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Generate impression based on findings. | Male 18 years old Reason: 18 year old male patient diagnosed with clear cell sarcoma is here for THERASPHERES MAPPING in conjunction with nuclear medicine History: liver metastases There is free tracer activity within the right lobe of the liver consistent with patient's patient's recent mesenteric angiogram with Tc-99m MAA infusion into the right hepatic artery. No scintigraphic evidence of shunting to the lungs. | No evidence of lung shunting. Radiotracer accumulation in the right hepatic lobe consistent with patient's recent right hepatic artery infusion. |
Generate impression based on findings. | 26 year old female status post cyst removal in the thyroid in 2013, with left supraclavicular palpable mass. RIGHT LOBE MEASUREMENTS: No definite measurement can be obtained as there was history of right thyroidectomy.LEFT LOBE MEASUREMENTS: 5.6 cm x 1.4 cm x 1.5 cm.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: There is suggestion of ill-defined hypoechoic tissue in the region of the right thyroid lobe. LEFT LOBE: Minimally complex cyst is noted measuring 3 mm x 2 mm x 3 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: In the region of left palpable supraclavicular mass, there is a benign appearing lymph node assuring 9 mm x 7 mm x 3 mm.OTHER: No significant abnormality noted. | 1. Benign appearing lymph node in the region of palpable left supraclavicular mass.2. Ill-defined hypoechoic tissue is noted in the region of the right thyroid lobe. Correlation with history is recommended to determine if there was partial or total right thyroidectomy performed. |
Generate impression based on findings. | right facial droop, right extremity weakness No evidence of acute ischemic or hemorrhagic lesion.Diffuse brain atrophy with prominent ventricular system and patchy low attenuations on bilateral periventricular white matter which represent non specific small vessel ischemic disease.However, more precise evaluation can be obtained with MRI scan for the evaluation of ischemic stroke.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 CT evidence of acute ischemic or hemorrhagic lesion.Advanced non specific small vessel disease with mild to moderate age appropriate brain atrophy.Brain MRI can be considered for further evaluation. |
Generate impression based on findings. | Male; 78 years old. Reason: stone History: groin pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructing right renal calculi. Multiple bilateral hypoattenuating renal lesions are incompletely characterized but most likely benign cysts. No ureteral calculi. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches. Focal aneurysmal dilation of the infrarenal abdominal aorta measuring up to 3 x 2.5 cm (series 3/80). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small fat-containing right inguinal hernia.OTHER: No significant abnormality noted | 1. No acute abdominopelvic abnormality evident.2. Punctate nonobstructing right renal calculi. No ureteral calculi. No hydroureteronephrosis.3. Small fat-containing right inguinal hernia. |
Generate impression based on findings. | C. 7-year-old male with melena and poorly differentiated neuroendocrine carcinoma. Evaluate disease burden. CHEST:LUNGS AND PLEURA: Probable AV malformation in the right upper lobe on image 36/90. Atelectasis in the left lower lobe.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Evaluation of the liver is limited by single phase imaging. However, no obvious mass.Small, dependent gallstones.SPLEEN: No significant abnormality notedPANCREAS: Slightly rounded appearance of the pancreatic head on image 97/211 and cannot completely exclude a mass on limited phase CT.ADRENAL GLANDS: 7-mm rounded nodule adjacent to but not obviously arising from right adrenal as well as a 6-mm rounded soft tissue nodule medial to the upper pole of the right kidney abutting the diaphragmatic crux. There are also at least two very small soft tissue nodules anterior to the upper pole of the left kidney.KIDNEYS, URETERS: Bilateral renal cystsRETROPERITONEUM, LYMPH NODES: Single, relatively small retrocaval lymph node on image 90/211.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: 2.1 x 2.5 cm soft tissue mass at the level of the left peritoneal reflection on image 112/211 extending between ribs.OTHER: 2.6 x 2.6 cm lobulated and likely enhancing soft tissue mass lateral to the right psoas muscle on image 134/211 just above the pelvic brim. A small soft tissue nodule posterior to the left rectus muscle within the abdomen on image 165/211. PELVIS:PROSTATE, SEMINAL VESICLES: Prostate calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: 2.1 x 2.5 cm soft tissue mass at the level of the left peritoneal reflection on image 112/211 extending between ribs.OTHER: 2.6 x 2.6 cm lobulated and likely enhancing soft tissue mass lateral to the right psoas muscle on image 134/211 just above the pelvic brim. A small soft tissue nodule posterior to the left rectus muscle within the abdomen on image 165/211. | Scattered soft tissue nodules involving the perirenal areas bilaterally, and the anterior peritoneum.Larger, lobulated soft tissue mass adjacent to the lateral right psoas muscle.A soft tissue mass extending between the left posterior ribs.A slightly rounded appearance of the pancreatic head.Gallstones. |
Generate impression based on findings. | 9-year-old female with history of renal stones. ABDOMEN:LUNG BASES: Lung bases are clear.LIVER, BILIARY TRACT: No significant abnormality noted. No intrahepatic biliary ductal dilatation is noted. The noncontrast gallbladder is normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval removal of a right double-J stent. Increased number of right renal stones with the majority in the mid to lower pole region. The largest renal stone on the right measures 12 mm and is situated in the mid pole. The double J stent on the left is still present traversing from the left renal pelvis into the urinary bladder. Increased number of renal stones on the left compared to prior study. The largest left renal stone is in the interpolar region measuring up to 12 mm. A majority of the left renal stones are in the mid to lower pole.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube is present in the stomach, unchanged. No evidence of bowel obstruction, pneumatosis, or free air.BONES, SOFT TISSUES: VP shunt traverses the anterior abdominal wall entering the peritoneum in the mid abdomen with tip in the pelvis . A small amount of free fluid is present in the pelvis, which is normal in the setting of a VP shunt.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Air is present within the bladder likely related to recent instrumentation. A calculus is present in the dependent portion of the urinary bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scoliosis is present.OTHER: No significant abnormality noted | 1.Interval removal of right nephroureteral stent.2.Increasing renal calculi bilaterally with the majority of the stones in the mid to lower pole regions. |
Generate impression based on findings. | which is bright on T2 and isointense on T1. It was not included on imaging on the prior exam it is associated with some enhancement following gadolinium administration. The patient has undergone left-sided craniotomy for removal of a left temporal lobe mass. There are postsurgical changes present as well as a cavity within the left temporal lobe and vasogenic pattern of hypodensity in the left temporal lobe. There is associated intracranial air present. Some subtle hyperdensities adjacent to the tumor bed within the left temporal lobe probably represent a small amount blood at the surgical site. There is adjacent scalp soft tissue swelling present.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. | 1.Status post recent left-sided craniotomy for left temporal lobe mass removal with attendant postoperative changes. |
Generate impression based on findings. | Left wrist injuryVIEWS: Left wrist AP, lateral and oblique 3/15/15 (3 views) Cast material obscures bone detail. Left wrist joint effusion due to the elevation of the pronator fat pad. No fracture or malalignment | Joint effusion with no fracture or malalignment. |
Generate impression based on findings. | which is bright on T2 and isointense on T1. It was not included on imaging on the prior exam it is associated with some enhancement following gadolinium administration. The patient has undergone left-sided craniotomy for removal of a left temporal lobe mass. There are postsurgical changes present as well as a cavity within the left temporal lobe and vasogenic pattern of hypodensity in the left temporal lobe. There is associated intracranial air present. Some subtle hyperdensities adjacent to the tumor bed within the left temporal lobe probably represent a small amount blood at the surgical site. There is adjacent scalp soft tissue swelling present.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. | 1.Status post recent left-sided craniotomy for left temporal lobe mass removal with attendant postoperative changes. |
Generate impression based on findings. | A minimally displaced left supraorbital frontal bone fracture is present which extends inferomedially to involve the superior orbital roof and medial orbital wall (lamina papyracea). There is significant associated overlying periorbital edema and soft tissue swelling. Ipsilateral intraorbital and underlying intracranial structures are unremarkable. There is pan-opacification of the paranasal sinuses as well as fluid within the right middle ear cavity and mastoid air cells. The left middle ear cavity and mastoid air cells are clear. Slight hyperdensity within sinus secretions suggests intermixed hemorrhage within paranasal sinus fluid.The ventricles and sulci are normal in size. There are no intracranial masses, mass effect or midline shift. There is no evidence for acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. | A minimally displaced left supraorbital frontal bone fracture is present which extends inferomedially to involve the superior orbital roof and medial orbital wall (lamina papyracea). There is significant associated overlying periorbital edema and soft tissue swelling. Ipsilateral intraorbital and underlying intracranial structures are unremarkable. There is pan-opacification of the paranasal sinuses as well as fluid within the right middle ear cavity and mastoid air cells. The left middle ear cavity and mastoid air cells are clear. Slight hyperdensity within sinus secretions suggests intermixed hemorrhage within paranasal sinus fluid. |
Generate impression based on findings. | Status post craniotomy Since the prior exam the patient has undergone additional craniotomy on the right hemisphere. There is a small amount of intracranial air are present. There is adjacent scalp soft tissue swelling and scalp are present as well surgical staplesThere is redemonstration of subcortical white matter hypodensities which are stable compared to the prior examThe visualized portions of the paranasal sinuses demonstrate minor opacities. The visualized portions of the mastoid air cells demonstrate partial opacification of right mastoid air cells and middle ear and hypoplasia of right mastoid air cells. This is stable when compared to the prior exam. The visualized portions of the orbits are intact. There is redemonstration of soft tissue narrowing of the right external auditory canal | 1.Status-post craniotomy with associated postoperative changes2.opacification of right middle ear and narrowing of the right external auditory canal are stable when compared to the prior exam. Please correlate with patient's clinical exam findings. The possibility of an underlying lesion cannot be excluded. |
Generate impression based on findings. | Female, 23 months old. Please assess for fracture History: frontal bone fracture, < 2years of ageEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 3/13/2015, 0149 The left frontal bone fracture is not well visualized on these images. No other acute or healing fractures identified.The skull is normal in morphology. No prevertebral soft tissue swelling. The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No focal pulmonary opacities are identified. No pleural effusion or pneumothorax. | The left frontal bone fracture is not well visualized on these images. See CT head/maxillofacial for further details. No additional fractures identified. |
Generate impression based on findings. | Rule out pancreatic abscess in patient with rising lipase. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: Bilateral small pleural effusions with overlying compressive atelectasis have increased in size. Patchy ground glass anteriorly at the left lung base. Motion artifact degrades images the lung bases.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Pancreatic head is somewhat indistinct with mild surrounding inflammation as noted previously, unchanged. No evidence of peripancreatic fluid collection.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Indwelling IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Unchanged bullet fragments at the thoracolumbar junction of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air in the bladder, presumably from recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left hip disarticulation.OTHER: Vascular calcification. Right femoral central venous catheter terminates in the right common iliac vein. | Mild inflammatory changes surrounding the pancreatic head, unchanged; no evidence of peripancreatic fluid collection. Enlarging bilateral pleural effusions. Limited study secondary to lack of intravenous contrast. |
Generate impression based on findings. | Male 6 years old Reason: eval fracture healing History: finger fractureVIEWS: Right fifth digit AP, lateral and oblique 3/13/15 (3 views) Interval worsening in palmar angulation and medial displacement of the Salter Harris one fracture of the distal phalanx of the right fifth digit. | Distal phalanx Salter-Harris one fracture worsening in alignment, as described. |
Generate impression based on findings. | Slurred speech, evaluate for acute intracranial process No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No hydrocephalus. No extra-axial collections. There are extensive areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. There is evidence of encephalomalacia involving the left occipital lobe which is unchanged. Chronic right inferior cerebellar infarct also again seen.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Unchanged advanced chronic small vessel ischemic disease and chronic infarcts in the left occipital lobe and right inferior cerebellum. |
Generate impression based on findings. | 27-year-old male patient with acute onset abdominal pain, nausea, diarrhea, and vomiting. Evaluate for GI pathology. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions are too small to characterize and likely represent cysts. No intrahepatic biliary ductal dilatation. No CT evidence of cholecystitis or cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating lesion in the midpole of the left kidney is too small to characterize and likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well-visualized and is within normal limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No acute intra-abdominal abnormality to account for patient's symptoms. |
Generate impression based on findings. | Nausea vomiting and failure to thrive. 73-year-old with complex medical history. Breast and thyroid cancer. CHEST:LUNGS AND PLEURA: Stable or equivocal enlargement of right lower lobe reference nodule measuring 1.8 x 1.6 cm (image 57; series 5). Additional calcified pulmonary nodules and micronodules compatible with prior granulomatous disease, unchanged. Right middle lobe atelectasis and/or scarring. Mild upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: Small nonenlarged mediastinal lymph nodes. Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. No significant mediastinal or hilar lymphadenopathy. Extensive coronary artery calcifications, stents, and postsurgical changes of CABG as noted previously. Mild thoracic aortic calcifications, unchanged. Stable 2.1 x 2.9 cm heterogeneous nodule within the left thyroid gland with associated dense calcification (series 4 image 7). Multiple additional small subcentimeter hypoattenuating foci within both lobes of the thyroid gland.CHEST WALL: Postsurgical changes of the left breast and left axilla. Fluid collection has resolved. Previously described left axillary lymph node has resolved. Sternotomy hardware.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined hypoattenuating focus at the dome of the liver is no longer visible. Additional small subcentimeter ill-defined hypoattenuating foci in the left lobe also not seen on today's exam. No intrahepatic or extrahepatic biliary ductal dilatation. Calcified hepatic granulomas are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Nonspecific 5 mm cystic lesion in the pancreas is unchanged (image 79; series 4).ADRENAL GLANDS: Stable nonspecific nodular thickening of the left adrenal gland (series 4 image 75).KIDNEYS, URETERS: Bilateral hypoattenuating foci within both kidneys, some of which are too small to characterize, and the largest which are compatible with renal cysts. No hydronephrosis or hydroureter. Left renal artery stent.RETROPERITONEUM, LYMPH NODES: Multiple small nonenlarged retroperitoneal lymph nodes. Moderate atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality identifiedBONES, 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: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the spine, greatest at L4-L5.OTHER: Mild ectasia of the right common iliac artery. | 1.Stable or equivocal enlargement of right lower lobe pulmonary nodule may represent metastatic disease. 2.Previously described liver lesions are no longer evident3.Other findings stable |
Generate impression based on findings. | 64 year old female who has a complaint of a tender, palpable area in the upper outer right breast. No family history of breast cancer. MAMMOGRAM: Three standard views of both breasts, and two 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. A triangular marker has been placed on the palpable area of concern within the upper outer quadrant of the right breast. No underlying mammographic abnormality is identified. The linear marker has been placed on a scar overlying the upper outer left breast, with. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. ULTRASOUND: On physical examination no palpable abnormality is identified. A targeted right ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass identified. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | There is moderate opacification of the right mastoid air cells and right middle ear cavity. Left mastoid air cells and left middle ear cavity are aerated. Minimal thickening along the right external auditory canal which is otherwise patent. No definite ossicular erosions although degree of opacification limits detection of subtle erosions. The bilateral inner ear structures (cochlea, vestibule, and semicircular canals) are normal. The cochlear and vestibular aqueducts are normal. The tegmen tympani appears intact. The internal auditory canals are normal. The facial nerve canals are unremarkable. The carotid canals, sigmoid sinus plates, and jugular fossae are normal. Dural venous sinuses are patent. No temporal bone fracture.There imaged intracranial contents are unremarkable. There is paranasal sinus disease with moderate mucosal thickening of left greater than right maxillary sinuses and patchy ethmoid sinus opacification. | 1.Opacification of the the right mastoid air cells and right middle ear cavity compatible with otomastoiditis. There is minimal soft tissue thickening in the right external auditory canal which is nonspecific and can be correlated by direct examination; external auditory canal is otherwise patent. No significant inflammatory changes or abscess in the adjacent soft tissues. No intracranial extension.2.Moderate paranasal sinus disease.Findings discussed with Dr. Constantine at the time of dictation. |
Generate impression based on findings. | 68 year old with history of right lumpectomy and complete axillary lymph node dissection in 2011 for IDC. Recent CT scan (3/11/15) showed soft tissue density in the right axilla. Focused ultrasound was performed for right axillary region. There is a circumscribed hypoechoic lesion measuring 29 x 16 mm, without increased blood flow, containing anechoic component, consistent with post-surgical changes with seroma. This lesion corresponds to the soft tissue density seen on the recent chest CT. No suspicious lesions are detected within right axillary region. | No sonographic evidence for malignancy. Benign post-operative changes in the right axillary region. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Redemonstrated are post-surgical changes from a right frontoparietal craniotomy and right hemispherectomy. Dystrophic appearing calcifications are again seen along the dura, which are unchanged. Unchanged small right sided extra-axial collection. Extra-axial air has slightly increased, likely due to removal of a previously demonstrated right temporo-occipital shunt catheter. Again seen is a ventriculostomy tube coursing through the left parietal lobe into the left lateral ventricle with the tip at the lateral aspect of the trigone, unchanged in position. There has been interval enlargement of the left temporal horn, otherwise the remainder of the lateral ventricles and fourth ventricle are stable in size. Periventricular hypodensities are again present which are stable compared to the prior exam. No evidence of acute intracranial hemorrhage, new mass or mass-effect. 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. | 1.Right sided extra-axial air has slightly increased, likely due to removal of a previously demonstrated right temporo-occipital shunt catheter. 2.Again seen is a ventriculostomy tube coursing through the left parietal lobe into the left lateral ventricle with the tip at the lateral aspect of the trigone, unchanged in position. 3.There has been interval enlargement of the left temporal horn, otherwise the remainder of the lateral ventricles and fourth ventricle are stable in size. 4.Findings discussed with Dr. Mahua Dey on 3/13/2015 at approximately 9:25 a.m. |
Generate impression based on findings. | 17-year-old female with a history of extensive actinomyces and pelvic abscess status post drainage.EXAMINATION: MR without and with IV contrast 3/12/15 PELVIS:Uterus and Adnexa: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: The previously noted fluid collection dorsal to the coccyx is significantly improved with only minimal rim enhancement and a residual cavity measuring 4 mm on axial images. A multiloculated rim enhancing fluid collection anterior to the coccyx appears larger in size with mild mass effect on the rectum. This multiloculated fluid collection crosses the midline posterior the rectum. The left portion of this fluid collection measures 3.9 x 1.7 cm (series 601, image 29). The right portion of the loculated fluid collection measures 2.2 x 1.0 cm (series 601, image 30). Inflammatory changes are adjacent to the coccygeal bones without definite evidence of osteomyelitis.OTHER: No significant abnormality noted | 1.Previously noted fluid collection dorsal to the coccyx is significantly improved.2.Abscess anterior to the coccyx is larger in size and now crosses the midline. |
Generate impression based on findings. | Reason: ? neck History: ? fracture. cervicalgia. The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are small left-sided uncovertebral osteophytes.At C4-5 there is loss of disk space height as well as some endplate reactive change, endplate osteophytes and uncovertebral osteophytes. There is narrowing of the spinal canal and neural foramina at this level left more than right. Overall there suspected to be a mild to moderate spinal stenosis and left sided encroachment exiting nerve rootsAt C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The thyroid gland has a heterogeneous appearance and is enlarged.There is some mucosal thickening along the visualized portions of the maxillary sinuses.Atherosclerotic calcifications are present at the carotid bifurcations. Atherosclerotic calcifications are present along the distal vertebral arteries. Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.There is no evidence for cervical spine fracture or subluxation.2.There are degenerative changes present in the cervical spine which are worse at C4-5 where there is suspected to be some mild or moderate spinal stenosis and left sided encroachment of exiting nerve roots.3.Heterogeneously enlarged thyroid gland is a nonspecific finding on CT. Please correlate with patient's clinical history and symptoms. |
Generate impression based on findings. | Female; 48 years old. Reason: left flank pain, hx of stones and UTIs History: left flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small amount of nonspecific fluid in the right inguinal canal.OTHER: Increased anterior soft tissue in the midline below the symphysis pubis, possibly secondary to pelvic floor insufficiency; correlate with pelvic exam as this is poorly evaluated on CT. | 1. No acute abdominopelvic abnormality.2. Fatty liver.3. Possible pelvic floor dysfunction correlation with pelvic physical examination is recommended. |
Generate impression based on findings. | 62-year-old male with history of right femoral fracture, follow-up exam. Two views of the right femur again demonstrate a plate and screw device affixing a healing/healed metadiaphyseal fracture, in near-anatomic alignment, similar to prior. Interval removal of the external fixation device. There has been maturation of callus along the proximal femoral diaphyseal osteotomy, indicating interval healing. Severe osteoarthritis affects the right knee. | Postoperative changes of a right femoral fracture and osteotomy fixation as above. Interval removal of the external fixation device. |
Generate impression based on findings. | The reference right paratracheal lymph node (series 7, image 72) measures 11 mm, previously 14 mm. Additionally, there is bulky bilateral subpectoral and axillary lymphadenopathy which is incompletely visualized, but has increased from the prior examination. The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. Again noted is a surgical clip posterior to the right parotid gland. The salivary glands are unremarkable. The thyroid gland is unremarkable. The oral tongue and floor of mouth are unremarkable. The major vasculature of the neck appears patent. There is straightening and mild degenerative disease of the cervical spine. The partially visualized skull base is normal. The lung apices are clear. | Mixed response with increased subpectoral and axillary lymphadenopathy. |
Generate impression based on findings. | 69-year-old female with history of neck pain. Six views of the cervical spine demonstrate slightly demineralized bones, suggesting osteopenia. The lower cervical spine is obscured on lateral views by overlying anatomy. No fracture is evident. There are small anterior and posterior vertebral body osteophytes at C5-6, and possible mild neuroforaminal narrowing at C3-4 and C4-5 on the left. The disk spaces are preserved.Five views of the lumbar spine demonstrate demineralization of the bones, suggestive of osteopenia. There are mild multilevel degenerative changes of the lumbar spine with relative sparing of L3-4. Moderate facet joint osteoarthritis affects the lumbar spine. Alignment is within normal limits. There is mild osteoarthritic disease of the sacroiliac joints. Atherosclerotic calcification affects the distal abdominal aorta; a vascular stent is seen anterior to L3-4. | Degenerative arthritic disease as described above. No acute fracture is evident. If there is strong clinical concern for fracture, CT is recommended. |
Generate impression based on findings. | Call back from screening mammogram for a new mass in the right breast. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. A small circumscribed round mass is present at anterior upper inner aspect of the right breast. Focused ultrasound of the right breast detects a round hypo-/anechoic mass, measuring 7 x 6 mm, at 3 o'clock position, 2-cm from nipple. Mild blood flow is detected at the periphery of this mass. | Hypo-/anechoic mass at 3 o'clock position in the right breast. Although the mass is likely a cyst, aspiration is recommended for confirmation. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 71 year old male with recurrent bacteriuria, history of kidney transplant. Evaluate for hydronephrosis. ` RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplanted kidney in the right iliac fossa is normal in echotexture measuring 12.8 cm in length. Minimally complex cyst is noted in the renal sinus of the lower pole measuring 3.3 cm x 2.4 cm x 3.8 cm.COLLECTING SYSTEM/URETER: Previous noted hydronephrosis has essentially resolved.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted. | Hydronephrosis essentially resolved. Lower pole cyst not significantly changed. |
Generate impression based on findings. | 41 year old female with history of left breast asymmetry. No family history of breast cancer. Family history of ovarian carcinoma in a maternal cousin at age 25. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The previously described asymmetry there are less conspicuous on today's examination. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Redemonstration of mild submandibular and submental lymphadenopathy which is stable to mildly progressed since 1/29/2013. There is slight enlargement of left 1B node measuring 10x7x11 mm previously 5x7x8 mm. Previously referenced right level Ib lymph node measures 10-mm in short axis, previously 9-mm. Additional subcentimeter scattered neck lymph nodes throughout the neck are not pathologic by CT criteria and similar to prior. There is a 6 mm right vallecular cyst and stable from prior study. Airway is patent. The parotid, salivary, and thyroid glands are unremarkable. The cervical vessels are patent. There are no soft tissue masses. Mild dependent atelectasis of the lung apices. Mild degenerative disease of the cervical spine again seen. | Compared to 1/29/2013 there is slight enlargement of nonspecific mild upper cervical lymphadenopathy as detailed above. |
Generate impression based on findings. | Male 42 years old; Reason: 42 y/o male with gastric ca on chemo. please compare to prior. History: see above ABDOMEN:LUNG BASES:LIVER, BILIARY TRACT: Multiple hypoattenuating lesions throughout the liver consistent metastases. Multiple hepatic metastases are stable/mildly decreased. The reference left hepatic metastasis measures 2.1 x 1.7 cm (series 4, image 29), smaller. The reference inferior right hepatic lobe metastasis measures 2.4 x 2.4 cm (image 60; series 4), smaller.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic duct dilatation is unchanged compared to recent studies, presumed secondary to mass effect/invasion from gastric mass. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Persistent severe left-sided hydronephrosis and reduced perfusion of the left renal cortex consistent with chronic obstruction with abnormal caliber change in the mid ureter. No definite mass is identified. This is not significantly changed compared to prior study.RETROPERITONEUM, LYMPH NODES: Reference right periaortic node measures 0.7 x 0.7 cm (image 50; series 4), smaller.BOWEL, MESENTERY: Gastric wall thickening is unchanged compared to prior study.BONES, SOFT TISSUES: Diffuse sclerotic metastatic disease throughout the osseous skeleton. Preservation of vertebral body height.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse sclerotic metastatic disease throughout the osseous skeleton. Preservation of vertebral body height.OTHER: No significant abnormality noted | Overall regression of disease with reference measurements given above. |
Generate impression based on findings. | 75-year-old male with COPD and abnormal finding on recent CT abdomen exam LUNGS AND PLEURA: Severe centrilobular emphysema is again noted. Pleural calcification and scarring are noted in the right apex, unchanged. A 11-mm calcified granuloma in the right upper lobe is unchanged. A previously noted adjacent nodule is no longer present on the current study. The questioned focal scar like opacity in the right lung base appears improved since the prior exam compatible with resolving atelectasis.MEDIASTINUM AND HILA: Right hypodense thyroid nodule.No significant mediastinal or hilar lymphadenopathy.Heart size is normal. No pericardial effusion.Severe coronary artery calcification.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Partially visualized anterior cervical fusion. No suspicious lesions are identified. Healed right ninth rib fracture.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hypodense lesion in the right lobe of liver is unchanged. Unchanged high attenuation lesion in the upper pole of the right kidney previously characterized as a hyperdense cyst. Additional subcentimeter hypodense renal lesions are too small to further characterize. Nonobstructive renal stone in the left kidney is unchanged. Severe atherosclerotic disease affects the abdominal aorta and its branches. There is narrowing of the origins of the celiac axis and SMA. | Interval improvement in focal scar like opacity in the right lung base compatible with maturing scar. |
Generate impression based on findings. | Male 76 years old Reason: s/p esophagectomy eval for leak History: same Single contrast evaluation of the esophagus and stomach showed no evidence of contrast extravasation to suggest leak. Contrast progressed to the stomach and proximal small bowel without delay.TOTAL FLUOROSCOPY TIME: 1:39 minutes | Limited single contrast evaluation of the esophagus and stomach, without evidence of anastomotic leak. |
Generate impression based on findings. | There is mild mucosal thickening in the ethmoid air cells. There is mild, scattered mucosal thickening throughout the maxillary and sphenoid sinuses, otherwise the maxillary, sphenoid, and frontal sinuses are clear. Bilateral mastoid air cells are clear. Bilateral ostiomeatal complexes are patent. There are Haller cells bilaterally and a concha bullosa on the left. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is mildly deviated rightward with a shallow right sided septal spur. Bilateral orbits and the posterior nasopharynx appear unremarkable. | Mild scattered sinus mucosal thickening, otherwise no significant abnormality seen. |
Generate impression based on findings. | 76-year-old female with altered mental status There is streak artifact from coil embolization in the region of the right posterior communicating artery. Redemonstrated is a left frontal approach external ventricular drain with tip in the left frontal horn, unchanged in position. There has been no significant interval change of a right frontal hematoma. Diffuse subarachnoid as well as intraventricular hemorrhage is stable. There is no interval acute hemorrhage. Mild ventriculomegaly is stable. No midline shift or evidence of brain herniation. There is continued partial opacification of the mastoid air cells, right greater than left. | 1.There has been no significant interval change of a right frontal hematoma. 2.Diffuse subarachnoid as well as intraventricular hemorrhage is stable. 3.There is no interval acute hemorrhage. 4.Mild ventriculomegaly is stable. |
Generate impression based on findings. | 32-year-old male patient with newly diagnosed paraneoplastic syndrome presents with ataxia and myoclonus. CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules are not significantly change from prior examination and are compatible with prior granulomatous disease. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiac size is normal without pericardial effusion.CHEST WALL: Left lower pole thyroid nodules not significantly changed compared to prior examination. No calcifications within this nodule. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration. No suspicious hepatic lesions. Again seen are nonspecific small portocaval and gastrohepatic lymph nodes.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter hypoattenuating lesions are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Scattered small mesenteric lymph nodes.BONES, SOFT TISSUES: Mild 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 multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted. | 1.No evidence of a neoplasm in the chest, abdomen or pelvis. 2.No significant change in nonspecific small portocaval and gastrohepatic lymph nodes.3.Fatty liver.4.Stable left lower pole thyroid nodule. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative unenhanced brain CT. |
Generate impression based on findings. | History of tobacco use and T3N0M0 glottic squamous cell carcinoma following radiation. Laryngoscopy: The true vocal cords were mobile bilateral with bilateral exophytic, irregular changes to the mucosal. There is irregular enlargement of the bilateral vocal cords with subglottic extension. The laryngeal cartilages and hypopharynx appear to be grossly intact. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is diffuse enlargement of the Waldeyer ring structures. There is a heterogeneous right thyroid nodule that measures up to 25 mm. The major salivary glands are unremarkable. There is mild calcification at the bilateral carotid bifurcations. There is mild multilevel degenerative cervical spondylosis. There are multiple dental caries with associated periodontal disease. There are multiple scattered subcutaneous nodules. The imaged intracranial structures are unremarkable. There is partially-imaged pulmonary emphysema. | 1. Irregular enlargement of the bilateral vocal cords with subglottic extension may represent residual tumor, perhaps with superimposed treatment effects. 2. Extensive dental disease.3. Nonspecific right thyroid nodule.4. Multiple nonspecific subcutaneous nodules.5. Nonspecific diffuse enlargement of the Waldeyer ring structures may be hyperplastic or reactive in nature. |
Generate impression based on findings. | Infectious process? New diagnosis of acute leukemia. Bilateral frontal and ethmoid sinuses are clear. There is a small osteoma at the left frontoethmoidal recess. Sphenoid sinuses are clear. Bilateral maxillary sinuses are small which may be related to chronic sinus disease. There is moderate opacification of the right maxillary sinus with evidence of prior right uncinectomy. There is minimal mucosal thickening in the left maxillary sinus. There is minimal rightward deviation of the nasal septum. The cribriform plate, fovea ethmoidalis and lamina papyracea appear normal. The osseous structures are unremarkable. The orbits are unremarkable. Mastoid air cells are clear. Limited view of the intracranial structure is unremarkable. There is periapical lucency associate with roots of the posterior right maxillary molar suggestive of odontogenic disease. | 1. No imaging evidence of acute sinusitis.2. There is moderate opacification of the right maxillary sinus which is atelectatic, likely related to chronic sinus disease. No findings to suggest an aggressive sinonasal process. |
Generate impression based on findings. | CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Normal heart size. No pericardial effusion. No visible coronary calcifications.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Few subcentimeter, ill-defined hypoattenuating lesions are too small to characterize (series 10/77 and series 8041/51). Dilation of the common bile duct measuring up to 17 mm with smooth distal tapering, likely normal variation in this patient status post cholecystectomy.SPLEEN: Small splenule (series 10/99).PANCREAS:Primary tumor: 4 cm x 4 cm x 3.4 cm cm mass in the pancreatic head. (Series 10/101 and series 80860/35).Pancreatic duct: 5 mm.Mesenteric Arteries:Arterial anatomy: NormalArterial tumor abutment or encasement: (1) Proximal celiac artery, SMA, and hepatic artery: No abutment or encasement.(2) Tumor abutment or encasement of additional arteries: i.e. IPDA, GDA, jejunal, middle colic, or ileocolic branches): There is abutment of the GDA (series 9/48).Mesenteric Veins:Venous anatomy: (1) Superior mesenteric vein (SMV) first jejunal branch: anterior to SMA. SMV terminates into the confluence. (2) Inferior mesenteric vein (IMV) drains into the central splenic vein near the portal-splenic confluence.Venous tumor abutment or encasement: SMV-PV-splenic vein confluence: No abutment or encasement.First jejunal vein branch: Tumor abutment (less than or equal to 180 degrees) of the right side of the SMV just inferior to first jejunal branch level.SMV, PV, or segmental SMV-PV occlusion: No occlusion. Portal venous system: Patent.Inferior vena cava (IVC): Patent.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Clonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Small amount of air within the bladder, most likely due to recent instrumentation.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. Pancreatic head mass, most likely due to pancreatic adenocarcinoma, abutting the GDA and SMV as detailed above. 2. Few hypoattenuating lesion in the liver is too small to characterize. These could represent metastases, and MRI is recommended for further evaluation.Findings discussed with Dr. Olugbile by telephone at 11:15AM on 3/13/15. |
Generate impression based on findings. | 52 year old female who has a complaint of new right breast lump. No family history of breast cancer. MAMMOGRAM: Three standard views, and 3 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. A triangular marker has been placed on an area of palpable concern within the inner slightly lower right breast. No underlying mammographic abnormality is identified. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla.ULTRASOUND: On physical examination, no palpable abnormality is identified.A targeted right ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass identified. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 56-year-old female patient with hepatitis C virus and cirrhosis. Evaluate for hepatic lesions. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Multiple bilobar ill defined areas of arterial enhancement without definite washout on delayed images are again noted.Right liver lobe segment 6 hypoattenuating lesion is compatible with a simple cyst and is unchanged compared to prior examination. Scattered subcentimeter hypoattenuating lesions are again noted and are compatible with cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant change in the left adrenal nodule compatible with an adenoma.KIDNEYS, URETERS: Small subcentimeter hypoattenuating right renal lesions appear similar compared to prior examination and are compatible with cysts.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes affect the abdominal aorta and its branches. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Cirrhotic liver without definite evidence of hepatocellular carcinoma. Scattered arterial enhancing foci are compatible with transient enhancement and can be followed. |
Generate impression based on findings. | Frontal sinus: The frontal sinuses are not well pneumatized and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: The maxillary sinuses are clear. There is trace mucosal thickening along the infundibula, although both ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: There is a small mucosal retention cyst in the left sphenoid sinus. There is trace mucosal thickening along the dependent right sphenoid sinus. Both sphenoethmoidal recesses are clear. There is minimal leftward nasal septal deviation. The left middle turbinate is paradoxical in configuration. The nasal turbinate morphology is otherwise within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is slightly higher on the right.Limited visualization of intracranial structures demonstrates a large area of abnormal essentially CSF low density along the left corona radiata extending into the left basal ganglia. There is associated volume loss with trace midline shift to the left. Additional smaller ill-defined area of abnormal low density is seen in the right putamen. There is also an area of rounded low density along the anterior aspect of the left middle cranial fossa adjacent to the left anterior temporal pole of uncertain etiology, possibly representing a prominent sulcus versus small arachnoid cyst. | 1. No significant sinus inflammatory changes, with minimal sphenoid disease.2. Partially visualized intracranial structures demonstrating chronic infarct in the left coronal radiata extending into the left basal ganglia, with additional ill-defined area of abnormal low density likely representing age indeterminate ischemia in the right putamen. Please correlate clinically and with any available prior imaging, and follow-up MRI may be obtained as clinically indicated. |
Generate impression based on findings. | 66 year old male with history of metastatic non-small cell carcinoma. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Postsurgical changes from left lower lobectomy with stable appearing left parahilar and paramediastinal scarring. Scattered nonspecific micronodules. No suspicious pulmonary lesions are identified.MEDIASTINUM AND HILA: The mediastinum is shifted to the left. The heart size is normal without pericardial effusion. Mild coronary artery calcifications are present. There is diffuse thickening of the mid esophagus. Questionable filling defect within the left atrial appendage.Reference anterior mediastinal lymph node measures 3 mm, previously 4 mm (image 24 of series 4).Reference right paratracheal lymph node measures 8 mm, previously 12 mm (image 24 of series 4).CHEST WALL: There is bridging of the left fifth and sixth ribs. Mild degenerative disease affects the visualized thoracolumbar spine. No suspicious osseous lesions identified.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable left hepatic lobe hypodensity. No suspicious hepatic lesions are identified. Status post cholecystectomy.SPLEEN: Stable splenic hypodensity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There are atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative disease affects the visualized thoracolumbar spine.OTHER: No significant abnormality noted. | 1. Reference right paratracheal lymph node has decreased in size measuring 8 mm, previously 12 mm.2. Questionable filling defect within the left atrial appendage. A dedicated echocardiogram is recommended to evaluate for possible thrombosis. |
Generate impression based on findings. | Acute respiratory failureVIEW: Chest AP Endotracheal tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right central line with tip in the right atrium. Cardiothymic silhouette normal. Left lower lobe atelectasis new from prior study. No pleural effusion or pneumothorax. | Left lower lobe atelectasis new from prior study. |
Generate impression based on findings. | Reason: evaluate for vascular event History: leftward gait and weakness Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Atherosclerotic calcifications are present at the carotid bifurcations.There are multilevel degenerative changes present in the cervical spine. There is mild anterior subluxation of C3 on C4 and endplate and uncal virtual osteophytes at C3-4, C4-5 C5-6 and C6-7 associated with narrowing of the neural foramina and narrowing of the spinal canal.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.There is a 2-mm infundibulum at the origin of the right posterior communicating arteryThere is extracranial origin of the left posterior inferior cerebellar artery.Atherosclerotic calcifications are present along the distal internal carotid arteries.CT head: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.Periventricular and subcortical white matter hypodensities of a moderate degree are present.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. | 1.No evidence for intracranial aneurysm.2.No evidence for cervicocerebral occlusive disease.3.No evidence for acute internal hemorrhage mass effect or edema.4.CT is insensitive for the early detection of nonhemorrhagic cerebral infarction.5.There are multilevel degenerative changes present in the cervical spine with findings that are suspicious for encroachment of the exiting nerve roots and possible spinal stenosis. |
Generate impression based on findings. | Male 85 years old Reason: Please eval for hole in stomach, or fistula to colon History: ho PEG tube placement, with PEG in transverse colon. Retained contrast in the large bowel limits evaluation of the study, however, within these limitations the following observations were made. Contrast opacified the stomach. There was no evidence of increased opacification of the colon to suggest a gastrocolonic fistulous connection. Partially visualized duodenal bulb was unremarkable.TOTAL FLUOROSCOPY TIME: 2:48 minutes. | No evidence of increased opacification of the colon to suggest a gastrocolonic fistula as described above. |
Generate impression based on findings. | Left DBS for right hand tremor. Intraoperative images demonstrate a left-sided deep brain stimulator that extends to the region of the left thalamus without evidence of gross intracranial hemorrhage or midline shift. There is right anterior frontal lobe encephalomalacia. A stereotactic frame is present. | Intraoperative images demonstrate a left-sided deep brain stimulator without evidence of gross intracranial hemorrhage or midline shift. |
Generate impression based on findings. | 62-year-old female patient with history of head and neck cancer. CHEST:LUNGS AND PLEURA: Again seen are multiple solid and cavitary metastatic pulmonary nodules. There is a new cavitating lesion in the right apex (series 4 image 14). Reference lesion in the left lower lobe measures 2.1 x 1.7 cm (series 4 image 61), previously 2.3 x 1.8 cm. Biapical scarring is also noted. Mildly increased tree in bud and ground glass opacities the left lateral lung base raise question of aspiration.MEDIASTINUM AND HILA: There are postsurgical changes from the total thyroidectomy with surgical clips in the neck and superior mediastinum. Reference right paratracheal lymph node above the aortic arch measures 1.7 cm (series 3 image 19), previously 1.8 cm. Mildly increased hypoattenuation suggesting necrosis. Reference subcarinal conglomerate nodal mass again demonstrates findings suggestive of necrosis and measures 3.2 x 2.8 cm (series 3 image 43), previously 3.3 x 3.3 cm when measured similarly.CHEST WALL: There postsurgical changes from the total thyroidectomy with surgical clips in the neck and superior mediastinum. Please correlate the findings above the thoracic inlet with the neck CT performed same day.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Hypoattenuating heterogeneous splenic lesion currently measures 5.9 x 4.8 cm (series 3 image 92), previously 5.7 x 5.4 cm.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: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mixed response with new cavitary lesion in the right lung apex and slight interval decrease in reference lesions in the thorax and spleen as detailed above.2.Tree in bud and ground glass opacities in the left lower lobe raise concern for aspiration. |
Generate impression based on findings. | Right ear: Moderate conductive hearing loss at 1000 to 2000 Hz. Speechreception threshold was 50 dB with air conduction, but 5 dB with masked bone conduction. Left ear: mild mixed hearing loss, between 500 and 4000 Hz. Speech reception threshold was 30 dB with air conduction, and 25 dB with masked bone conduction. Tympanograms were normal. Right: The short process of the incus contacts the mastoid septations. The ossicular chain otherwise appears to be intact. The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: The short process of the incus contacts the mastoid septations. The ossicular chain otherwise appears to be intact. The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. | The short processes of the incudes contact the mastoid septations bilaterally, which may represent ossicular fixation. |
Generate impression based on findings. | There are new scattered punctate foci of diffusion restriction along the left corona radiata, with corresponding T2/FLAIR hyperintensity. There is also associated patchy enhancement which extends into the posterior left putamen with corresponding subtle FLAIR abnormality. 3-D T1 postcontrast images are degraded by patient motion artifact. There is a punctate focus of enhancement which persists in the right precentral sulcus as seen on 3901/20, with additional subtle FLAIR hyperintensity sulcus. There is also a stable punctate focus of enhancement in the right paramedian superior vermis as seen on 4003/88. Apparent minimal rim enhancement the left occipital pole on 4001/45 may actually represent minimal leptomeningeal enhancement rather than parenchymal, compared to prior imaging and current FLAIR images.There is redemonstration of several right-sided burr holes with susceptibility secondary to chronic hemosiderin deposition along a right frontal burr hole extending into the deep right frontal white matter, likely related to previous Ommaya reservoir tract. The ventricles and sulci are stable. The basal cisterns remain patent. There is no midline shift or mass effect. There are confluent areas of T2 signal hyperintensity within the deep white matter of the bilateral frontal lobes, right greater than left, and the left parietal lobe, which likely represent post-radiation changes. There is slight decreased confluence of the abnormal signal in left greater than right periatrial regions. There is a punctate focus of susceptibility in white matter on 901/79. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Small mucosal retention cysts or small air-fluid levels are noted in the maxillary sinuses, right greater than left side.SPINE | 1. Interval development of scattered foci of diffusion restriction along the left corona radiata with associated patchy enhancement and abnormal FLAIR hyperintensity. Additional patchy enhancement in FLAIR abnormality extends into the left posterior putamen. Differential diagnosis would include evolving subacute infarcts, parenchymal leukemic involvement such as chloroma or involvement by pial spread to perivascular spaces, and less likely demyelinating process. Possibility of other primary malignancy given history of whole brain radiation in 2012 is not entirely excluded, and may be angiocentric in nature. Please correlate clinically.2. Stable punctate focus of leptomeningeal enhancement along the right precentral sulcus. Although nonspecific, in conjunction with persistent punctate enhancement in the right superior vermis and left occipital pole sulcal enhancement of, residual leptomeningeal involvement by ALL remains a possibility.3. Interval slight decreased extent of left great than right periatrial white matter abnormal signal upon background of diffuse confluent abnormal FLAIR hyperintensity within the white matter likely relating to postradiation changes.4. Transitional lumbosacral spinal anatomy. Interval complete resolution of cauda equina nerve root previously minimally residual fine nodular enhancement, noted retrospectively, and nerve root thickening, consistent with resolved spinal leptomeningeal metastatic disease.5. Stable nonspecific dural thickening and enhancement along the distal thecal sac |
Generate impression based on findings. | Interval improvement of the midline shift with only trace rightward deviation. Previously seen uncal herniation has resolved. There is mild increase in external herniation at the craniectomy defect. Stable postsurgical changes of left frontotemporoparietal craniectomy. There is evolution of intraparenchymal hematoma centered within the left subinsular region measuring approximately 6.1 x 3.6 cm extending superiorly into the left frontal and parietal lobes with surrounding edema. There is also evolution of small adjacent subarachnoid hemorrhage. Again seen is hypoattenuation compatible with prior infarcts involving the right inferior cerebellar hemisphere. Multiple additional areas of hypoattenuation including the right pons and right anterior basal ganglia also again noted. No hydrocephalus. There is a left-sided surgical drain at the level of the craniectomy. | Continued evolution of the left intraparenchymal and smaller subarachnoid hemorrhage. There is continued improvement of midline shift and resolution of uncal herniation. There is mild increase in external herniation through the craniectomy defect. |
Generate impression based on findings. | Reason: hx AVM with crainiotomy >20 years ago, evaluate for bleed; needs anticoagulation for new DVT History: new DVT BLE Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient assesses right-sided craniotomy. There is encephalomalacia present along the medial aspect of the right parietal lobe at the cuneus extending towards the cingulate gyrus.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. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive disease.3.Please note that conventional angiography is more sensitive in the detection of residual arteriovenous malformation relative to CT angiography.4.there is no evidence for acute intracranial hemorrhage mass effect or edema.5.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | 57-year-old male with history of head and neck cancer. Evaluate for response. CHEST:LUNGS AND PLEURA: There are large left greater than right bilateral pleural effusions with associated compressive basilar atelectasis of bilateral lower lobes and the lingula. There is adjacent pleural and diaphragmatic nodularity and enhancement compatible with metastatic disease. Coarse interstitial opacities along the medial aspect of the left lung are consistent with radiation fibrosis. Stable right lower lobe calcified granuloma. Scattered micronodules.MEDIASTINUM AND HILA: The heart size is normal. There is a moderate pericardial effusion. Calcified right hilar nodes are likely the sequela of prior granulomatous disease. Mild coronary artery calcifications.Left AP window node measures 11 mm, previously 12 mm (image 45 series 3). Interval increase in size and number of left cardiophrenic lymph nodes. New right hilar lymphadenopathy measuring 21 mm (image 50 of series 3). New right paratracheal lymph node measures 18 mm (image 37 of series 3).CHEST WALL: Mild multilevel degenerative disease affects 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: Bilateral cysts have not significantly changed.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered 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: Mild multilevel degenerative disease affects the visualized thoracolumbar spine.OTHER: Small fat containing umbilical hernia. | 1. Overall increase in size of bilateral pleural effusions with associated atelectasis. Adjacent pleural thickening, nodularity and enhancement highly concerning for metastatic disease.2. Increasing mediastinal lymphadenopathy as above compatible with metastatic disease.3. Stable small to moderate pericardial effusion. |
Generate impression based on findings. | 55-year-old male with histoplasmosis now with cough, shortness of breath, fevers, evaluate for changes after treatment LUNGS AND PLEURA: Innumerable pulmonary nodules are noted diffusely throughout both lungs demonstrating mild to moderate interval improvement since the prior exam.. A majority of the nodules are subcentimeter and milliary in size though decreased in size. Separately there is slight interval increase in a right lower lobe nodule now measuring 6 mm (series 6, image 53) that was not clearly distinguished on the previous exam. The noted consolidation in the left lung base has significantly improved since prior exam with persistent focal opacity. Right basilar atelectasis appears improved since exam. No pneumothorax or pleural effusion.MEDIASTINUM AND HILA: Reference right paratracheal lymph node appears similar in size since prior exam now measuring 9 mm, previously 10 mm (series 4, image 24). Additional scattered subcentimeter mediastinal lymph nodes. No significant hilar lymphadenopathy.CHEST WALL: Minimal degenerative changes affect the thoracic spine. No suspicious osseous lesions are identified.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Probable gastric diverticulum is seen posteriorly, unchanged. Scattered subcentimeter retroperitoneal lymph nodes. | 1.Innumerable bilateral pulmonary nodules demonstrating mild to moderate improvement compatible with interval treatment for histoplasmosis. 2.A slight interval increase in a solitary right lower lobe subcentimeter nodule now measuring 6 mm. Further attention on subsequent studies can be given. 3.Near complete resolution of bilateral lower lobe consolidation. Persistent left lower lobe focal opacity. |
Generate impression based on findings. | 54-year-old female patient with pelvic discomfort and history of accidental bladder nicking. Evaluate for mass or cyst. CHEST:LUNGS AND PLEURA: There is a lung nodule in the anterior left costophrenic angle that measures 8 x 8 mm (series 5 image 69). Trace basilar atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter hypoattenuating lesions are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free fluid in the pelvis. | 1.No substantial change in left lower lobe 8mm nodule.2.No intra-abdominal abnormalities. |
Generate impression based on findings. | 65 year old female who was recalled from screening mammogram for right breast architectural distortion. Family history of breast carcinoma in her maternal grandmother. MAMMOGRAM: An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The previously identified area of architectural distortion of the upper outer right breast partially disperses on compression views, with subtle distortion remaining. No dominant mass, or suspicious microcalcification in the right breast. ULTRASOUND: On physical examination, no palpable abnormality is identified.A targeted right ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified. | Subtle distortion within the upper outer right breast, without sonographic correlate. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram, with tomosynthesis, is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | History of TxN2c squamous cell carcinoma of unknown primary who is ~3 years, 8 months since completion of RT on 3/4/11. There are unchanged post-treatment findings related to left neck dissection and radiation therapy. There is no evidence of mass lesions or significant cervical lymphadenopathy. For example, a right level 2A lymph node currently 6 mm in short axis, previously also 6 mm. There is mild diffuse thickening of the cervical esophagus. The airways are patent. The major salivary glands are unchanged. The thyroid gland is heterogeneous with multiple partially calcified nodules. There is unchanged atherosclerotic calcification of the carotid bifurcations. There is unchanged absence of the right internal jugular vein at the C5 level with external jugular collaterals. The imaged intracranial contents are unremarkable. There are small mucous retention cysts in the bilateral maxillary sinuses with scattered mild mucosal thickening of the ethmoid air cells. There is unchanged multilevel degenerative spondylosis. | 1. No evidence of tumor or significant lymphadenopathy.2. Unchanged heterogeneous thyroid gland with multiple partially calcified nodules.3. Unchanged mild diffuse thickening of the cervical esophagus may be treatment-related edema. |
Generate impression based on findings. | 69-year-old male with history of recurrent squamous cell carcinoma of the left vocal cord. Baseline scan. CHEST:LUNGS AND PLEURA: Mild paraseptal predominant emphysema. Right basilar opacities may represent aspiration or infection. No suspicious pulmonary nodules are identified.MEDIASTINUM AND HILA: Right thyroid mass is stable when compared to prior. The heart size is normal without pericardial effusion. There are moderate coronary artery calcifications. Calcified left hilar lymph nodes likely the sequela of prior granulomatous disease. There are calcifications of the thoracic aorta.CHEST WALL: There are multiple nodules scattered about the visualized subcutaneous soft tissues, the largest of which is located just posterior to the T4 spinous process measuring 2.9 x 2.5 cm. No suspicious osseous lesions identified. Mild multilevel degenerative disease affects the visualized thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There are scattered diffuse microcalcifications. No suspicious hepatic lesions.SPLEEN: Scattered microcalcifications.ADRENAL GLANDS: Right adrenal nodule measures 2.5 x 2.5 cm. Nodular appearing left adrenal gland.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered 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: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Innumerable subcutaneous nodules with the largest located posterior to the spinous process of T4. These are likely benign as they demonstrate no increased FDG uptake on recent PET.2. Right adrenal nodule with mild FDG activity is nonspecific and may represent an adenoma or possibly a metastatic focus. Followup imaging with MRI is recommended.3. Hypodense right thyroid lesion. If patient care warrants further imaging, a dedicated ultrasound may be obtained.4. Right basilar opacities may represent aspiration or infection. |
Generate impression based on findings. | T4aN2bM0 left base of tongue carcinoma treated with chemoradiation. There are stable post-treatment findings in the neck with supraglottic mucosal edema and stranding in the subcutaneous tissues. There is no evidence of measurable mass lesions in the treatment bed. There is no evidence of mass lesions at the base of the tongue. There is a small left air-filled laryngocele. There is no evidence of lymphadenopathy by CT criteria. The thyroid gland and salivary glands are unchanged. The distal right internal jugular and mid left internal jugular vein are not discernible. There is mild degenerative disease of the cervical spine. There is no evidence of suspicious bony lesions. There is mild mucosal thickening in the maxillary sinuses. There is partial opacification of the bilateral mastoid air cells. The imaged intracranial structures are unremarkable. There is prominence of the bilateral superior opthalmic veins. | No evidence of measurable tumor recurrence or significant lymphadenopathy. |
Generate impression based on findings. | Female; 78 years old. Reason: follow-up on lung cancer on treatment History: None ABDOMEN:LUNG BASES: Small right pleural effusion with mild underlying right basilar subsegmental atelectasis. Surgical clips in the right hilum and near the distal esophagus. Please see report from dedicated CT chest performed concomitantly.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease in the abdomen and pelvis. Please see report from dedicated CT chest performed concomitantly. |
Generate impression based on findings. | Spinal fusion Interval posterior fixation of L4-5 with bilateral pedicular screws affixing a grade 1 antral listhesis. Interposed graft material. Mild sclerosis and otherwise unchanged lumbar appearance.Moderate atherosclerotic changes of the aorta. Detail is somewhat limited due to extensive overlying gas and stool. Cholecystectomy clips | Interval L4-5 fixation |
Generate impression based on findings. | Shoulder fracture Minimal heterotopic bone without significant interval change in the mildly angulated proximal right humeral diaphyseal oblique fracture. Mild osteoarthritic to shoulder | Mild interval healing without significant change in alignment |
Generate impression based on findings. | Follow-up fracture Motion degrades sensitivity along with extensive overlying cast material, however tomographic imaging was additionally supplied. No significant change in alignment observed, specifically gross alignment is observed involving the distal radial fracture. Mild widening of the scapholunate space raises the question of a mild ligamentous injury. Consider dedicated and repeat imaging if of concern. | Anatomic alignment persists |
Generate impression based on findings. | 47-year-old female with pain after recent fall. Two views of the left hand demonstrate a 3 to 4-mm fragment of bone along the volar aspect of the fifth PIP joint, compatible with a mildly displaced volar plate fracture, which is best seen on the oblique view. A poorly defined lucency in the lunate may represent may bone cyst or ganglion.Four nonweightbearing views of the right knee demonstrate mild soft tissue swelling along the anterior aspect of the patella. We see no underlying fracture or large joint effusion. The alignment is within normal limits.Four nonweightbearing views of the left knee suggest perhaps mild soft tissue swelling along the anterior aspect of the patella and a small joint effusion. There is no fracture or malalignment. | 1.Mildly displaced volar plate avulsion fracture of the base of the middle phalanx of the fifth finger.2.Mild soft tissue swelling anterior to the bilateral patellae. 3.Small left knee joint effusion. |
Generate impression based on findings. | 87 year old female who has a complaint of diffuse left breast tenderness. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 73-year-old female, smoker, right rib cage pain. Three views of the rib cage do not demonstrate fracture or focal rib lesion. Degenerative arthritic changes are present in the lower lumbar spine. Please refer to the chest radiograph report of the same date for details regarding the posterior pleural-based mass in the right upper lobe as well as the right apical nodule, and other pulmonary findings. | No rib fracture or focal rib lesion. Please refer to accompanying chest radiograph report for details regarding right lung masses.Findings were relayed via alpha page to Dr. Mindy Schwartz at the time of dictation. Kristen, the nurse for Dr. Schwartz, was also notified at 10:30 a.m. by the Thoracic Radiology Section. |
Generate impression based on findings. | Male; 46 years old. Reason: elevated PSA - 115- will have prostate biposies for confirmation of prostate cancer History: elevated PSA - 115- will have prostate biopsies for confirmation of prostate cancer ABDOMEN:LUNG BASES:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 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: Surgical suture row of the transverse colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Numerous buckshots are scattered throughout the abdomen and pelvis.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatomegaly with the prostate gland measuring up to 4.4 x 3.2 cm (series 7/138).BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Numerous buckshots are scattered throughout the abdomen and pelvis. | 1. No evidence of metastatic disease in the abdomen and pelvis.2. Prostatomegaly. |
Generate impression based on findings. | Pain Interval progressing and now near severe osteoarthritic with tricompartmental changes greater than medial compartments. Changes include narrowing, sclerosis and osteophytes. No significant effusions. Of additional note is a poorly defined calcific density projected behind the right knee, possibly a loose body within a Baker's cyst | Near severe osteoarthritis with a questionable Baker's cyst and loose body on the right |
Generate impression based on findings. | Male 14 years old Reason: eval fracture healing History: s/p ORIFVIEWS: Left knee AP, lateral and oblique 3/13/15 (3 views) Interval cast removal. Hardware of ORIF of the proximal tibial tuberosity and metaphyses these unchanged. Minimal periosteal reaction along the lateral, posterior and medial aspects of the proximal tibia are noted. Alignment is anatomic. | Healing tibial proximal metaphyseal fracture with no evidence of hardware complications. |
Generate impression based on findings. | Call back from screening mammogram for developing masses in the right breast. CC, ML views and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. A large circumscribed round mass is present at upper outer quadrant, and a circumscribed round mass is present at medial right breast. Both masses are vaguely seen on the prior study, and appear enlarged.Ultrasound for the right breast was performed. At 9 o'clock position, there is an oval-shaped simple cyst measuring 36 x 10 mm, and 3 o'clock position there is an oval-shaped simple cyst, measuring 14 x 8 mm. Both of these cysts correspond to the masses on mammography. No solid lesions or suspicious findings are detected. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. In view of patient's dense breasts, tomosynthesis should be utilized at the time of next screening study. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Pain Left tibial rod is observed with two fixation screws both proximally and distally. Small scattered minimal fragments and an associated healing transverse fracture through the mid fibula also identified. Fracture planes are moderately well visualized although edges and distinct compatible subacute timing. | Well-positioned left tibial IM rod |
Generate impression based on findings. | 69-year-old female patient with history of diffuse large B-cell lymphoma status post chemotherapy. CHEST:LUNGS AND PLEURA: Severe upper lobe predominant emphysema. Scattered nonspecific micronodules noted. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Reference small pretracheal lymph node measures up to 6 mm and axial dimension (series 3 image 34). No mediastinal or hilar lymphadenopathy. Cardiac size is normal without pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again seen is a large, predominately fat containing hiatal hernia.BONES, SOFT TISSUES: Mild to moderate multilevel degenerative changes affect the thoracolumbar spine. There is grade 1 anterolisthesis of L4 on L5 and L5 on S1.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant interval change compared to prior examination. |
Generate impression based on findings. | DLBCL post chemotherapy. There has been further interval decrease in size of the cervical lymphadenopathy. For example, a right level 2A lymph node measures 10 x 8 mm, previously 13 x 11 mm, and contains punctate calcifications. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is multilevel degenerative spondylosis of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. There is extensive pulmonary emphysema. | 1. Further interval decrease in size of the cervical lymphadenopathy. 2. Extensive pulmonary emphysema. |
Generate impression based on findings. | Male 12 years old Reason: evaluate hand for fracture History: HAND INJURYVIEWS: Right hand AP, lateral and oblique 3/13/15 (3 views) There is a buckle boxer fracture of the fifth metacarpal with normal anatomic alignment. | Buckle broke up fracture of the fifth metacarpal as described. |
Generate impression based on findings. | Diffuse large B-cell lymphoma. Evaluation for SCT. SKULL: No suspicious lesions are identified. A left hearing aid is noted.CERVICAL SPINE: No suspicious lesions are identified. There is anterior osteophyte formation from C3-C6 and slight anterolisthesis of C4 on C5.THORACIC SPINE: No suspicious lesions are identified. There is multilevel anterior osteophyte formation.LUMBAR SPINE: No suspicious lesions are identified. There is grade I anterolisthesis of L4 on L5. RIBS: No suspicious lesions are identified. A right chest port is noted. Right upper quadrant surgical clips are present.PELVIS: No suspicious lesions are identified. Suture material is noted in the lower pelvis.UPPER EXTREMITY: Right humerus: No suspicious lesions are identified.Left humerus: No suspicious lesions are identified.Right forearm: No suspicious lesions are identified.Left forearm: No suspicious lesions are identified.LOWER EXTREMITY: Right femur: No suspicious lesions are identified.Left femur: No suspicious lesions are identified.Right tibia/fibula: No suspicious lesions are identified. A side plate and screw device affixes the distal fibula. Two orthopedic screws affix a medial malleolus fracture. Left tibia/fibula: No suspicious lesion is identified. | 1. No suspicious osseous lesions are identified.2. Degenerative changes as noted above. |
Generate impression based on findings. | Male 9 years old Reason: acute abd r/o appendicitis History: abd pain w/ guarding, testicular painVIEWS: Abdomen AP supine and upright on 3/13/15 1030 hrs (two views) Normal abdominal gas pattern. No evidence of free air or obstruction. No ascites. Visualized osseous structures look intact. | Normal examination. |
Generate impression based on findings. | Male 3 years old Reason: Screen for tumors of the liver, kidney, and adrenal gland History: Beckwith-Wiedemann syndromeEXAMINATION: Sonogram abdomen 3/13/15 LIVER: Normal echotexture with no evidence of intra-or extrahepatic biliary duct dilatation.GALLBLADDER, BILIARY TRACT: No evidence of gallbladder stones or sludge. No extrahepatic biliary duct dilatation.PANCREAS: Normal echotexture of pancreatic head and body. Pancreatic tail is obscured by gas.SPLEEN: No significant abnormality noted.KIDNEYS: No evidence of kidney mass or hydronephrosis. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. | Normal examination. |
Generate impression based on findings. | Male 63 years old Reason: prostate cancer History: prostate cancer Two foci of increased radius tracer uptake in the right lateral eighth and ninth ribs, in linear pattern consistent with fractures from traumatic injury. Otherwise no suspicious foci of increased uptake. | Increased uptake in the right lateral ribs in linear pattern most consistent with traumatic injury, correlate with patient history. Otherwise no specific findings to suggest osseous metastatic disease. |
Generate impression based on findings. | Male 12 years old Reason: r/o fx History: Fell on the concert floor with the left arm hit the ground last pm; Left write and low forearm swelling and pain sinceVIEWS: Left forearm AP and lateral left wrist AP, lateral and oblique 3/13/15 (5 views) There is a buckle fracture of the distal metaphyses of the left radius and mild soft tissue swelling. | Buckle fracture of the distal radius. |
Generate impression based on findings. | Call back from screening mammogram for enlarged lymph node in the left axilla. Focused ultrasound for the left axillary region was performed. Detected is an enlarged lymph node measuring 21 mm with thickened cortex measuring 8 mm. Blood flow pattern of this lymph node is normal. Other than this enlarged lymph node, there are a few benign appearing small lymph nodes without cortical thickening. | Abnormally enlarged lymph node in the left axilla. Ultrasound-guided core needle biopsy is recommended. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | 42-year-old female with history of influenza/bacterial pneumonia/ARDS now with persistent sepsis LUNGS AND PLEURA: Low lung volumes. Again seen is diffuse dense ground glass opacity with consolidation surrounding the tracheobronchial tree. Diffuse bronchiectasis is noted. The overall findings appear worse compared to the prior exam.. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Tracheostomy with ET tube 4 cm above the carina. Left internal jugular central venous catheter tip is in the SVC.Scattered enlarged mediastinal lymph nodes are likely reactive in etiology.Moderate cardiomegaly. Mild pericardial effusion.Moderate coronary artery calcification.Main pulmonary artery is mildly enlarged suggestive of pulmonary artery hypertension.CHEST WALL: Mildly prominent axillary and cardiophrenic lymph nodes. No significant retrocrural lymphadenopathy. Osseous structures are within normal limits. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Gastrostomy tube is present. | Low lung volumes with diffuse groundglass opacity and traction bronchiectasis compatible with ARDS appears worse compared to the prior exam. |
Generate impression based on findings. | Metastatic follicular carcinoma of the thyroid (metastatic to the lungs) and invasive ductal carcinoma of the breast T1cN0M0. History of thyroid resection and chemotherapy. There is no appreciable change in size of a heterogeneous mass within the inferior right thyroid resection bed that extends inferiorly into the mediastinum and measures approximately 27 x 29 x 50 mm. There is associated bilateral cervical lymphadenopathy, which appears to have slightly decreased in size. For example, the cystic or necrotic right level 4 lymph node, measures 21 x 19 mm, previously 23 x 25 mm. The inferior right jugular vein is narrowed by the surrounding lymphadenopathy. Additional lymphadenopathy is partially imaged in the mediastinum. The airways are patent. There is asymmetric fatty atrophy of the right parotid gland. The other major salivary glands are unremarkable. The mass along the planum sphenoidale is largely excluded from the field of view of this study. The mastoid air cells and paranasal sinuses are grossly clear. There are multiple lungs lesions, many of which are cavitary. | 1. No significant change in the recurrent thyroid cancer, but the metastatic cervical lymph nodes appear to have slightly decreased in size. 2. Multiple lungs lesions are compatible with metastases. Please refer to CT chest report for additional details. 3. The mass along the planum sphenoidale is largely excluded from the field of view of this study. |
Generate impression based on findings. | 83-year-old female with history of bilateral ankle pain and swelling status post fall. Three views of the left ankle demonstrate soft tissue swelling. There is an oblique fracture through the medial malleolus, the margins of which are indistinct, with adjacent periosteal reaction, which suggests a subacute fracture. Spurring along the dorsal aspect of the head of the talus and ossicle formation dorsal to the talonavicular joint may reflect old trauma. There is enthesophyte formation along the posterior calcaneus. The Achilles' tendon appears thickened and the possibility of Achilles tendinosis or tearing cannot be excluded. A small tibiotalar joint effusion is present.Three views of the right ankle demonstrate soft tissue swelling. A linear lucency through the tip of the medial malleolus may represent a nondisplaced fracture. Ossification along the dorsal aspect of the talar head may reflect prior trauma. There is suggestion of a small tibiotalar joint effusion. | Medial malleolar fractures and other findings as described above. |
Generate impression based on findings. | Male 19 years old Reason: CF exacerbation admission: evaluate for interim changes VIEWS: Chest PA/lateral (two views) 3/13/15 at 1052 hrs Central line tip is at the right atrium. Gastrostomy tube noted. Cardiac silhouette size is normal. Persistent increased AP diameter of the chest. Peribronchial thickening and bronchiectasis noted , ill-defined left retrocardiac airspace opacity either atelectasis or pneumonia. | Ill-defined left retrocardiac airspace opacity on a background of changes from cystic fibrosis. |
Generate impression based on findings. | Restricted diffusion, matching ADC hypointensity, associated with T2 hyperintensity is present involving bilateral supratentorial hemispheric cortices, internal capsules, as well as basal ganglia. Symmetric bilateral susceptibility abnormality is noted within the putamen and caudate bilaterally.There are a few scattered foci of T2 hyperintensity within the white matter without associated restricted diffusion, mass effect, or susceptibility abnormality consistent with mild chronic small vessel ischemic disease.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Fluid throughout the sinuses and mastoid air cells is consistent with the patient's intubated status. | 1.Restricted diffusion, matching ADC hypointensity, associated with T2 hyperintensity is present involving bilateral supratentorial hemispheric cortices, internal capsules, as well as basal ganglia, providing evidence for diffuse cytotoxic edema which can be seen in the setting of hypoglycemic encephalopathy.2.Symmetric bilateral susceptibility abnormality is noted within the putamen and caudate bilaterally. This appearance could be due to early petechial hemorrhage, prior to hyperdense findings developing on noncontrast head CT. However, this could also be secondary to asymmetric iron deposition. |
Generate impression based on findings. | 15-year-old female with lymphoma status post induction chemotherapy. LUNGS AND PLEURA: Interval resolution of bilateral pleural effusions. Interval removal of left chest tube. Significant interval improvement in lower lobe consolidation and atelectasis bilaterally. No suspicious pulmonary nodules or masses. There is no significant nodularity of the pleura.MEDIASTINUM AND HILA: A central is present with tip at the cavoatrial junction. The heart size is normal without evidence of pericardial effusion. The great vessels are normal. Again noted is a filling defect extending from the left internal jugular veins the brachiocephalic vessel no coronal images (series 80224, image 67 and 66). Compared to prior exam there is significantly better opacification of the brachiocephalic vein. No significant mediastinal, hilar, cardiophrenic, retrocrural lymphadenopathy. Large anterior mediastinal mass is significantly decreased in size measuring approximately 1.9 cm in AP dimension. It is difficult to determine how much of this represents normal thyroid tissue versus disease. Please refer to same day PET for further evaluation.CHEST WALL: No significant abnormality noted. No axillary lymphadenopathy. The osseous structures are normal in appearance.UPPER ABDOMEN: Hepatomegaly and decreased attenuation of the hepatic parenchyma is consistent with fatty infiltration. | 1.Persistent filling defect in the left internal jugular vein extending into the brachiocephalic.2.Significant interval decrease in size of anterior mediastinal mass.3.Significant interval improvement in bilateral pleural effusions and lower lobe consolidation.4.Hepatomegaly and decreased attenuation of the hepatic parenchyma is consistent with fatty infiltration. |
Generate impression based on findings. | There is no evidence of acute intracranial hemorrhage. Areas of white matter hypoattenuation suggests small vessel ischemic disease of indeterminate age. The ventricles and sulci are mildly prominent, likely from age-related volume loss. There is no CT evidence of acute cerebral or cerebellar cortical infarct. There are no masses, mass effect, edema, or midline shift. The imaged paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. It should be noted, however, that non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | 70 year female with new diagnosis of acute leukemia, evaluate for infectious process LUNGS AND PLEURA: Calcified micronodule adjacent to the minor fissure may represent a granuloma. No suspicious nodules or masses. No specific evidence for infection. No pleural effusion or pneumothorax. Minimal right upper lobe atelectasis.MEDIASTINUM AND HILA: Large heterogeneous nodular left thyroid lobe with punctate calcification.Severe atherosclerotic calcification of the aorta and its branches. The heart size is normal. No pericardial effusion. Severe atherosclerotic calcification of the coronary arteries. The pulmonary artery measures 3.7 cm suggestive of pulmonary artery hypertension.Prominent right paratracheal lymph node with a fatty hilum is favored to be benign.CHEST WALL: Moderate degenerative changes affect the thoracic. No significant axillary, cardiophrenic, or retrocrural lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No specific evidence for infection as clinically questioned. 2.Heterogeneous nodular left upper lobe punctate calcification. Consider ultrasound if clinically warranted. |
Generate impression based on findings. | 62-year-old female patient with concern for malignancy given 30-pound weight-loss, lung nodule seen on chest radiograph, and incidental adrenal mass on MRI spine. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: There are diffuse mediastinal lymphadenopathy. A reference pretracheal lymph node measures 1.1 cm (series 8 image 31) and a subcarinal lymph node measures 1.1 cm (series 8 image 47).CHEST WALL: There is a 2.0 x 1.5 cm heterogeneous, largely hypoattenuating nodule in the right lower lobe of the thyroid (series 8 image 7).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: There is an adrenal lesion that measures 3.7 x 4.8 cm (series 8 image 103) that contains macroscopic fat and punctate calcifications. The right adrenal gland is normal in appearance.KIDNEYS, URETERS: Subcentimeter bilateral hypoattenuating lesions in the bilateral kidneys are too small to characterize and likely represent cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Findings compatible with a left adrenal myelolipoma.2.Significant mediastinal lymphadenopathy is of uncertain etiology. Consider lymphoma; further work up is recommended.3.Incidental right lower lobe thyroid nodule. |
Generate impression based on findings. | Rheumatoid arthritis. Evaluate for erosions. Three views of the left hand are provided. No acute fracture or malalignment is identified. No erosive changes are seen. There is minor negative ulnar variance.Three views of the right hand are provided. No acute fracture or malalignment is identified. No erosive changes are seen. There is minor negative ulnar variance.Three views of the left foot are provided. No acute fracture or malalignment is evident. No erosive changes are seen.Three views of the right foot are provided. No acute fracture or malalignment is evident. No erosive changes are seen. | No erosive changes are identified. |
Generate impression based on findings. | Male 53 years old Reason: Crohn's disease, new significant dilation of small bowel noted on CT scan from 11/2014. Determine if high-grade short segment stenosis at the anastomosis. History: abdominal discomfort. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was one hour. Series 12, show's patient's point of pain, located medially above the pelvic inlet. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts or fistuale. There was a long segment of dilated distal ileum extending from the left paracolic gutter to the pelvis and across the midline to the right lower quadrant over a length of about 17cm. Within this dilated loop, there is a focal stricture in the left lower quadrant measuring approximately 1.7 cm in length and 0.7 cm in diameter at the point of maximal narrowing (Series 14, annotated). No additional strictures were identified. Patient is status post right hemicolectomy with a patent ileocecectomy anastomosis, which was clearly identified during the pneumocolon portion, and appears widely patent, measuring 1.3 cm in diameter; this can be seen on annotated Series 21, image 1. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 9:36 minutes. | No radiologic signs of active disease. Chronic short segment small bowel stricture in the left lower quadrant appears unchanged from 2011. |
Generate impression based on findings. | Shoulder pain. Four views of the left shoulder reveal a total shoulder reverse ball and socket arthroplasty device in anatomic alignment without evidence of hardware complication. There is mild increased heterotopic bone formation along the inner proximal humerus. No acute fracture is identified. Surgical skin staples remain in place. | Reverse total shoulder arthroplasty device without evidence of hardware complication. |
Generate impression based on findings. | Pain, stiffness. Evaluate for inflammatory or erosive arthritis. Three views of the left hand are provided. No acute fracture or malalignment is evident. Mild juxta-articular osteopenia cannot be excluded, however, no erosive changes are seen. There is minor negative ulnar variance. A small ossification adjacent to the ulnar styloid is likely an accessory ossicle. Three views of the right hand are provided. No acute fracture or malalignment is evident. Mild juxta-articular osteopenia cannot be excluded, however, no erosive changes are seen. There is minor negative ulnar variance. A small ossification adjacent to the ulnar styloid is likely an accessory ossicle. A well-defined lucency with sclerotic margins within the scaphoid likely represents a cyst.Three views of the left foot are provided. No acute fracture is identified. No erosive changes are seen. There is a small os trigonum.Three views of the right foot are provided. No acute fracture is identified. No erosive changes are seen. | Mild juxta-articular osteopenia of the hands cannot be excluded, however, there are no other radiographic findings such as erosions to suggest an inflammatory or erosive arthropathy. |
Generate impression based on findings. | 49-year-old female with cough, short of breath, fatigue, elevated WBC for evaluation of pneumonia LUNGS AND PLEURA: No pneumothorax. No pleural effusion.Mild bronchial thickening and mild bronchiectasis at the lung bases. Mosaic attenuation. No convincing evidence of infection.MEDIASTINUM AND HILA: Tracheostomy tube is in place.Enlarged mediastinal lymph nodes such as a right anterior mediastinal lymph node measuring 16 mm (series 4, image 22) are nonspecific but may be related to pulmonary artery hypertension.Enlarged main pulmonary artery measuring 4.2 cm compatible with severe pulmonary artery hypertension.Moderate cardiomegaly with findings suspicious for right heart strain. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Enlarged left adrenal gland with mildly nodular contour. Nonspecific soft tissue nodule adjacent to the pancreatic tail measures 8 mm (series 4, image 86). | Mosaic attenuation bilaterally may be due to chronic thromboembolic disease or small airways disease. A dedicated CT examination with ILD protocol may be considered for confirmation. No convincing evidence of infection. Signs of severe pulmonary arterial hypertension and right heart strain. |
Generate impression based on findings. | Postop ankle. Three views of the left ankle with weight-bearing reveal a side plate and screw device affixing the distal fibula along with a syndesmotic screw and two screws affixing the medial malleolus. Alignment is anatomic. The fracture lines are indistinct suggestive of healing. The ankle mortise is intact. There is mild soft tissue swelling about the ankle. | Orthopedic fixation of multiple healing ankle fractures. |
Generate impression based on findings. | Redemonstrated is a small focus of T2 hyperintensity involving the medial right frontal lobe (best seen FLAIR imaging series 801 image 22-25/28) which involves cortical gray matter. It does not have significant mass effect, with no signal abnormality on other sequences, and does not enhance. Given differences in technique, there has been no significant interval change in morphology or size.Better demonstrated at 3 Tesla imaging are 2 punctate foci of T2 hyperintensity within the subcortical white matter of bifrontal lobes (one each side) without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Mucosal thickening is present within left ethmoid air cells as well as scattered foci in sporadic locations within other paranasal sinuses, unchanged. There are no air-fluid levels. The mastoid air cells are clear. | 1.Redemonstrated is a small focus of T2 hyperintensity involving the medial right frontal lobe which involves cortical gray matter. It does not have significant mass effect, with no signal abnormality on other sequences, and does not enhance. Given differences in technique, there has been no significant interval change in morphology or size. As before, this appearance is nonspecific and given its small size and location may represent an inflammatory process, gliosis from past pathology (traumatic, infectious, or inflammatory) or even neoplasia. Recommendations are made to obtain follow-up MRI brain at 3 Tesla with gadolinium at 6 months to assess for interval change.2.Better demonstrated at 3 Tesla imaging are 2 punctate foci of T2 hyperintensity within the subcortical white matter of bifrontal lobes (one each side) without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement. These are nonspecific in appearance and the differential diagnosis would most likely include migraine sequelae, small vessel disease, or prior trauma. |
Generate impression based on findings. | Male 46 years old Reason: elevated PSA- 115- will have prostate biopsies for confirmation History: elevated PSA- 115- will have prostate biopsies for confirmation No abnormal osseous foci are identified to indicate metastatic disease. | No evidence of bone metastases. |
Generate impression based on findings. | Multinodular goiter. There are postoperative findings in the lower neck. There is a markedly enlarged heterogeneous thyroid gland, left lobe larger than right, that extends from the level of the suprasternal notch to the level of the thyrohyoid membrane. There is mild deviated of the trachea to the right without significant narrowing of the trachea. There are right tonsilloliths. There is no significant cervical lymphadenopathy based on size criteria. The major salivary glands are unremarkable. The osseous structures are unremarkable, aside from osteointegrated dental implants. The imaged intracranial structures are unremarkable. There is mild scattered paranasal sinus mucosal thickening. The imaged portions of the lungs are clear. | Multinodular goiter without significant trachea narrowing or substernal extension. |
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