 80296, image 24), previously 3.5 x 1.8 cm. The second cavitary lesion near the left hilum noted on the prior exam is not seen on the current study, compatible with resolving/resolved infection.MEDIASTINUM AND HILA: Unchanged prominent left paratracheal lymph node. Additional scattered subcentimeter mediastinal lymph nodes. No significant hilar lymphadenopathy. Heart size is normal. No pericardial effusion. Moderate coronary artery calcification. The pulmonary artery is enlarged consistent with pulmonary artery hypertension.CHEST WALL: Unchanged prominent retrocrural lymph node. No significant axillary or cardiophrenic lymphadenopathy. No subdural lymphadenopathy. No suspicious osseous lesions are identified.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small amount of abdominal ascites is present. Small subcentimeter lesion in the right lobe of the liver was not clearly seen on the prior exam (series 3, image 89). Large amount of debris within the stomach. | 1.Right lower lobe collapse with right upper lobe and left lower lobe centrilobular nodules, bronchiectasis, and bronchial wall thickening suggestive of bronchitis/bronchiolitis, which is likely partly chronic in nature. New right middle lobe peripheral consolidation consistent with pneumonia. Consider indolent atypical mycobacterial infection.2.Left upper lobe cavitary lesion is unchanged and suspicious for semi-invasive aspergillus.3.Enlarged pulmonary artery consistent with pulmonary artery hypertension. |
Generate impression based on findings. | headache, follow up of ventriculostomy tube insertion. No evidence of acute ischemic or hemorrhagic lesion.A remained ventriculostomy tube in the right lateral ventricle is still seen and no change. Another ventriculostomy tube inserted through the left parietal lobe and the tip position on the left lateral ventricle frontal horn, no change since prior exam.The ventricle size appears to be stable.There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The paranasal sinuses and mastoid air cells are clear. | No change since prior exam.No evidence of acute ischemic or hemorrhagic lesion on this scan. |
Generate impression based on findings. | 44 year-old male with hematuria. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild, focal parenchymal loss involving the upper pole of the left kidney. Kidneys otherwise appear unremarkable without evidence for calculus, mass or hydronephrosis. No calcifications identified in the course of the urinary tract.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is significantly enlarged and deforms the urinary bladder. Probable TURP defect. No gross bladder wall abnormality.BLADDER: No gross bladder wall abnormality.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal upper tracts. Enlarged prostate gland. No gross bladder abnormality. |
Generate impression based on findings. | 43-year-old female with history of left wrist fracture. Overlying cast material limits fine bone detail. Again seen is a comminuted intra-articular fracture of the distal radius, with fracture fragments in near anatomic alignment. Adjacent callus formation indicates some interval healing. A minimally displaced ulnar styloid fracture is identified. | Healing distal radius fracture as above. |
Generate impression based on findings. | Left knee pain and swelling. Left knee injury two weeks ago cheerleading, knee buckled. Evaluate for ACL tear, meniscus tear. MENISCI: There is a complex tear of the posterior horn of the lateral meniscus including a "Wrisberg rip" with additional tearing of the posterior horn near the root. The body and anterior horn of lateral meniscus are intact. The medial meniscus is intact.ARTICULAR CARTILAGE AND BONE: There is a "Segond fracture" of the lateral tibial plateau as seen on prior radiographs with edema of the underlying bone marrow. There is edema within the lateral femoral condyle more anteriorly with mild depression of the overlying articular surface compatible with a mild impaction fracture. There is also edema within the posterior aspect of the medial tibial plateau with slight overlying depression of the articular surface, perhaps representing a "countercoup" impaction fracture. Minimal edema is noted within the medial femoral condyle and fibular styloid. We see no fluid-filled articular cartilage defect.LIGAMENTS: There is a full-thickness midsubstance tear of the anterior cruciate ligament. The posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament complex is intact. EXTENSOR MECHANISM: No significant abnormality noted.ADDITIONAL | Anterior cruciate ligament tear, lateral meniscal tear, and fractures as described above. |
Generate impression based on findings. | Compare hemorrhage Again seen is a large intraparenchymal hematoma measuring 4.6x 3.6 x 3.4 cm centered at the left insula and frontoparietal operculum. Again seen is hematocrit effect. There is mild surrounding edema and mass effect with partial effacement of the left lateral ventricle, similar to prior. Minimal rightward midline shift. No uncal herniation. No hydrocephalus. No other focus of hemorrhage is seen.There is a small lytic lesion involving the right parietal calvarium with punctate foci of hyperdensity and extra-axial extension with calcifications. Lytic lucency in the left frontal bone is favored to represent a hemangioma, with additional lucencies at the vertex bilaterally at the vertex compatible with arachnoid granulations. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. | 1. Compared to most recent CT from 3/12/2015, no significant change in size of intraparenchymal hematoma centered at the left frontal operculum. There is local mass effect without significant midline shift or uncal herniation. There is hematocrit effect which may be related to coagulopathy/anticoagulant use. 2. Right parietal lytic calvarial lesion with extra-axial extension and calcification is favored to represent a benign etiology such as hemangioma or meningioma and unchanged since 2/10/2015. Comparison with more remote prior studies would be helpful if available. |
Generate impression based on findings. | 64-year-old male with history of lung cancer. CHEST:LUNGS AND PLEURA: Postoperative changes of left upper lobectomy. Moderate centrilobular and paraseptal emphysema. Small left pleural effusion. Spiculated nodule in the left lower lobe is no longer visualized. Small area of diffuse mild ground glass opacities in the posterior aspect of the right upper lobe may represent aspiration. Mild dependent atelectasis on the right.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Multiple coronary artery stents are present. There are scattered calcifications of the thoracic aorta. No significant mediastinal lymphadenopathy. There are scattered calcifications of the thyroid gland.CHEST WALL: Right-sided AICD with lead in expected location. Mild to moderate multilevel degenerative changes affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is mild bilateral perinephric stranding, which is nonspecific. Stable appearing right lower pole hypodensity, likely representing a cyst.PANCREAS: There are scattered calcifications throughout the pancreas compatible with chronic pancreatitis.RETROPERITONEUM, LYMPH NODES: There are diffuse atherosclerotic calcifications of the abdominal aorta and its branches. No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative disease affects the visualized lumbar spine.OTHER: No significant abnormality noted. | 1. The previously noted 7-mm left lower lobe nodule is no longer visualized.2. New small left pleural effusion.3. Small focus of groundglass opacities in the posterior aspect of the right lower lobe likely the sequela of aspiration. |
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