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Generate impression based on findings. | Male 60 years old Reason: renal cancer with bone metastases History: renal cancer Increased review tracer uptake in the posterior left ninth rib appears similar to prior examination, consistent with patient's known pathologic fracture. No new suspicious osseous lesions. Findings consistent with partial right nephrectomy are again noted. | Stable radioisotope uptake in the known left ninth rib pathologic fracture. No evidence of new osseous metastatic disease. |
Generate impression based on findings. | Male 56 years old Reason: 56M with rectal cancers/p LAR/DLI, please eval for anastomotic leak History: please eval for anastomotic leak, foul smelling drainage per anus Following retrograde administration of barium into the rectum and distal colon via the transanal inserted 14-French Coley catheter: There was prompt opacification of a large crescentic presacral collection measuring approximately 6 x 5 x 10 cm. Subsequently, contrast filled the distal sigmoid, with a narrowing evident just proximal to the anastomosis, which measured approximately 2 cm in length, which is of uncertain etiology and may reflect underdistention, although stricturing or inflammation are also possible. | 1.Large presacral collection arising posterior to the colorectal anastomosis, most consistent with a contained leak.2.Luminal narrowing of the pre-anastomotic large bowel, perhaps related to inflammation or stricturing.These findings were relayed to Dr. Kakuku 11:00 13/13/2015 |
Generate impression based on findings. | 62-year-old male with colon cancer metastatic to liver. CHEST:LUNGS AND PLEURA: Any left upper lobe on image 37/116 there is a 1.5 x 2.5 cm partly solid and irregularly marginated mass. The findings are worrisome for a primary lung cancer. No other focal pulmonary parenchymal abnormality.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: There are multiple rounded low attenuation mass is identified within the liver. These are unchanged from CT dated 2/14/15 with a mass in the dome measuring 1.8 x 2.5 cm on image 78/226. Several of these masses are significantly smaller than remote CT of 8/15/14. In addition, in the inferior right lobe is a 3.8 x 5.6 cm mass with a CT appearance consistent with hemangioma which is stable on all exams.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small, simple -- appearing left renal cystRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is wall thickening involving the rectum and sigmoid and in the area of resection which appears stable when compared to 2/14/15. In addition, there is mesenteric stranding extending from the anastomotic site into the right lower quadrant with slight thickening of the wall of small bowel loops which may be related to prior surgery and/or radiation and is stable as wellBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incomplete distended and appears thick walledLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is wall thickening involving the rectum and sigmoid and in the area of resection which appears stable when compared to 2/14/15. In addition, there is mesenteric stranding extending from the anastomotic site into the right lower quadrant with slight thickening of the wall of small bowel loops which may be related to prior surgery and/or radiation and is stable as wellBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | .Stable hepatic masses. The largest represents a hemangioma.Findings worrisome for primary left upper lobe lung cancer.Stable appearance of rectum and sigmoid wall thickening with mesenteric stranding |
Generate impression based on findings. | Female; 64 years old. Reason: Location of GI bleed History: Bloody stools ABDOMEN:LUNG BASES: Moderate cardiomegaly. Low-density cardiac blood pool from anemia. Severe coronary calcifications. IVC and hepatic veins are engorged, with reflux of contrast, compatible with right heart failure. LIVER, BILIARY TRACT: Two subcentimeter right lobe hypodensities are too small to further characterize but stable. High density material within the gallbladder, most compatible with vicarious excretion of previously administered contrast.SPLEEN: No focal splenic lesion.PANCREAS: No focal pancreatic lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Multiple nonobstructing bilateral renal stones versus vascular calcifications. Multiple bilateral renal cysts and other subcentimeter hypodensities which are too small to further characterize. Stable symmetric perinephric stranding is nonspecific. RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and its branches. Small nonenlarged retroperitoneal lymph nodes.BOWEL, MESENTERY: Small amount of contrast extravasation into the terminal ileum approximately 4 cm from the cecum is again seen and compatible with active hemorrhage. High density within the colon most compatible with hemorrhage and/or vicariously excreted contrast material.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate volume upper abdominal ascites.VASCULATURE: Interval coil embolization of an ileocolic branch in the right lower quadrant. The celiac axis, SMA, and IMA demonstrate calcifications at their ostia, however are widely patent.PELVIS:UTERUS, ADNEXA: Multiple calcified uterine fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Continued small bleed from the terminal ileum despite coil embolization.Findings discussed with Dr. Wachtel at 1:19 p.m. on 3/13/15. |
Generate impression based on findings. | Male 10 years old Reason: eval elbow alignment History: elbow dislocationVIEWS: Left elbow AP and lateral 3/13/15 (two views) Cast material obscures fine bone details. Healing fracture is in anatomic alignment. | Healing fracture in anatomic alignment. |
Generate impression based on findings. | Reason: dizziness, bleed? History: as above The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. Some peripheral retinal/choroidal based calcifications are present at the lateral aspect of the eyes at the approximate level of the ora serrata. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Malignant neoplasm of the prostate with back pain CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Subcentimeter thyroid nodules. No significant mediastinal adenopathy.CHEST WALL: Diffuse widespread osseous metastasesABDOMEN:LIVER, BILIARY TRACT: Probable liver cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Indwelling infrarenal IVC filter.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Widespread bony metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic enlargement with impingement on the bladder base.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Widespread bony metastases.OTHER: No significant abnormality noted | Widespread bony metastases. Correlate with bone scan. |
Generate impression based on findings. | 67-year-old female with history of bladder cancer -- surveillance ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No enhancing lesions. Gallstones appear stable.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Chronic right hydronephrosis and cortical atrophy is unchanged. Left kidney appears normal. 10 minutes excretory phase imaging continue to show excretion from the right kidney. Left collecting system shows prompt excretion and normal appearance without evidence of neoplasm or hydronephrosis. The left ureter is well opacified and seen throughout its entire length to the urinary diversion ileal conduit in the right lower quadrant.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Parastomal hernia in the right lower quadrant containing colon, nonobstructive. Umbilical hernia unchanged.BONES, SOFT TISSUES: No evidence of bowel obstruction is seen with postoperative changes in the gastrointestinal tract without complication. No free mesenteric fluid.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Prior hysterectomy without other complication. BLADDER: Status post cystectomy with right lower quadrant ileal conduit urinary diversion unchanged. No evidence of recurrent or residual tumor in surgical bed.LYMPH NODES: No significant abnormality noted in the iliac chains bilaterally. Reference inguinal lymph node measures 1.2 x 1.1 cm (series 7, image 131), unchanged. BOWEL, MESENTERY: No evidence of bowel obstruction is seen with postoperative changes in the gastrointestinal tract without complication. No free mesenteric fluid. Presumed bowel noted along the left pelvic sidewall.BONES, SOFT TISSUES: Unchanged fluid in the pelvic wall as described previously.OTHER: No significant abnormality noted | No substantial interval change and no definite evidence of residual or recurrent disease. |
Generate impression based on findings. | 32-year-old female with a two medic hip pain times several months. Two views of the left hip demonstrate normal anatomic alignment. There is no evidence of acute fracture or malalignment. There is perhaps mild prominence of the anterior aspect of the femoral head-neck junction, suggestive of mild CAM deformity of questionable clinical significance. | Possible mild CAM deformity of uncertain clinical significance. No acute findings to account for the patient's pain. |
Generate impression based on findings. | 55-year-old male with relapsed multiple myeloma with rising creatinine and elevated bilirubin. LIMITED ABDOMENLIVER: Coarse echogenicity of the liver measuring 16.9 cm in length. No focal hepatic lesions.BILIARY TRACT: Status post cholecystectomy. Mild prominence of the common bile duct with no intrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 13.1 cm in length. RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 12.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Increased echogenicity of the left kidney measuring 11.8 cm in length. No hydronephrosis or shadowing calculi are noted. | 1. Course echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. Patent hepatic inflow and outflow vasculature.2. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. 3. Mild prominence of the common bile duct with no intrahepatic ductal dilatation. |
Generate impression based on findings. | Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation with mild disc height loss are present at L4/5 and L5/S1.T12/L1: UnremarkableL1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: There is a left central to right foraminal disc protrusion with prominent annular tear causing mild right lateral recess and mild proximal right neural foraminal stenosis.L5/S1: There is a central disc protrusion which abuts, flattens, and compresses bilateral S1 nerve root sheath origins (left somewhat greater than right), also causing a mild degree of central stenosis. There is no neural foraminal stenosis. | 1.L4/5: There is a left central to right foraminal disc protrusion with prominent annular tear causing mild right lateral recess and mild proximal right neural foraminal stenosis.2.L5/S1: There is a central disc protrusion which abuts, flattens, and compresses bilateral S1 nerve root sheath origins (left somewhat greater than right), also causing a mild degree of central stenosis. |
Generate impression based on findings. | 62 year-old female with that pain status post fall from counter-height stool. Three views of the thoracic spine demonstrate tiny vertebral body osteophytes, but no fracture. Moderate degenerative disk disease affects the visualized cervical spine.Five views of the lumbar spine demonstrate mild degenerative disk disease at L5/S1, as well as mild facet osteoarthritis at L5/S1. No fracture is evident.Three views of the sacrum/coccyx demonstrate mineralization along the right ischium, likely representing chronic calcific hamstring tendinosis. No fracture is evident. | Degenerative arthritic changes as described above. No acute fracture is evident. |
Generate impression based on findings. | Female 36 years old Reason: h/o ileocolonic crohns s/p resection with low mag. Please eval transit time and length of remaining small. History: low mag. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 55 minutes. Patient is status post multiple small bowel resections and status post ileocecectomy. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. An end to side ileocecectomy anastomosis is widely patent, with reflux of gas into the neoterminal ileum upon pneumocolon. No separation of bowel loops was present to suggest fibrofatty proliferation. TOTAL FLUOROSCOPY TIME: 6:24 minutes. | Patient ileocecectomy with end to side anastomosis. |
Generate impression based on findings. | Female 36 years old Reason: Evaluate for nausea, history of UC with IPAA. Need to evaluate for adhesions causing abdominal distension, bloating and nausea History: Nausea with vomiting Scout radiograph showed a nonobstructive bowel gas pattern. Suture material projects over the lower pelvis, presumably related to prior formation.Transit time to the ileoanal anastomosis was 45 minutes. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. At least two loops of bowel within the mid pelvis appeared adherent to one another, suggestive of adhesions. There was expected pre-anastomotic dilatation of the small bowel, without evidence of fixed narrowing or stricturing.TOTAL FLUOROSCOPY TIME: 4:15 minutes | 1.Findings consistent with small bowel adhesive disease without evidence of obstruction.2.Expected pre-anastomotic dilatation of the small bowel. |
Generate impression based on findings. | Follow-up. Three views of the left ankle show mild diffuse soft tissue swelling, which has decreased. There are unchanged tiny densities distal to the medial malleolus which are likely chronic in etiology. No acute superimposed fracture is identified. | Improvement in soft tissue swelling without acute fracture. |
Generate impression based on findings. | Reason: evaluate for autoimmune pancreatitis History: abdominal pain, CT in Oct 2014 suggesting pancreas abnormality ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. Parallel course of the cystic duct with borderline low insertion on the common duct.SPLEEN: Occlusion at origin of splenic vein redemonstrated.PANCREAS: The pancreas is not diffusely enlarged and has normal T1 signal characteristics. No peripancreatic fluid. The visualized portions of the pancreatic duct are smooth, although the duct is not well seen through the body and tail. Although the pancreatic tail is more blunted, there is no abnormal T1 or T2 signal within this region to suggest more focal autoimmune pancreatitis.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. | 1.No definite evidence of autoimmune pancreatitis, further described above. If clinical concern persists, can correlate with IgG serologies. |
Generate impression based on findings. | Malignant neoplasm of the kidney, follow-up. CHEST:LUNGS AND PLEURA: Multiple diffuse parenchymal lung nodules are unchanged bilaterally. Reference lesion in the right lower lobe again measures 6 mm (image 57; series 5). Left lower lobe atelectasis has resolved. MEDIASTINUM AND HILA: Left hilar adenopathy has regressed and measures 2.1 x 1.0 cm (image 46; series 3). Reference paraesophageal lymph node measures 2.1 x 1.5 cm (image 75; series 3), also smaller.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesions are seen in the left lobe superiorly and the inferior right lobe. Reference measurement in right lobe (series 3, image 104) measures 1.6 x 1.5 cm, unchanged. Patient is status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Previously described left adrenal mass represents adenopathy, in retrospect, and currently measures less than 1 cm in diameter, much smaller compared to previous. Reference right retroperitoneal mass abutting the liver (image 95; series 3) is smaller measuring 6.3 x 4.1 cm.KIDNEYS, URETERS: Status post right nephrectomy. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Para-aortic retroperitoneal adenopathy is seen. Reference aorta caval lymph node (series 3, image 117) measures 1.9 x 1.9 cm, smaller.BOWEL, MESENTERY: No significant abnormality noted. in the stomach or colon. Reference lymph node (series 3, image 124) measures 3.0 x 2 .9 cm, smaller.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 noted in the pelvis. BONES, SOFT TISSUES: No significant abnormality noted, however nuclear medicine bone scintigraphy is a more sensitive indicator of metastatic skeletal disease.OTHER: No significant abnormality noted | Marked interval regression of disease. Reference measurements are given above. |
Generate impression based on findings. | Male 67 years old Reason: evaluate Dobbhoff placement History: Dobbhoff placement There is a Dobbhoff tube with its tip projecting over the body of the stomach. There is mild gaseous distention of multiple loops of small bowel as well as gas within the colon consistent with mild ileus. The heart is enlarged. Pacemaker leads in expected location. | Dobbhoff tube tip projecting over the body of the stomach. |
Generate impression based on findings. | No definite large osseous defect is seen ovaries, specifically along the cribriform plate. There is focal attenuation along the cribriform plate on coronal image 80358/73, although this is a symmetric finding and the bone appears more contiguous on the sagittal reformatted images.Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: The maxillary sinuses are clear. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinuses are clear. The sphenoethmoidal recesses demonstrate minimal opacification. There is mild leftward nasal septal deviation. The nasal turbinate morphology is within normal limits. There is a question of trace fluid along the left superior meatus abutting the neck of the left superior turbinate.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. Dystrophic calcification is incidentally noted in the right lateral maxillary subcutaneous fat. There is redemonstration of a subcentimeter pineal cystic structure. | No definite skull base bony defect. Nuclear medicine cisternogram may be more sensitive for CSF leak. |
Generate impression based on findings. | 55-year-old female with frequent asthma exacerbation, dyspnea, for workup of ILD LUNGS AND PLEURA: No pleural effusion or pneumothorax. No suspicious nodules or masses. No focal consolidation. No evidence of air trapping.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Mild coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No suspicious osseous lesions. No significant axillary, retrocrural, or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No specific evidence of interstitial lung disease. No acute cardiopulmonary abnormality. |
Generate impression based on findings. | Male 35 years old Reason: 35M with UC s/p TAC/IPAA c/b recurrent SBO with creation of ileostomy. now with abdominal pain and nausea History: s/p J-pouch c/b SBO, with creation of ileostomy. now returning with abd pain, nausea. CT without concerning findings. please further eval. Scout radiograph showed a nonobstructive bowel gas pattern. Left lower quadrant ostomy is in place.Transit time to the colon was one hour. There is a single dominant focus of distorted bowel, with multiple loops of bowel tenting towards a central focus in the left upper quadrant, with prestenotic dilatation, compatible with a dominant small bowel adhesion and partial small bowel obstruction. The adhesion is inferior to the ileostomy and ventrally located relative to the majority of the small bowel. No ulcers, sinus tracts or fistula were evident on this examination. TOTAL FLUOROSCOPY TIME: 2:58 minutes. | Dominant left upper quadrant adhesion resulting in partial small bowel obstruction as detailed above. |
Generate impression based on findings. | 27-year-old female with history of right shoulder pain status post altercation; tenderness to palpation over the AC joint. Three views of the right shoulder demonstrate a 3-cm corticated ossicle along the anterior aspect of the acromion, likely representing a normal variant os acromiale. No acute fracture is evident. The acromioclavicular and glenohumeral joints are normally aligned. | Ossicle along the anterior acromion process likely represents a normal variant os acromiale. No acute fracture is evident. If further evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 60 year-old female with lower back pain. Two views of the lumbar spine demonstrate mild demineralization of the bones, suggestive of osteopenia. There is minimal leftward curvature of the lumbar spine. Mild degenerative disk disease is present at L4-5. There is moderate facet joint osteoarthritis affecting the lower lumbar spine, right greater than left. Vertebral body heights are preserved. Grade 1 anterolisthesis at L4 is likely secondary to the facet joint osteoarthritis. | Degenerative disk and facet joint osteoarthritis as described above. |
Generate impression based on findings. | Reason: h/o VPS for NPH History: surveillance of ventricles The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a ventriculostomy tube course into the right frontal lobe into the right lateral ventricle with tip adjacent to the septum pellucidum. The temporal horns of the lateral ventricles are mildly dilated. Biventricular diameter at the level of the ventriculostomy entry into the right lateral ventricle is currently 54 mm and previously was 51 mm. Third ventricular diameter is currently 15 mm and previously was the same .No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is hypodensity present in the left basal ganglia and internal capsule associated with a adjacent exit vacuo effectThe visualized portions of the paranasal sinuses demonstrated mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There is a calcification present along the lateral aspect of the right eyeball at the expected level of the ora serata. | 1.No evidence for acute intracranial hemorrhage, mass effect or edema.2.Although the lateral ventricles appear slightly larger in the current exam this can be accounted for on the basis of ex vacuo effect due to a recent lacunar infarct adjacent to the left lateral ventricle. The third ventricle is stable.3.Chronic lacunar infarct involving the left basal ganglia has evolved since the prior exam when it was in the subacute phase. |
Generate impression based on findings. | The cervical spine is in normal alignment, with a normal cervical lordosis. There is moderate disk narrowing at C5-C6 and moderate-severe disk narrowing at C6-7. Disk desiccation is present at these levels as well as along the upper cervical spine. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are minimal endplate degenerative marrow changes. The spinal cord is of normal caliber and signal. There is no pathological cord enhancement. There is diffuse smooth pachymeningeal enhancement seen intracranially as well as along the visualized spine appearing similar to that visualized portion of abnormality on the outside images.At C5-C6, there is a diffuse posterior osteophyte disk complex. There is moderate central spinal canal stenosis. Right greater than left uncovertebral hypertrophy also contributes to moderate right and mild to moderate left foraminal narrowing. There is also ligamentum flavum thickening.At C6-C7, there is a mild diffuse posterior osteophyte disk complex with left paracentral prominence. There is bilateral uncovertebral hypertrophy with resultant mild-moderate central spinal canal stenosis and moderate to severe left and mild-moderate right foraminal narrowing. Right greater than left ligamentum flavum thickening is also noted.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remainder of the cervical spine. No abnormal CSF signal intensity collection is identified emanating from the thecal sac or the foramina. | 1. No definite pseudomeningocele identified or other evidence of CSF leak along the cervical spinal canal.2. Redemonstration of diffuse smooth pachymeningeal enhancement as partially visualized on prior outside MRI brain, also involving the entire visualized spine on current exam. 3. Mild-moderate spondylotic changes at C5-C6 and C6-C7, resulting in moderate central spinal canal stenosis at C5-C6. There is also moderate-severe left foraminal narrowing at C6-C7 as well as moderate right foraminal narrowing at C5-C6. |
Generate impression based on findings. | History of metastatic GI cancer admitted for osteonecrosis and osteomyelitis. There are postsurgical findings related to right partial mandibulectomy. There appears to have been interval resolution of the fluid collection in the treatment bed, although metal hardware artifact partially obscures this region. There is diffuse subcutaneous stranding of the overlying soft tissues. There is unchanged lucency surrounding the most superior right mandibular screw. There is also unchanged cortical irregularity and bone marrow sclerosis in the remaining portions of the mandibular body. There is no significant lymphadenopathy in the neck. There has been interval resolution of thrombus the right internal jugular vein. There is a right subclavian venous catheter. There is moderate atherosclerotic calcification of the carotid bulbs bilaterally. The thyroid gland is unremarkable. There are multiple sinonasal polypoid lesions. There are right maxillary mucous retention cysts. There is complete opacification of the left maxillary sinus with atelectasis. There is partial opacification of the right mastoid air cells. There is multilevel spondylitis of the cervical spine. There is more pronounced wedge deformity of the T4 vertebral body with approximately 25% loss of height. There is deformity of the nasal skeleton, which likely represents a prior fracture. There is a nonspecific partially-imaged opacity in the right lung. | 1.Postsurgical findings related to right partial mandibulectomy with persistent cellulitis, but apparent interval resolution of the abscess in the treatment bed, although metal hardware artifact partially obscures this region. 2. Persistent cortical irregularity and bone marrow sclerosis in the remaining portions of the mandibular body may represent osteonecrosis or osteomyelitis and loosening of the most superior right mandibular screw. 3. Interval resolution or right internal jugular vein thrombus.4. More pronounced wedge deformity of the T4 vertebral body with approximately 25% loss of height.5. Chronic paranasal sinus disease with evidence of silent sinus syndrome on the left and sinonasal polyposis.6. Persistent nonspecific partial opacification of the right mastoid air cells.7. Nonspecific partially-imaged opacity in the right lung. |
Generate impression based on findings. | There are no fractures. The marrow signal is benign. Benign hemangiomas are noted within T11, T12, and L1 vertebral bodies. The conus is normal in signal and morphology and terminates at an appropriate level.There are numerous small T2 hyperintense foci present within the visualized liver. Additionally, there is a solitary 14 mm T2 hyperintense focus within the kidney.Disc desiccation is present at L3/4 and L4/5 with mild disc height loss of L3/4 and moderate disc height loss of L4/5. A small Schmorl's node is present involving the superior endplate of L1.T12/L1: UnremarkableL1/2: UnremarkableL2/3: Mild bilateral facet hypertrophy without stenosis.L3/4: Mild disc bulge and moderate bilateral facet hypertrophy with small bilateral facet effusions. There are no significant stenoses.L4/5: Grade 1 anterolisthesis L4 on L5, asymmetric bulge to the right with disc uncovering, ligamentum flavum thickening, severe bilateral facet hypertrophy, and a right facet effusion. There is moderate central, mild left lateral recess, and mild right neural foraminal stenosis.L5/S1: Mild bilateral facet hypertrophy without stenosis. | 1.There are numerous small T2 hyperintense foci present within the visualized liver. Additionally, there is a solitary 14 mm T2 hyperintense focus within the kidney. Although these most likely represent simple cysts, they are incompletely evaluated given lumbar spine MRI acquisition technique. Thus, recommendation is made to obtain abdomen CT with contrast for more complete characterization, if this has not been performed at another institution.2.L3/4: Moderate bilateral facet hypertrophy with small bilateral facet effusions. There are no significant stenoses.3.L4/5: Grade 1 anterolisthesis L4 on L5, severe bilateral facet hypertrophy, and a right facet effusion. There is moderate central, mild left lateral recess, and mild right neural foraminal stenosis.4.Results were discussed with Dr. Altkorn on 3/13/2015 at approximately 1:05 p.m. |
Generate impression based on findings. | Reason: Hx of PSC rule out changes and cholangiocarcinoma History: PSC ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated slight irregularity and beading noted diffusely affecting the intrahepatic biliary system appearing similar to the prior study, consistent with the stated history of primary sclerosing cholangitis. No significant biliary dilatation. No dominant stricture.The posterior segment of right hepatic lobe has biliary drainage directly into the common bile duct, a normal variant. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No significant interval change in findings compatible with known history of primary sclerosing cholangitis. |
Generate impression based on findings. | 47-year-old male with NIDCM, getting workup for LVAD LIVER: Normal echogenicity of the liver measuring 17.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity at 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity with no evidence of pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 10.6 cm in length.KIDNEYS: Normal echogenicity of the right kidney measuring 11.1 cm in length. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the left kidney measuring 11.1 cm in length. No hydronephrosis or shadowing calculi are noted. Inferior left renal pole cyst measures 1.2 cm x 1.2 cm x 1.1 cm.ABDOMINAL AORTA: Visualized aorta is normal in caliber. There is a longitudinally oriented echogenic structure within the midabdominal aorta likely representing patient's intraaortic balloon pump. INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Foley within a decompressed bladder limits evaluation. | 1. Longitudinally oriented echogenic structure within the midabdominal aorta likely representing patient's intraaortic balloon pump. 2. Left inferior pole renal cyst. |
Generate impression based on findings. | There is mild nonspecific prominence of the lateral ventricles. The ventricles and sulci are otherwise within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is a dystrophic calcification along the right sylvian fissure. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is incidental paucity of soft tissue within the sella especially for a female patient of this age, which may represent partially empty sella. | Mild nonspecific prominence of the lateral ventricles. Otherwise, unremarkable noncontrast CT brain, with incidental possible partially empty sella. |
Generate impression based on findings. | Female 57 years old Reason: Lung Transplant Evaluation History: dyspnea Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 70.3 % of peak activity (normal >70 %)1 hour: 45.5 % of peak activity (normal 30-90 %) 2 hours: 11.5 % of peak activity (normal <60 %) 4 hours: 6.8 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | Male 56 years old Reason: staging exam History: prostate cancer newly diagnosed Small foci of increased radiotracer uptake in the left posterior 11th rib, as well as in the left parietal bone, which are suspicious for osseous metastases. | Multiple small foci which are suspicious for osseous metastases. |
Generate impression based on findings. | There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout the lumbar spine sparing the L3/4 level.T12/L1: UnremarkableL1/2: Trace retrolisthesis L1 on L2 and asymmetric bulge to the right. There is mild right neural foraminal stenosis.L2/3: Minimal disc bulge without stenosis.L3/4: UnremarkableL4/5: Grade 1 anterolisthesis L4 on L5, asymmetric bulge to the left with disc uncovering, ligamentum flavum thickening, severe left facet hypertrophy, moderate facet hypertrophy, and bilateral facet effusions. There is moderate left neural foraminal and mild right neural foraminal stenosis.L5/S1: Diffuse annular disc bulge containing a small right posterolateral annular fissure, moderate left facet hypertrophy, moderate to severe right facet hypertrophy, and small bilateral facet effusions. There is mild to moderate left neural foraminal and mild right neural foraminal stenosis. | 1.L1/2: Trace retrolisthesis L1 on L2 and mild right neural foraminal stenosis.2.L4/5: Grade 1 anterolisthesis L4 on L5, severe left facet hypertrophy, moderate facet hypertrophy, and bilateral facet effusions. There is moderate left neural foraminal and mild right neural foraminal stenosis.3.L5/S1: Small right posterolateral annular fissure, moderate left facet hypertrophy, moderate to severe right facet hypertrophy, and small bilateral facet effusions. There is mild to moderate left neural foraminal and mild right neural foraminal stenosis. |
Generate impression based on findings. | Interval postoperative changes are seen from T3-T8 bilateral laminotomies, with extensive edema in the paraspinal musculature and overlying soft tissues. At these levels, the previously confluent T1 hyperintensity relating to epidural lipomatosis is no longer identified, with scattered areas of heterogeneous signal likely representing postoperative blood products and fluid. No large focal epidural fluid collection is identified. The thoracic thecal sac caliber is not significantly changed compared to preoperative imaging. There is actually suggestion of slight decreased ventral CSF signal within the thecal sac at the C7 through T2 levels. Prominent dorsal epidural lipomatosis remains along the lower thoracic levels.The thoracic spine is in normal alignment, with slight acute thoracic kyphosis centered at T6-T7. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is redemonstration of focal central T2 hyperintensity within the cord at the T11-T12 level, which may represent a small syrinx. This measures 5 x 3 mm in greatest axial dimensions on 701/22. The spinal cord is otherwise of normal caliber and signal.There is minimal right dependent pulmonary opacity, likely representing atelectasis. | 1. Interval extensive postoperative changes along the upper to mid thoracic spine relating to multilevel laminotomies, although without significant improvement in MR appearance of the thecal sac caliber, with possible slight effacement of the ventral CSF signal within the thecal sac at the cervical thoracic junction. Previously noted epidural lipomatosis at the levels of surgery replaced by likely a combination of postoperative fluid and/or blood products.2. Stable appearance of trace T2 hyperintense signal at the T11-T12 level within the cord, likely representing focal syringohydromyelia. |
Generate impression based on findings. | History hepatocellular carcinoma now status post Therasphere treatment. CHEST:LUNGS AND PLEURA: Moderate centrilobular and paraseptal emphysema, unchanged. MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Severe atherosclerotic calcifications of the coronary arteries. Moderate hiatal hernia. Subcentimeter pretracheal lymph node is stable.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver.*Hepatic segment 7 TACE defect now measures 2.2 cm (series 10, image 31), unchanged. *Adjacent arterially enhancing lesion in the superior aspect of the the described defect demonstrates washout and measures 1.6 x 1.8 cm (series 80769, image 37), unchanged. *The arterially enhancing lesion with washout in the hepatic dome (segment 7) measures 1.4 x 1.8 cm (series 10, image 20), unchanged. *Additional arterial enhancing lesion in segment 7 without washout measures 1.2 x 0.9 cm (image 22; series 10), smaller.*Additional arterial enhancing lesion with washout in the inferior right hepatic lobe (segment 6) now measures 0.9 x 0 .7 cm, smaller (image 35; series 10).*Numerous small hypoattenuating lesions in the liver are unchanged.SPLEEN: Unchanged small infarct. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter low attenuation lesions within the bilateral kidneys too small to characterize.RETROPERITONEUM, LYMPH NODES: Patent endograft. Thrombosed aneurysm sac.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. Enhancement in the distal esophagus and proximal stomach compatible with varices and enhancement in the rectum consistent with hemorrhoids.BONES, SOFT TISSUES: No significant abnormality noted. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is colonic diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: Fluid collection in the subcutaneous fat superficial to the right femoral artery, similar to prior. Dural ectasia in the sacrum.OTHER: No significant abnormality noted. | 1.Multiple arterially enhancing hepatic lesions compatible with HCC as detailed above, not significantly changed from prior. 2.Cirrhotic morphology of the liver with findings compatible with portal hypertension. |
Generate impression based on findings. | 27-year-old male patient with right lower quadrant pain x 3 weeks. Evaluate for bowel disease. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: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. There scattered prominent mesenteric lymph nodes in the right hemiabdomen and pelvis (series 3 images 81 through 86).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Prominent mesenteric lymph nodes in the right lower quadrant raise question of mesenteric adenitis given the absence of any other findings to account for patient's symptoms. |
Generate impression based on findings. | Reason: History of small cell lung cancer. History: dizziness. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Atherosclerotic calcifications are present along the distal internal carotid arteries.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. The right eyeball lens is thin. | 1.No intracranial mass lesions are appreciated to suggest brain metastases. No evidence for acute intracranial hemorrhage, mass effect or edema. |
Generate impression based on findings. | Reason: MRI MRA showed possible left temporo-occipital AVM History: left facial pain, numbness and facial droop Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. There is a 2.2x1.0x1.2 cm compact arteriovenous malformation just deep to the left temporoparietal sulcus which is supplied via the left angular artery. There is a larger superficial draining vein which is fusiformly dilated near the nidus and narrowed along its midportion which drains into the left sigmoid sinus. There is a smaller venous drainage extending into the superior sagittal sinus.Left external carotid artery: There is no evidence for arteriovenous fistula. There is no evidence for AVM. There is no angiographic evidence for vasculitis.Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. The vertebral arteries are similar in size . There is reverse filling of the posterior communicating arteries which are small. There is no angiographic evidence for vasculitis. There is a small pial collateralization into the left temporal lobe from the left temporoccipital artery with a minimal supply to the AVM.Right vertebral artery: There is a reverse filling of the posterior communicating arteries which are small. There is no angiographic evidence for vasculitis. There is a small pial collateralization into the left temporal lobe from the left temporoccipital artery.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no angiographic evidence for AVM.Right external carotid artery: There is no evidence for arteriovenous fistula. There is no angiographic evidence for vasculitis.Right common iliac artery: There is a small non-flow limiting defect at the puncture site associated with mild vasospasm which improved by the end of the procedure. There is no evidence for dissection. | 1.There is a 2.2x1.0x1.2 cm compact arteriovenous malformation just deep to the left temporoparietal sulcus which is supplied via left angular artery branches for the most part and a tiny supply from a pial collateral from the left temporoccipital artery. Venous drainage is superficial with the dominant draining vein having some ectasia and narrowing.2.Above findings were discussed with Dr Awad. |
Generate impression based on findings. | Stable appearing left vallecula from 12/12/2014 study. There is thickening of the preepiglottic soft tissue without measurable mass, likely post treatment changes.Continued decrease in the size of the left level 3 nodal mass. Left level 3a lymph node measures 1.3 x 0.7 cm (series 8 image 48) previously measured 2.4 x 1.4-cm. smaller anterior left level 3 lymph node also decreased in size measuring 0.6-cm in the short axis (series 8 image 46), previously 1.0-cm. Scattered cervical lymph nodes that are not pathologic by CT size criteria. The airway is patent. The imaged intracranial contents are unremarkable. Osseous structures are unremarkable. Salivary glands and thyroid gland appear unremarkable. Major cervical vessels are grossly patent.Right sided port. Lung apices are clear. Mild degenerative disk disease of the lower cervical spine. | 1.Continued interval reduction of the cervical lymphadenopathy.2.Stable appearing left vallecula from 12/12/2014 study. No evidence of locoregional recurrence. |
Generate impression based on findings. | Chest pain and tachycardia. PULMONARY ARTERIES: Technically limited examination due to inadequate contrast opacification despite attempt at repeat scanning. No filling defects are identified in the main pulmonary arteries or lobar branches. Segmental and subsegmental emboli may not be visible on this examination due to limitations and cannot be ruled out.LUNGS AND PLEURA: No pleural fluid or pneumothorax. No focal air space opacities, suspicious nodules or masses.Mild bronchial wall thickening in the right lower lobe with intermittent areas of subsegmental airway occlusion which could be due to debris within the lumen or from the inflammation of the airway wall, nonspecific.MEDIASTINUM AND HILA: Mild coronary artery calcifications. The left ventricle is mildly enlarged. Polypoid filling defect within the distal esophageal trachea isoattenuating to soft tissue, measuring 7 by approximately 12 mm in transaxial dimensions (4/25) and 1.9-cm in cranial caudal length (coronal image 39). No pneumomediastinum or surrounding fluid collections.CHEST WALL: Small subpectoral subclavicular and axillary lymph nodes bilaterally, abnormal in multiplicity though not in size. Probable lower thoracic spine stenosis, poorly assessed, (4/226).UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Limited scanning range is unremarkable. | Limited examination without evidence of pulmonary embolus to the lobar level. Filling defect in the distal esophageal lumen could be a potential cause of chest pain and is of unclear etiology as it is isoattenuating to soft tissue. This could be retained food products, a polyp or a mass. Correlation with esophagram or direct visualization with endoscopy is recommended. Mild bronchial wall thickening with intermittent narrowing and occlusion of a subsegmental areas in the right lower lobe which may be inflammatory or secondary to aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 74-year-old female patient with epigastric pain. Please comment on pancreas and kidneys. Patient with acute renal failure. Exam is not sensitive for detecting lesions in the solid organs due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNG BASES: There is a pleural-based solid nodule in the left lower lobe that measures 4 mm (series 4 image 4). Basilar atelectasis.LIVER, BILIARY TRACT: No CT evidence of cholelithiasis or cholecystitis. No intra-or extrahepatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal calculi or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic changes affect the abdominal aorta and its branches.BOWEL, MESENTERY: There is questionable thickening of the gastric antrum, however, this may be secondary to peristalsis.BONES, SOFT TISSUES: Again seen is grade 2 anterolisthesis of L4 on L5 and chronic compression deformity of the T12 vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified mass in the fundus of the uterus likely represents a calcified fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is well-visualized and is within normal limits. Mild colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No abnormalities noted in the kidneys or pancreas in this limited noncontrast examination. 2.Questionable gastric antrum thickening may be due to peristalsis and is of uncertain clinical significance. An upper endoscopy can be obtained if there is clinical concern for pathology.3.Pleural based micronodule can be followed as clinically indicated. |
Generate impression based on findings. | Images are motion degraded through the skull base and posterior fossa. 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. Fluid is present within the frontal, ethmoid, and sphenoid sinuses likely due to the patient's recent incubated status. Mastoid air cells are clear. An enteric tube is present via the right nares. | Images are motion degraded through the skull base and posterior fossa. Given this caveat, no acute CT abnormality to explain the patient's symptoms. |
Generate impression based on findings. | Low back pain with right lower extremity radiculopathy. Evaluate for spondylolisthesis, fracture, DDD. Three views of the lumbar spine reveal no acute fracture. Alignment is anatomic. Vertebral body heights are maintained. There is mild narrowing at the L5/S1 level which may represent degenerative disease or incomplete segmentation. | Mild narrowing of L5/S1 as above. |
Generate impression based on findings. | Pain. Four views of the left foot reveal no acute fracture. There is ankylosis of the fifth digit DIP joint. There are multiple accessory ossicles in the foot. There is a well corticated calcification superior to the posterior calcaneus which is likely chronic in etiology, possibly post-traumatic. There is a mild pes cavovalgus deformity. | Mild pes cavovalgus deformity. |
Generate impression based on findings. | 68 year old female who was recalled from screening mammogram for left breast mass. Family history of breast carcinoma in her mother and sister. An ML view and 3 spot compression views of the left 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 3-mm mass with the central slightly outer left breast demonstrates partial resolution on spot compression images, and is not significantly changed from examination dated December 8, 2011. No suspicious microcalcifications or areas of architectural distortion in the left breast. | High probability benign mass within the central slightly outer left breast. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram 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. | 71-year-old female patient with history of bladder cancer status post cystectomy. Surveillance imaging. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Two hypoattenuating lesions are noted in the midpole of the right kidney and are not significantly changed compared to prior examinations. Symmetric excretion on delayed images bilaterally without filling defects.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes affect the abdominal aorta and its branches.BOWEL, MESENTERY: Again seen are postsurgical changes and Indiana pouch formation.BONES, SOFT TISSUES: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild multilevel degenerative changes affect the thoracolumbar spine.OTHER: No significant abnormality noted. | Postsurgical changes from cystectomy and Indiana pouch without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 79-year-old female with orbital marginal zone lymphoma and known abdominal aortic aneurysm. Recent lower abdominal pain. Evaluate for lymphadenopathy. CHEST:LUNGS AND PLEURA: Mild pleural thickening of the left lung is unchanged. Calcified granuloma in the left lung is unchanged. No new suspicious pulmonary masses or nodules.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aortic arch and coronary arteries. There are scattered small paratracheal, and mediastinal lymph nodes. The subcarinal reference lymph node measures 1.0 x 0.9 cm (image 38; series 3), unchanged. The reference right axillary lymph node measures 1.4 x 0.9 cm (image 7; series 3), unchanged. Trace pericardial effusion and/or thickening is stable.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: Atrophic left kidney, unchanged.RETROPERITONEUM, LYMPH NODES: No substantial interval change infrarenal abdominal aortic aneurysm measuring 3.4 cm (image 128; series 3). Complex aortic plaque with focal dissection in the juxtarenal aorta.BOWEL, MESENTERY: Scattered subcentimeter mesenteric lymph nodes are not significantly changed in size or number.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The uterus is absent or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered subcentimeter inguinal lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disk disease of the lower lumbar spine.OTHER: No significant abnormality noted. | The reference lymph nodes are stable with no evidence of metastatic disease. |
Generate impression based on findings. | Female; 36 years old. Reason: HCC fibrolamellar type, evaluate interval change prior consideration of clinical trial. History: none LUNGS AND PLEURA: Stable right lower lobe mixed density mass measures 11.5 x 10.4 cm, previously 11.5 x 10.4 (series 14/59). Associated compressive atelectasis adjacent to the mass. Adjacent pleural based mass is grossly stable.MEDIASTINUM AND HILA: Massive enlargement of the azygos vein secondary to caval occlusion. No mediastinal lymphadenopathy. Prominent right hilar node unchanged. Reference left axillary node measures 1.7 x 1 cm, previously 1.9 x 1.0 cm (series 14/18).CHEST WALL: Prominent collaterals in the musculature of the back.ABDOMEN:LIVER, BILIARY TRACT: The large hypervascular mass arising from the caudate lobe measures 7.2 x 4.9 cm, unchanged (series 14/89) and compatible with the patient's known fibrolamellar HCC. There is heterogeneous geographic attenuation of the hepatic parenchyma during the arterial phase, likely perfusional in etiology. Two small satellite lesions in the right lobe of the liver are grossly stable size. No new lesions.SPLEEN: The spleen is enlarged and there are extensive perisplenic venous collaterals. The mass at the splenic hilum measures 5.4 x 4 cm, previously 5.3 x 4 (14/83), not significantly changed.PANCREAS: The reference mass dorsal to the uncinate process measures 2.6 x 2.1 cm, unchanged (series 14/108).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: : No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy, not significantly changed. Reference peripancreatic lymph node measures 2.4 x 2.0 cm, unchanged (series 14/110). Reference retrocrural node measures 5.2 x 3.6 cm, unchanged (series 14/73). The infrarenal IVC remains thrombosed, and there is marked vascular collateralization.BOWEL, MESENTERY: Scattered hypervascular mesenteric lymph nodes are again identified.BONES, SOFT TISSUES: There are prominent subcutaneous collaterals circumferentially affecting abdomen and pelvis.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: Diffuse body wall collaterals.OTHER: No significant abnormality noted. | No significant interval change in multiple index lesions. No new sites of disease. |
Generate impression based on findings. | 40 year-old female with lumbosacral pain status post fall. Five views of the lumbar spine demonstrate mild to moderate facet joint osteoarthritis affecting the lower lumbar spine. The lumbar vertebral body heights are preserved, as are the intervertebral disk spaces. The sacrum is not completely visualized, although we do not see a fracture. There appears to be a transitional lumbosacral vertebral body. A compression fracture of T12 with step-off along the anterior aspect of the vertebral body suggests an acute fracture; there is approximately 15 to 20% loss of height anteriorly. There is possible mild superior endplate depression at T11. | Findings suggestive of acute compression fracture of T12. We see no fracture of the lumbar spine or visualized sacrum. |
Generate impression based on findings. | COPD and pulmonary nodules. LUNGS AND PLEURA: Severe centrilobular emphysema. No pleural fluid or pneumothorax.New 22 x 20 mm (4/33) irregular nodule with air bronchograms. Lesion extends to lateral pleural surface which is slightly tented. This lesion occurs adjacent to the previously seen 5-mm nodule which has now become calcified, probably a granuloma, but was not present on the previous examination. Scattered subcentimeter nodular opacities associated with groundglass suggestive of distal bronchial impaction. An 11-mm ground glass density lesion superior segment of the right lower lobe (4/36, coronal image 25) appears less dense when compared to prior study suggesting postinflammatory scarring but should continue to be monitored. Additional punctate opacities nonspecific.MEDIASTINUM AND HILA: Normal heart size. Mild anterior pericardial thickening or fluid. Moderate coronary artery calcifications and calcification of the aortic root. No lymphadenopathy.CHEST WALL: Scoliosis and degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Cholelithiasis without signs of cholecystitis. Mild atherosclerotic calcification of the abdominal aorta and its branches. | New indeterminate 22-mm irregular nodule within the right upper lobe. Morphology is suspicious for malignancy however this could potentially be postinflammatory or infectious (atypical mycobacteria for example). If the referring clinical service has outside prior examinations which can be obtained and submitted for comparison, this may aid in determination of chronicity and differential diagnosis. Correlation with PET scan is suggested. If this lesion persists in 6 weeks, further evaluation will be recommended at that time. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (11/12/14), ultrasound images of left breast and left axilla (11/12/14), images from ultrasound guided biopsy of the left breast and left axilla with specimen radiograph and post procedural left mammographic images (11/12/14) performed at Advocate South Suburban Hospital. DIGITAL MAMMOGRAPHIC IMAGES (11/12/14):The breast parenchyma is heterogeneously dense. A triangular marker is placed at 12 o'clock position of left breast, denoting the area of palpable lump. Ill-defined mass with pleomorphic calcifications is identified in the left posterior 12 o'clock position, posterior to the triangular marker. The mass measures at least 3 cm.Diffuse skin thickening and trabecular engorgement is present in the left breast, suggesting diffuse disease.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST AND LEFT AXILLA (11/12/14):A lobulated mass with internal calcifications, measuring 52 x 21 mm, is detected at 12 o'clock position, 4-cm from nipple, in the left breast. This mass corresponds to the ill-defined mass with calcifications visualized on the mammogram. At left axilla, there is a round hypoechoic mass, likely an enlarged lymph nodes with effaced hilum, measuring 27 x 20 mm. Next to this enlarged lymph node, another lymph node (10 mm) with thickened cortex is present.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF THE LEFT BREAST AND LEFT AXILLA WITH SPECIMEN RADIOGRAPH AND POST PROCEDURAL LEFT MAMMOGRAPHIC IMAGES (11/12/14):Ultrasound guided needle biopsy was performed for the left breast 12 o'clock mass and left axillary lymph node. Both biopsies were performed with appropriate needle placement. A marker clip was placed within the each lesion. Postprocedural monograms demonstrate a marker clip located immediate inferior and lateral from the ill-defined mass at 12 o'clock position. A clip within the left axillary lymph node is not visualized on mammogram, but the clip is confirmed on ultrasound image. Specimen radiograph shows a few calcifications within one of the specimens.Per pathology report, the results of both biopsies were malignant. | Biopsy proven left breast cancer with metastatic left axillary lymph node. In view of the presence of diffuse skin thickening and trabecular engorgement of the left breast, breast MRI should be considered for pre-treatment assessment.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Tenderness in the T7 area. Question of fracture. Two views of the thoracic reveal a mild anterior wedge deformity of either the T6 or T7 vertebral body. This appears similar to a radiograph from 1/20/2015. No acute fracture is evident. | Mild anterior wedging of either the T6 or T7 vertebral body, similar to a prior radiograph from 1/20/2015. |
Generate impression based on findings. | 46-year-old male with right ankle pain and tenderness over the lateral malleolus status post fall. Three views of the right ankle demonstrate mild soft tissue swelling. No underlying acute fracture is evident. Mild deformity of the medial malleolus may reflect old trauma. A normal variant os trigonum is present posterior to the talus. | Mild soft tissue swelling and other findings as above, without acute fracture. |
Generate impression based on findings. | Recurrent squamous cell carcinoma in the right infratemporal fossa, tumor progressing on chemo/RT based on radiation resimulation. There are postoperative findings related to partial right mandibulectomy with graft reconstruction. Although incompletely imaged, there has been interval increase in size of the ill-defined heterogeneous mass centered within the right infratemporal fossa. There is also a new fluid collection in the right masseter muscle and retromolar trigone region with associated demineralization of the right mandible and formation of periosteal reaction. There is no significant lymphadenopathy in the neck. There is mild asymmetric prominence of the right parotid duct, but no radioattenuating calculi. The thyroid gland appears unchanged. There is a right internal jugular venous catheter. There is no significant narrowing of the major vessels in the neck. The. There is multilevel degenerative spondylosis of the cervical spine. There are multiple nodules in the partially-imaged lungs. | 1. Although partially-imaged, the recurrent tumor centered in the right infratemporal fossa with associated perineural spread appears to have increased in size. 2. New fluid collection in the right masseter muscle and retromolar trigone region with associated demineralization of the right mandible and formation of periosteal reaction may represent superimposed abscess and osteomyelitis or radiation necrosis amidst tumor infiltration.3. Multiple nodules in the partially-imaged lungs are compatible with metastases. Please refer to the separate chest CT report for additional details.4. Opacification in the trachea may represent aspirated debris.5. A small amount of fluid within the right mastoid air cells is non-specific.Discussed with Dr. Haraf at 2: 45 PM on 3/13/15. |
Generate impression based on findings. | 37-year-old male status post fracture, follow-up. Two views of the left knee demonstrate orthopedic screws affixing a comminuted intra-articular fracture of the proximal tibia, in near anatomic alignment. Some of the fracture lines appear less distinct, suggestive of some interval healing. There is no radiographic evidence of hardware complication. Two pins and tension wires affix the patellar fracture in near anatomic alignment. The fracture line remains visible, though the margins are slightly less distinct, suggestive of some interval healing.Three views of the pelvis demonstrates a plate and screw device affixing a fracture of the left acetabulum in near-anatomic alignment. The fracture lines appear perhaps slightly less distinct, suggestive of some interval healing. Mineralization along the superolateral aspect of the femoral head likely represents postoperative heterotopic ossification. | Orthopedic fracture fixation of the pelvis and knee as described above. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is an incidental empty sella which is minimally prominent in size.CERVICAL SPINE | 1. No acute intracranial abnormality. Incidental empty sella.2. No acute fracture or subluxation. |
Generate impression based on findings. | Male 50 years old with abdominal pain. Nonobstructive bowel gas pattern. No specific radiographic evidence account for patient's pain. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Pain. Evaluate right shoulder. Three views of the right shoulder reveal a fracture of the greater tuberosity of the humeral head in near anatomic alignment, as seen on the prior exam. There is no evidence of dislocation.Additional views of the right humerus reveal the aforementioned humeral head fracture. | Humeral head fracture as described above. |
Generate impression based on findings. | 60 year-old male patient with history of metastatic renal cell carcinoma. CHEST:LUNGS AND PLEURA: Scattered micronodules appear similar compared to prior examination. No suspicious pulmonary nodules. Peripheral lingular scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Cardiac size is within normal limits without pericardial effusion.CHEST WALL: Again seen is a left ninth rib lytic lesion (series 3 image 66), unchanged. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Status post right adrenalectomy.KIDNEYS, URETERS: Postoperative findings of partial nephrectomy of the left upper lobe are again noted. Nonenhancing low attenuation collection along the surgical margin is slightly smaller compared to prior.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Mild atherosclerotic changes affect the abdominal aorta and its branches.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: Sigmoid diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination without new sites of disease. Unchanged left posterior rib lesion. |
Generate impression based on findings. | There is redemonstration of postoperative changes related to left neck dissection. There is stable decreased musculature along the left floor of mouth. The left submandibular gland is surgically absent. There is scarring along the small left sternocleidomastoid muscle. PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: There is stable but decreased left parotid volume, which is postsurgical. The postcontrast appearance of the remaining salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are otherwise unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is an indwelling right internal jugular venous catheter. The left internal jugular vein does not contrast opacify, although this is a stable finding. Scattered cervical spondylotic changes are noted with underlying developmental narrowing of the cervical spinal canal. There is a left maxillary sinus mucosal retention cyst. | 1. Stable postoperative changes within the left neck, without evidence of recurrent disease.2. Chronic left internal jugular vein nonvisualization which may be due to surgical ligation . |
Generate impression based on findings. | 56-year-old male with malignant melanoma and metastatic disease post interferon therapy. Evaluate response. CHEST:LUNGS AND PLEURA: No change in 4 mm nodular density at the right base.MEDIASTINUM AND HILA: Small superior mediastinal lymph node unchanged measuring 0.8 x 0.9 cm on image 25/218. There are other smaller lymph nodes which are stable. A superior paratracheal previously described in the prior report be located on the prior exam or from 7/9/13. Stable pericardiac lymph node.CHEST WALL: Non enlarged enhancing lymph nodes are stableABDOMEN: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: Reference whole lymph node at the level of the celiac axis measures 1.5 x 2.1 cm on image 97/218 without change. Other periportal and peripancreatic as well as gastrohepatic ligament nodes are stableBOWEL, 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: Bilateral hip arthroplasties.OTHER: No significant abnormality noted | Stable CT of the chest abdomen and pelvis with nonenlarged mediastinal nodes and borderline upper abdominal adenopathy as well a small stable right lung nodule. |
Generate impression based on findings. | 75-year-old male with history of squamous cell carcinoma of the tongue. CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions are identified. There is minimal pleural nodularity along the posterior aspect of the left hemithorax appearing similar to prior.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. No significant mediastinal lymphadenopathy. Severe coronary artery calcifications.CHEST WALL: Mild multilevel degenerative disease affects the visualized thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable right hepatic lobe hypodensity, likely representing a benign cyst.SPLEEN: Stable splenic hypodensity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild nonspecific perinephric stranding.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: 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.Postsurgical changes from prior gastric bypass surgery.BONES, SOFT TISSUES: Mild multilevel degenerative disease affects the visualized thoracolumbar spine.OTHER: Anterior abdominal wall fluid collection has nearly completely resolved. | 1. No evidence of metastatic disease.2. Near complete resolution of anterior abdominal wall fluid collection. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: None change basilar scarring.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Very small nonspecific hypodensities consistent with cysts.Cholelithiasis.SPLEEN: Small calcified granuloma consistent with previous infection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophy of the native kidneys, with the transplanted kidney in the right side of the pelvis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of metastatic disease. |
Generate impression based on findings. | Male 60 years old Reason: prostate cancer History: back pain Increased radiotracer uptake involving multiple vertebral bodies in the cervical, thoracic and lumbar spine, as well as throughout the pelvis, bilateral proximal femurs, multiple ribs and right proximal humerus consistent with extensive osseous metastatic disease. | Extensive osseous metastatic disease. On CT, lesion occupies greater than 50% of the right femoral neck. Extensive focus noted in the right proximal humerus, consider dedicated imaging to evaluate for possible impending fracture. |
Generate impression based on findings. | Malignant neoplasm of the prostate. Weight loss. The following observations are made given the limitations of an unenhanced study.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is a 2.6 x 3.7 x 5.2 cm ill-defined soft tissue mass in the right lower quadrant (image 76; series 3 and image 48; series 80264) in close contiguity and possibly extending from the appendix. Consider chronic appendicitis with phlegmon versus appendiceal carcinoma.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: See aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right lower quadrant soft tissue abnormality possibly representing an appendiceal mass as discussed above; consider chronic appendicitis versus appendiceal carcinoma. Dr. Dale informed of these findings at the time of dictation. |
Generate impression based on findings. | Recurrent head and neck CA in the right infratemporal fossa, tumor progressing on chemo/RT, evaluate for metastases. CHEST:LUNGS AND PLEURA: Interval development of scattered solid nodules. A lesion in the right lower lobe is centrally cavitary (4/67). Largest expansile endovascular lesion near the right costophrenic angle (4/78) measures 15 x 13 mm. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Right chest port tip in the right brachiocephalic vein. Normal heart size. No pericardial fluid. Moderate coronary artery calcifications. No mediastinal lymphadenopathy. Bilateral mild hilar lymph node enlargement, new from previous, measuring 13-mm on the right (3/44).CHEST WALL: Right chest port.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Gallbladder is distended, but there is no evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube retention device the stomach.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New pulmonary nodules and mild hilar lymphadenopathy suspicious for metastatic disease. |
Generate impression based on findings. | Reason: vertebral or basilar disease History: pontine stroke 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 left carotid bifurcation. There is a 60 ring of the proximal right internal carotid artery associated with atherosclerotic plaque and extending along a 15-mm segment of the proximal most portion of the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.There is medial deviation of the right internal carotid artery into the retropharyngeal space at the C2 vertebral body level.There are degenerative changes present along the cervical spine with facet hypertrophy as well as endplate and uncovertebral osteophytes at C3-4, C4-5, C5-6 and C6-7 with a resultant narrowing of the spinal canal suggestive of spinal stenosis at C5-6 and C6-7 and encroachment of the exiting nerve roots bilaterally at C3-4, C4-5, C5-6 and C6-7.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.There is a persistent trigeminal artery present on the right side with a para sellar course. The basilar artery below this is diminutive .The anterior communicating artery and the posterior communicating arteries are identified and are intact. There is a fetal origin of the right posterior cerebral artery associated with a hypoplastic right P1 segment. The left posterior communicating artery is tiny. There is fenestration of the enteric communicating artery. The left A1 segment is larger than the right A1 segment. 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.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.There is 60% stenosis based on NASCET criteria present along a 1.5 cm segment of the proximal right internal carotid artery.3.Persistent trigeminal artery on the right side.4.Multilevel degenerative changes are present along the cervical spine with moderate to spinal stenosis suspected at C5-6 and C6-7. There is encroachment of the exiting nerve roots present at C5-6, C6-7 as well as C3-4 and C4-5 due to degenerative changes. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of colon cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Normal-sized intramammary lymph node in the left upper outer quadrant. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Reason: 72 y/o m with COPD, CAD s/p CABG and MV/AV repairs, with pulmonary nodules, eval for progression compared to OSH chest CT 12/14. History: long smoking history (50 pack years) LUNGS AND PLEURA: At least 3 poorly defined pulmonary nodules which were present in the left lung have decreased or resolved. However some new nodular opacities have developed in the right middle lobe and right lower lobe. This sequence favors an inflammatory etiology.Bilateral pleural thickening and calcification with diaphragmatic calcified plaques, suggestive of previous asbestos exposure.Very small loculated effusions at the lung bases with associated pleural thickening and scarring.MEDIASTINUM AND HILA: Multiple moderately enlarged superior mediastinal lymph nodes are present measuring up to 11 mm in short axis diameter. Or marked subcarinal lymphadenopathy is present, inseparable from esophagus to two absence of contrast material but measuring over 2 cm in short axis diameter.Pacemaker leads, mitral and aortic valve prostheses in place.Severe coronary artery calcification.CHEST WALL: Status post median sternotomy with incomplete sternal effusion.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. | 1.Resolution of several left lung nodules and appearance of right lung nodules, suggestive of an inflammatory etiology, possibly related to aspiration.2. Calcified pleural plaques with pleural thickening and basilar scarring and small loculated effusions, consistent with previous asbestos exposure. Two to the patient's apparently high-risk status, continued CT surveillance is recommended. |
Generate impression based on findings. | Encephalomalacia and gliosis is present involving the left occipital lobe with ex-vacuo dilatation of the adjacent left occipital horn. Overlying this region has been prior craniotomy. Elsewhere there is hypodensity within the white matter without associated mass effect. Otherwise the remaining portions of the ventricles 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. | 1.Encephalomalacia and gliosis is present involving the left occipital lobe with ex-vacuo dilatation of the adjacent left occipital horn most likely secondary to remote infarction. Overlying this region has been prior craniotomy. 2.Small vessel disease of indeterminate ages. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History benign right breast biopsy. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable asymmetry in the left inner breast which may represents a prominent sternalis muscle, seen back to at least 2010. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 78-year-old female with malignant neoplasm of the lung LUNGS AND PLEURA: Postsurgical changes of a right lower lobectomy. Small right pleural effusion and mild basilar atelectasis. Multiple pleural nodules are better seen on today's study given presence of of IV contrast. These are probably unchanged from the prior exam but pleural metastases cannot be excluded.No suspicious nodules or masses identified. Scattered pulmonary micronodules, some of which are calcified.MEDIASTINUM AND HILA: Scattered prominent mediastinal and hilar lymph nodes not significantly changed since prior exam. Unchanged anterior mediastinal lymph node noted on the prior exam. For reference, a right paratracheal lymph node measures 17 mm (series 5, image 29). Heart size is normal. No pericardial effusion. Mild coronary artery calcification.CHEST WALL: No significant interval change in size of the right cardiophrenic lymph nodes. No significant retrocrural or axillary lymphadenopathy. No new suspicious osseous lesions. Minimal degenerative changes affect the spine. Lytic lesion with sclerotic border in the manubrium is unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Enteric contrast is noted within stomach and small bowel. Diffuse low-attenuation of the liver, may represent fatty infiltration. | 1.Postoperative findings of right lower lobectomy, without evidence of localized tumor recurrence at the resection site. 2.Nodularity to the right pleura as described above; pleural metastases cannot be excluded.3.Stable mildly prominent mediastinal lymph nodes; nodal metastases cannot be excluded.4.Small right pleural effusion. |
Generate impression based on findings. | 64-year-old male with history of base of tongue squamous cell carcinoma. CHEST:LUNGS AND PLEURA: Multiple tree in bud opacities within the right upper lobe. No suspicious pulmonary lesions identified. No pleural effusions.MEDIASTINUM AND HILA: The heart size is normal a small pericardial effusion, increased in volume. Scattered prominent mediastinal lymph nodes appear unchanged and are likely reactive in etiology. Calcified left hilar nodes are likely the sequela of prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable appearing hypoattenuating right adrenal nodule.KIDNEYS, URETERS: Stable bilateral renal hypodensities, likely representing benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Postsurgical changes of prior gastric bypass. A percutaneous feeding tube is present.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small fat-containing umbilical hernia. | 1. No evidence of pulmonary metastatic disease.2. Tree in bud opacities in the right upper lobe are likely the sequela of aspiration bronchiolitis.3. Small pericardial fluid collection increased in volume. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Styloid tenderness. Slipped on ice and landed on wrist. Pain second through fourth metacarpals and radial to ulnar head. Question of fracture. Three views of the left wrist reveal mild soft tissue swelling about the wrist. No acute fracture is evident. There is a well corticated ossicle adjacent to the lateral distal radius is likely chronic in etiology and possibly post traumatic. Additionally, there is mild sclerosis of the radius at the radiocarpal joint and mild widening of the scapholunate interval which is also likely degenerative and chronic in etiology. | 1. Soft tissue swelling without acute fracture.2. Degenerative changes as above. |
Generate impression based on findings. | Undifferentiated connective tissue disease and history of pneumonia. Borderline low DLCO evaluate for fibrosis. Dyspnea. LUNGS AND PLEURA: No evidence of pulmonary fibrosis. Scarring and mild bronchiectasis in the anterior right upper lobe. Equivocal bronchiectasis in the right middle lobe the medial segment. Mild linear scarring in the lung bases. No pleural fluid or pneumothorax. No air trapping.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the coronary arteries. Normal heart size. Calcification in the region of the mitral valve annulus. Physiologic volume of pericardial fluid. No significant lymphadenopathy.CHEST WALL: Scattered sclerotic foci in the thoracic spine, the majority are located near endplates are likely degenerative however the lesion and T7 is larger than expected (sagittal image 53, axial image 44) and is indeterminate, statistically most likely benign in a patient without known malignancy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. No significant abnormality noted. | 1. Mild bronchiectasis but no evidence of interstitial fibrosis. 2. Severe atherosclerotic calcification of the coronary arteries. 3. Indeterminate T7 vertebral body sclerotic focus of unclear etiology. If the patient is experiencing pain in this region, further assessment may be made with bone scan, though a degenerative lesion is favored. |
Generate impression based on findings. | Joint pain. Evaluate for OA versus RA. Three views of the right hand reveal no acute fracture. There is joint space narrowing and osteophyte formation of the basilar joint. There is subluxation of the radiocarpal joint. There is chondrocalcinosis of the triangular cartilage. There are chronic appearing erosions of the second through fourth proximal phalanxes. Three views of the left hand reveal no acute fracture. There is joint space narrowing and osteophyte formation of the basilar joint. There is subluxation of the radiocarpal joint. There is chondrocalcinosis of the triangular cartilage. There are chronic appearing erosions of the second through fourth proximal phalanxes. There are post-traumatic changes of the first interphalangeal joint and second DIP joint. | Constellation of findings are compatible with an inflammatory arthritis. |
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. visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative unenhanced brain CT. |
Generate impression based on findings. | Pain. Preop. Three views of the left knee are provided. Again seen is cement within the distal femur, presumably due to treatment of a giant cell tumor. Thin lucency surrounding the cement appears similar to that seen on the prior study and is of doubtful clinical significance. I see no radiographic evidence of tumor recurrence. Moderate to severe osteoarthritis affects the knee with near bone-on-bone apposition of the medial tibiofemoral compartment and tricompartmental osteophytes. There is also a small joint effusion. Moderate osteoarthritis affects the right knee, as seen on the frontal view.The mechanical axis radiograph of the left lower extremity shows the aforementioned postoperative changes of the distal femur as well as osteoarthritis of the knee. There is approximately 6 degrees of varus alignment of the knee with respect to the neutral mechanical axis. | Postoperative changes of a giant cell tumor treatment and osteoarthritis as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Multiple bilateral benign calcifications do not appear significantly changed. Some of these are vascular in etiology. Left breast benign mass also stable in size. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in a niece at age 28. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Two new focal asymmetries are present in the left upper breast. A few bilateral benign calcifications are again noted. No suspicious microcalcifications or areas of architectural distortion are present. | Left breast focal asymmetries for which further evaluation with spot compression and possibly ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Left ankle pain: Evaluate for stress fracture versus degenerative changes. Pain in the navicular area in the medial malleolus. Right ankle pain: Pain in the navicular area and base of fifth metatarsal. Evaluate for stress fracture versus degenerative changes. Three views of the left ankle reveal no acute fracture or malalignment. There are vascular calcifications. The ankle mortise is intact. There is no joint effusion. There is no soft tissue swelling.Three views of the right ankle reveal no acute fracture or dislocation. No joint effusion is noted. The ankle mortise is intact. There is no soft tissue swelling. | No specific radiographic findings to account for the patient's pain. |
Generate impression based on findings. | 55-year-old female presents for 6 month follow-up of right breast mass. History of benign right breast biopsy. Family history of breast carcinoma in her sister. Family history of ovarian and cervical carcinoma in her sister. Three standard 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 Hydromark clip is noted adjacent to the asymmetry within the upper outer right breast, which is not significantly changed from prior examination. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla. | Stable right breast asymmetry. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due July 2015. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 85 years, Male, Reason: h/o BCC skin and lung mets, compare to previous, measurements pls History: non. CHEST:LUNGS AND PLEURA: Status post right wedge resection. Nodularity adjacent to the suture material is unchanged. Multiple bilateral nodules are increased in size. A right upper lobe nodule measures 1 cm (image 28; series 5), larger. An additional right upper lobe nodule measures 1.3 cm in diameter (image 33; series 5). Bilateral subpleural nodules at the bases have enlarged. Basilar scarring/atelectasis is unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal with moderate pericardial effusion, unchanged. Severe coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic cysts are unchanged.SPLEEN: No significant abnormality notedPANCREAS: Cystic dilatation of the main pancreatic duct measuring up to 1.5 cm with multiple smaller cysts throughout the body and tail is overall unchanged. A multi-lobulated cystic lesion in the head of the pancreas measures 2.2 x 1.8 cm (image 111; series 3), unchanged. A stone within the neck of the pancreas is unchanged. No focal obstructing lesion is evident.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: Mesenteric calcification.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Massively enlarged heterogeneous prostate is stable. Right-sided hydrocele.BLADDER: Bladder wall thickening and diverticula are likely related to chronic outlet obstruction.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteopenia with moderate degenerative changes of the spine. OTHER: No significant abnormality noted. | 1.Progression of pulmonary metastasis.2.Cystic dilatation of the main pancreatic duct with multiple cystic lesions are stable. |
Generate impression based on findings. | Status post ankle ORIF Again seen is a plate and screws affixing a distal fibular fracture in near-anatomic alignment. The fracture is perhaps slightly less distinct on the current study than on the prior study, suggesting some interval healing. Also again seen is an orthopedic screw affixing a medial malleolus fracture in near-anatomic alignment; the fracture line is slightly less distinct on the current study than on the prior study, suggestive some interval healing. I see no hardware complications. There is mild soft tissue swelling. There is a mild flat foot deformity. The bones appear slightly demineralized, presumably from disuse. | Orthopedic fixation of healing ankle fractures as above. |
Generate impression based on findings. | 81 years, Male. Reason: eval NGtube location post advancement History: NGT advancement There is a nasogastric tube, which has been advanced, with its tip and sideport projecting over the proximal stomach. Dilated loops of jejunum are partially imaged on this examination. Please refer to same day chest radiograph for thoracic findings. | NG tube sideport overlies the proximal stomach. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign biopsies and bilateral breast reduction. Family history of breast cancer in an aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Parenchymal distortion compatible with bilateral breast reduction again noted. Scattered benign calcifications are again seen. Stable focal asymmetry in the left upper outer breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Six weeks postop. Evaluate bilateral hip pinning for femoral neck fractures. Two views of the right hip reveal three Knowles pins within the right femur. A bandlike lucency is again visualized partially traversing the medial cortex of the femoral neck, though less distinct than the prior study.Two views of the left hip reveal three Knowles pins affixing a fracture of the femoral neck. Additional AP view of the pelvis reveals a uterine contraceptive device. | Orthopedic fixation of a nondisplaced left femoral neck fracture and right femoral neck stress fracture. |
Generate impression based on findings. | Reason: 72 y/o with esophageal ca and known PE s/p esophageal resection 2/20/15 now with chest pain please evaluate for pgoression of PE, esophageal leak, History: see above CHEST:LUNGS AND PLEURA: Interval partial resolution of several subpleural opacities in the right lung and subsegmental atelectasis that may have been secondary to pulmonary embolism.New small left pleural effusion with underlying opacity suggestive of atelectasis.No new suspicious nodules.MEDIASTINUM AND HILA: Interval resolution of the right lower lobe pulmonary embolus. Mildly enlarged high right paratracheal lymph node measuring 7 mm, unchanged.Interval gastric interposition procedure with a distended fluid-filled intrathoracic stomach.No visible coronary artery calcification. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hemangioma anterior to the gallbladder as previously described.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Very mildly enlarged left adrenal gland measuring about 13 mm in transverse diameter, unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Filter device in the infrarenal IVC.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Jejunostomy tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post gastric interposition with no sign of recurrent disease.Interval resolution of right lower lobe pulmonary embolus.New small nonspecific left pleural effusion. |
Generate impression based on findings. | 75-year-old male with right upper lobe nodule, cough LUNGS AND PLEURA: Right upper lobe nodule measures 14 x 21 mm, previously 18 x 22 mm (series 5, image 41). On the coronal sequence, the nodule measures 12 mm, previously 11 mm (series 80256, image 89). On the sagittal sequence, the nodule measures 11 x 17 mm, previously 11 x 15 mm (series 80259, image 51). Allowing for scan and variability and differences in patient inflation, there is no significant change in size. Additional scattered calcified and noncalcified micronodules significantly changed since prior exam.Mild dependent bibasilar atelectasis/scarring. Trace pleural effusions.MEDIASTINUM AND HILA: Postoperative findings compatible with cardiac transplant. Heart size is normal. No pericardial effusion. No visible coronary artery calcification.Low attenuation nodule in the anterior mediastinum measuring 14 x 23 mm (series 3, image 26), previously 16 x 23 mm is not significantly changed. Slight interval decrease in size of the right tracheoesophageal lymph node noted on the prior exam (series 3, image 10).Scattered subcentimeter mediastinal lymph nodes are not significantly changed since prior exam.Mildly patulous esophagus.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. The osseous structures are within normal limits. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology.Partially exophytic hypoattenuating cystlike lesions in the kidneys bilaterally incompletely included in the scanning range. | Overall, no significant change in size of right upper lobe nodule abutting the minor fissure with measurements detailed above. This nodule has been present and has increased in dimension and density over time; an indolent neoplastic process cannot be excluded. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Basal cell carcinoma. Neck: There are postoperative findings related to partial left anterior maxillectomy, left turbinectomy, partial septectomy, and left orbital floor reconstruction. There is a lytic defect with persistent ill-defined soft tissue along the medial aspect of the left maxillary alveolus that contains a subcentimeter cystic component. There is also persistent soft tissue in the reconstructed left check extending superiorly towards the inferior aspect of the left orbit. In addition, there is persistent soft tissue effacement of the left pterygopalatine fossa. There is no significant cervical lymphadenopathy. The thyroid and major salivary glands appear unchanged. The major cervical vessels appear unchanged, with extensive cerebrovascular calcifications. There are degenerative changes affecting the right temporomandibular joint. There are multiple pulmonary nodules.Orbits: There is mild residual post-treatment stranding in the inferior left orbital fat, but no evidence of discrete intraorbital mass lesions. There has been interval resolution of left lacrimal sac distention. There are bilateral lens implants. | 1. Extensive postoperative findings related to left maxillectomy with persistent nonspecific soft tissue containing a cystic component along the medial aspect of the left maxillary alveolus and soft tissue in the left cheek subcutaneous tissues, but no evidence of intraorbital tumor involvement or significant lymphadenopathy in the neck.2. Multiple pulmonary nodules are consistent with metastases. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | There is a stable right frontal approach ventriculostomy catheter with the tip near the left foramen of Monro. The ventricles and sulci are stable, again with disproportionate dilatation of the lateral and third ventricles with respect to sulcal prominence. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | Stable ventricular caliber with disproportionate dilatation of the lateral and third ventricles consistent with known history of NPH. No change in ventriculostomy catheter position. |
Generate impression based on findings. | 74-year-old female patient with recent diagnosis of small lymphocytic lymphoma prior left axillary lymph node biopsy needs initial staging to evaluate disease burden. CHEST:LUNGS AND PLEURA: Scarring noted in the lingula. No suspicious pulmonary lesions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications. Cardiac size is normal without pericardial effusion.CHEST WALL: Scattered small axillary lymph nodes, left greater than right. Enlarged soft tissue nodule in the left axilla measures 1.5 cm (series 3 image 15) with associated inflammatory changes that may be secondary to prior lymph node biopsy.ABDOMEN:LIVER, BILIARY TRACT: Multiple date hypoattenuating lesions in the liver too small to characterize and likely represent cysts.SPLEEN: Two subtle ill defined hypoattenuating areas are noted in the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes. Mild to moderate atherosclerotic changes affect the abdominal aorta and its branches.BOWEL, MESENTERY: Hazy mesentery in the left hemiabdomen with scattered enlarged lymph nodes. A reference node measures 1.7 x 1.4 cm (series 3 image 123).BONES, SOFT TISSUES: Levoscoliosis of the lumbar spine with moderate to severe multilevel degenerative changes in the thoracolumbar spine. There is grade 1 anterolisthesis of L3 on L4 and grade 1 retrolisthesis of L4 on L5.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Bulky uterus may be secondary to fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Levoscoliosis of the lumbar spine with moderate to severe multilevel degenerative changes in the thoracolumbar spine. There is grade 1 anterolisthesis of L3 on L4 and grade 1 retrolisthesis of L4 on L5. Left lateral abdominal wall intramuscular lipoma (series 3 image 144).OTHER: No significant abnormality noted. | 1.Enlarged mesenteric lymph nodes. 2.Mildly enlarged left axillary lymph node with surrounding inflammatory changes may be from prior biopsy.3.Subtle hypoattenuating splenic lesions are nonspecific and can be followed on subsequent imaging. |
Generate impression based on findings. | Pain. Evaluate right shoulder. Three views of the right shoulder reveal no acute fracture or dislocation. There is mild osteophyte formation at the acromioclavicular joint and glenohumeral joint. There is chondrocalcinosis in the glenohumeral joint. | Mild osteoarthritis of the glenohumeral and acromioclavicular joints. |
Generate impression based on findings. | Right rotator cuff pain. Three views of the right shoulder reveal no acute fracture or dislocation. The bones appear demineralized. There is minimal osteoarthritis of the acromioclavicular joint. The acromiohumeral distance is mildly decreased. | Mild acromioclavicular joint osteoarthritis. |
Generate impression based on findings. | There is redemonstration of a ring-enhancing mass demonstrating discontiguous new diffusion restriction in the posterior left superior frontal gyrus. There is a slight hyperintensity consistent with vasogenic edema and may in part represent posttreatment changes as well. Although the enhancing margin of the mass is somewhat discontinuous, it measures 1.9 x 1.9 cm in greatest dimension 14/174, previously measuring 1.5 x 1.5 cm on 1/22/2015, and 1.2 x 1.1 cm on 10/6/2014. When compared back to the appearance from 10/1/2014, the lesion appears increasingly centrally necrotic.The ventricles and sulci are prominent, consistent with moderate-severe global volume loss, greater than expected for the patient's stated age. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. There is also patchy abnormal signal symmetrically within the pons. There is a stable defect in the left caudate extending to the left corona radiata, most consistent with a chronic lacunar infarct. There is no new pathological enhancement. There is no diffusion abnormality to suggest acute ischemia. 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. Perfusion imaging post-processing is nondiagnostic, possibly relating to technical factors for the source acquisition. | 1. Interval increase of size of ring enhancing mass in the left superior frontal gyrus and now with diffusion restriction. Increased surrounding abnormal signal which could represent a combination of worsening vasogenic edema and/or posttreatment changes.2. Stable appearance of other scattered T2/FLAIR hyperintense foci within the white matter without enhancement, although these may represent chronic small vessel ischemic changes. Stable chronic left caudate to corona radiata lacunar infarct and additional chronic small vessels can be changes in the pons. |
Generate impression based on findings. | AsthmaVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex, aortic arch and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | ConstipationVIEW: Abdomen AP Disorganized nonobstructive bowel gas pattern. No Sitz markers are identified. Minimal amount of fecal burden in the descending colon. | No Sitz markers are identified. |
Generate impression based on findings. | Female; 63 years old. Reason: rule out aortoenteric fistula History: bloody bowel movements, pancreatic complex cyst, recent anticoagulation with renal artery thrombus ABDOMEN:LUNG BASES: Small right pleural effusion. Mild bibasilar subsegmental atelectasis.LIVER, BILIARY TRACT: Pneumobilia. An anterior branch of the right portal vein is thrombosed; distally there is a large area of wedge-shaped relative hyperattenuation in the right hepatic lobe due to perfusional differences. The remainder of the portal venous system is patent. No suspicious liver lesions. Pneumobilia, likely due to prior sphincterotomy. No biliary ductal dilation. SPLEEN: No significant abnormality notedPANCREAS: The majority of the pancreas is replaced by a large, loculated fluid collection, most compatible with acute necrotic collection and measuring up to approximately 14.3 x 5.5 cm (series 11/55). This is not significantly changed since prior studies. No splenic artery pseudoaneurysm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There are two right renal arteries, with thrombosis of the accessory inferior right renal artery causing a small infarct of the right kidney lower pole (series 11/75).RETROPERITONEUM, LYMPH NODES: There are two acute thrombi within the abdominal aorta, which are stable since prior study on 3/9/15 but new since 3/3/15. The larger thrombus is seen adherent to the anterior wall at the same level as the closely apposed third portion of the duodenum (series 10/66). Though no contrast extravasation or extraluminal gas is seen to suggest aortic-enteric fistula, the location of the thrombus raises the question of aortic-enteric fistula with the duodenum, particularly in light of the patient's history of GI bleeding.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 noted OTHER: Mild pelvic ascites. | 1. Acute thrombi within the abdominal aorta which raises possibility of aortic-enteric fistula given clinical history and close anatomic apposition of transverse duodenum and aorta. Consider upper endoscopy for further evaluation.2. Right kidney lower pole infarct.3. Large acute necrotic collection replacing most of the pancreatic parenchyma. No splenic artery pseudoaneurysm.4. Thrombus occluding a branch of the right portal vein.Findings were discussed with Dr. Skelly at 1:45 p.m. on 3/13/15. |
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