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Generate impression based on findings. | Chest tube removalVIEW: Chest AP Cardiothymic silhouette at the upper limits of normal. Mediastinal clips, epicardial pacer leads and right central line unchanged. The right chest tube has been removed in the interval. Minimal patchy atelectasis in the right upper lobe. No evidence of pneumothorax. | Right chest tube removal without evidence of pneumothorax. |
Generate impression based on findings. | 44-year-old female presents for 6 month follow-up of right breast mass status post benign biopsy in August 2014. History of bilateral reduction mammoplasty in 2002. No family history of breast cancer. Three standard views of the right breast, with additional CC and MLO views, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. A new ring-shaped biopsy clip is present within the central outer right breast. The previously identified mass at this location is not present on today's 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. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, for which the patient is due in August 2015. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Postop. Prosthetic assessment. Three views of the left knee reveal a total knee arthroplasty device situated in anatomic alignment without evidence of hardware complication. There is maturation of minimal heterotopic bone along the lateral aspect of the lateral tibial plateau. No acute fracture is evident. Single AP image of the right knee reveals severe osteoarthritis. | Left total knee arthroplasty without evidence of hardware complication. |
Generate impression based on findings. | Male 57 years old History: continued pain s/p cholecystectomy, evaluate for bile leak. Angiographic images are unremarkable. Prompt clearance of radiotracer from the blood pool and uniform accumulation of the tracer by the liver is present. There is normal excretion of tracer into the intrahepatic ducts, common bile duct, and duodenum, indicating patent common bile and cystic ducts. | Normal hepatobiliary imaging. No evidence of bile leak. |
Generate impression based on findings. | Female 49 years old Reason: 49F s/p lap RYGB c/b obstruction s/p LOA with persistent N/V History: N/V Single contrast evaluation of the esophagus demonstrated normal mural contours without evidence of fixed narrowing. Contrast flowed promptly into the residual gastric pouch and into the proximal jejunum without delay. The gastrojejunal anastomosis was widely patent. There was no evidence of extravasation to leak.There was dilatation of a proximal loop of small bowel measuring up to approximately 3.1 cm in maximal diameter just proximal to a focal narrowing, in the region of distorted small bowel loops, suggestive of partial obstruction related to an adhesion. Contrast progressed through the small bowel slowly, perhaps related to the patient's narcotic medication. After 3 hours, the exam was terminated and a follow-up overhead radiograph were recommended to evaluate the distal extent of the small bowel.TOTAL FLUOROSCOPY TIME: 4:52 minutes | Postsurgical changes related to Roux-en-Y gastric bypass, with dilatation of a proximal loop of jejunum, just proximal to a focal narrowing, likely related to adhesive disease, as detailed above. |
Generate impression based on findings. | Status post right lumpectomy for breast cancer in 2002, presents today for routine follow up. No current breast complaints. Three standard views of both breasts with a right exaggerated CC view and spot compression view of left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements. Postsurgical changes including volume loss, distortion, and multiple surgical clips in the right breast are noted. A small asymmetry at medial posterior left breast on CC view disperses with spot compression. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient.If the patient submits her old mammograms, we can compare them with the current study to establish stability.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: restaging CT esophageal cancer s/p resection s/p recurrence s/p RT s/p stent s/p chemo History: none currently CHEST:LUNGS AND PLEURA: Interval increase in left pleural effusion now moderate in size. Small trace right pleural effusion. Bibasilar atelectasis is increased. Scattered nodular groundglass opacities in the right upper lobe, posterior segment, is nonspecific and may reflect aspiration. No suspicious nodules or masses.MEDIASTINUM AND HILA: Reference right hilar lymph node measures 12 x 14 mm, previously 12 x 15 mm (series 3, image 43). Additional scattered subcentimeter, mildly prominent mediastinal lymph nodes are noted not significantly changed since prior exam. At the superior aspect of the stent, the cervical esophageal wall is thickened to 10 mm, increased from 4 mm (series 3, image 13). Esophageal stent is unchanged in position with similar appearance of circumferential thickening of the esophageal wall at the level of the carina. No pneumomediastinum. There is a mild contour abnormality of the esophagus/jejunum at the level of the diaphragmatic inlet. This is nonspecific and attention may be given to this study on future studies.Heart size is normal. No pericardial effusion. Severe coronary artery calcification.Hypodense right greater than left thyroid lobe nodules.CHEST WALL: Degenerative changes affect the thoracolumbar spine. No suspicious osseous lesions are identified.No axillary, retrocrural, or cardiophrenic lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy. No suspicious lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Increased multiple punctate calcifications in bilateral kidneys may represent non-obstructing stones. Small lesion in the inferior pole of the left kidney is stable since 2013 and likely represents a hemorrhagic or hyperdense cyst given lack of growth but is incompletely assessed. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branch vessels. Reference gastrohepatic lymph node (series 3, image 91) measures 11 x 11 mm, previously 13 x 16 mm. This is not significantly changed accounting for differences in scan variability. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Postoperative changes seen in the upper abdomen from prior gastrectomy and esophageal jejunal anastomosis. Infiltration of the fat near the celiac axis is similar.BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine. No suspicious osseous lesions are identified.OTHER: No significant abnormality noted. | 1.Increased thickening of the cervical esophogeal wall at the superior aspect of the stent as described above suspicious for tumor. Elsewhere unchanged circumferential thickening of the esophageal wall. 2.Increase in number of multiple small nonobstructing renal stones bilaterally. 3.Scattered nodular groundglass opacities in the right upper lobe, posterior segment, is nonspecific and may reflect aspiration. 4.No specific evidence of pulmonary metastasis. |
Generate impression based on findings. | 63-year-old male patient with history of duodenal carcinoid and lymphadenopathy presents for surveillance. 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:CHEST:LUNGS AND PLEURA: Left apex scarring noted. Peripheral interstitial thickening and bronchiectasis in the bilateral lung bases. Left basilar atelectasis/scarring.MEDIASTINUM AND HILA: Note that the evaluation of the mediastinum is limited due to beam hardening artifact from arm positioning. Given this limitation there are several small scattered mediastinal lymph nodes. Reference left paratracheal node measures 0.9 x 0.6 cm (series 80372 image 19), previously 0.9 x 0.8 cm. Para-aortic node measures 2.7 x 1.8 cm (series 80372 image 35), previously 2.1 x 1.2 cm and demonstrates a fatty hilum.CHEST WALL: Scattered small left axillary lymph nodes with fatty hila. Asymmetric gynecomastia again noted. Metallic densities in the right posterior lateral chest wall.ABDOMEN:LIVER, BILIARY TRACT: Liver granuloma. No focal hepatic lesions in this limited examination. Layering high density material within the gallbladder likely represents sludge and/or stones. Hepatomegaly, measuring up to 19 cm in craniocaudal dimension.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal adenoma measures 1.7 x 1.2 cm (series 80372 image 83), previously 1.7 x 1.6 cm.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Previously referenced gastrohepatic node is unchanged and measures 0.6 cm (series 80372 image 80), previously 0.7 cm. Previously referenced portacaval lymph node currently measures 2.6 x 1.2 cm (80372 image 93), previously 3.0 x 1.7 cm.BOWEL, MESENTERY: Polypoid duodenal mass appears grossly similar compared prior examination given differences in bowel distention.BONES, SOFT TISSUES: Moderate to severe multilevel degenerative changes affect the thoracolumbar spine. There are inflammatory changes and foci of air in the subcutaneous tissues of the left lower back.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered enlarged inguinal and pelvic lymph nodes appear similar to mildly decreased compared to prior. Reference right inguinal lymph node measures 2.1 x 1.1 cm (series 80372 image 194) previously 2.4 x 1.1 cm and appears to be a conglomerate of two separate nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic focus in the right femoral intertrochanteric region. Scattered sclerotic foci in the pelvis are unchanged.OTHER: No significant abnormality noted. | 1.Overall stable to slight interval decrease in reference lymph nodes in the thorax, abdomen, and pelvis. Reference measurements provided above.2.Grossly stable duodenal polypoid lesion given limitations of differential bowel distention between examinations. 3.Inflammatory changes and foci of air in the subcutaneous tissues of the left lower back. Recommend correlation with physical examination and history of prior injections. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild disk narrowing at L5-S1. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are bilateral L5 pars interarticularis defects, as seen on prior radiograph. The distal spinal cord and conus are within normal limits with the conus terminating at the T12-L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. There is mild facet arthropathy L4-L5 and L5-S1 bilaterally.There may be partial visualization of the fundus of the uterus in the presacral area, with possible retroflexion. The visualized portion appears slightly heterogeneous suggesting possible fibroids. | 1. Chronic bilateral L5 spondylolysis with minimal L4-L5 and L5-S1 spondylotic changes. No significant stenosis at any level. No MR evidence of cauda equina syndrome.2. Possible partial visualization of the fundus of the uterus which may be retroflexed, with heterogeneous appearance suggesting possible fibroids. Pelvic ultrasound may be obtained as clinically indicated. |
Generate impression based on findings. | 73 year old female who has a complaint of palpable, tender area in the right upper breast/chest wall. History of left mastectomy in 2007. Patient received radiation. No family history of breast cancer. The patient is predominantly Spanish-speaking. The patient's daughter was present to assist in interpretation. MAMMOGRAM: Three standard, and one spot compression, views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A triangular marker is noted within the right upper breast on MLO view, with no underlying mammographic abnormality identified. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla.ULTRASOUND: On physical examination, no palpable abnormality is identified. Patient stated there was a focal pain within the upper chest wall.A targeted right ultrasound was performed for the patient’s area of concern. There is no solid or cystic mass identified. | No mammographic or sonographic evidence of malignancy. Patient should return to her physician for management of focal tenderness. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Recurrent squamous cell carcinoma status post adenoidectomy/tonsillectomy and a left neck dissection. MRI of the skull base on 2/19/15 demonstrated interval increase size of signal abnormality in the left sided skull base. Inferiorly, it extended down to the left carotid bifurcation with increased infiltration into the adjacent paraspinal muscles and into the occipital bone and the inferior aspect of the petrous temporal bone. Neck: Dental streak artifact obscures portions of the neck. There are post-treatment findings in the neck related to lymph node dissection and radiation therapy. There is an infiltrative heterogeneous mass in the left perivertebral space that measures approximately 20 x 45 mm in transverse dimensions with infiltration of the paraspinal muscles, protrusion into the left jugular foramen, and apparent mild irregularity of the adjacent inferior aspect of the skull base. The mass partially encases the V3 segment of the left vertebral artery. The mass also appears to extend into the left carotid space to the level of the carotid bifurcation, where it encases the proximal left internal carotid artery, which is mildly narrowed, and abuts the proximal left external carotid artery. There is mild low attenuation plaque at the carotid bifurcation as well. The left internal jugular vein is not apparent. There is opacification of the left mastoid air cells, perhaps due to mass effect upon the Eustachian tube. The thyroid and remaining salivary glands are unremarkable. The airways are patent. There is degenerative cervical spondylosis. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.Head: There is no discernible evidence of intracranial mass or abnormal enhancement. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. | 1. Post-treatment findings in the neck with evidence of recurrent infiltrative tumor in the left perivertebral space with apparent skull base invasion and left vertebral artery encasement, as well as within the left carotid space with encasement of the internal carotid artery.2. No discernible evidence intracranial tumor extension or brain metastases. However, an MRI may be more sensitive for the detection of subtle intracranial tumor involvement. |
Generate impression based on findings. | 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: The postcontrast appearance of the salivary glands is unremarkable. There is an irregular area of nonspecific enhancement in the left lobe of the thyroid gland centrally .ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are bilateral enlarged level Ib lymph nodes, measuring up to 1.6-cm on the right and 1.4-cm on the left. However these do not demonstrate a rounded morphology and appear elongated a fatty hila. There are no other pathologically enlarged cervical lymph nodes.OTHER: There is minimal mucosal thickening in the maxillary sinuses. There is a small right sphenoid sinus mucosal retention cyst. There is moderate atherosclerotic calcification of the carotid bifurcations. There are mild cervical spondylotic changes. There is trace grade 1 anterolisthesis of C7 on T1. | 1. Mild minimal bilateral level Ib cervical lymphadenopathy although without suspicious morphology. These are nonspecific and may be reactive in etiology.2. Nonspecific left central thyroid irregular enhancement. |
Generate impression based on findings. | 65-year-old female with right rib pain status post fall yesterday. Three views of the ribs do not demonstrate fracture or malalignment. Please refer to accompanying chest radiograph for detailed description of intrathoracic findings. Moderate to severe degenerative disease of the right shoulder; questionable fracture of the humeral head, for which dedicated right shoulder radiographs are recommended. | No evidence of rib fracture. Questionable fracture of the humeral head, for which dedicated right shoulder radiographs are recommended. |
Generate impression based on findings. | 88 year old female with a history of left lumpectomy for breast cancer followed by radiation treatment. The patient does not recall the time of her treatment. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Left breast is smaller in size than the right breast, unchanged. Surgical clips with a focal asymmetry at posterior lower inner quadrant of left breast are unchanged. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 39 year-old female with right ankle pain. Three views of the right ankle demonstrate normal alignment without acute fracture. A normal variant os trigonum is present posterior to the talus. There is mild soft tissue swelling. | No acute fracture or malalignment. |
Generate impression based on findings. | Female 73 years old Reason: 73yo w/ h/o breast CA s/p chemo/XRT. progressive decreased PO intake, FTT. Assess for pathology History: decreased PO intake. Limited single contrast evaluation of the esophagus demonstrated no fixed narrowing to suggest stenosis, or intraluminal filling defects to suggest mass lesion. Motility was not able to be assessed secondary to patient's inability to tolerate the prone position.Limited views of the stomach and duodenum showed normal anatomic configuration. Contrast progressed promptly from the stomach into the duodenal sweep and proximal jejunum. No fixed narrowing to suggest stenosis, or intraluminal filling defects to suggest mass lesion were seen on the limted AP images.During the examination, while the patient was in a supine position, with the bed at approximately 45 degrees, the patient collapsed and slid down the table, without falling off. The patient was promptly repositioned and endorsed mild tenderness below her knees. This was documented in the form of an incident report and scanned into PACS. Fluoroscopy time: 2:19 minutes | Limited evaluation, no evidence of stricturing. |
Generate impression based on findings. | 63-year-old male with history of tonsillar and supraglottic squamous cell carcinoma. CHEST:LUNGS AND PLEURA: Streaky left upper lobe opacities are likely post infectious or related to aspiration. Scattered nonspecific pulmonary micronodules. Right basilar pleural thickening and upper lobe opacities are no longer visualized.MEDIASTINUM AND HILA: Right chest port with tip in SVC. Heart size normal without pericardial effusion. Severe coronary artery calcifications. No significant mediastinal lymphadenopathy.CHEST WALL: Multiple healed rib fractures are noted. No evidence of axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is unchanged pneumobilia, intra-and extra hepatic biliary ductal dilatation with air-fluid levels present within the common bile duct which is likely postoperative in etiology and chronic. Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities are unchanged and likely benign.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered atherosclerotic calcifications of the abdominal aorta and its branches. No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.A G-tube is present within the stomach.BONES, SOFT TISSUES: There is deformities of the lower lumbar spine and abnormal bridging between the right L4 spinous process and right iliac wing, likely post traumatic. Small fat containing right lumbar hernia.OTHER: No significant abnormality noted. | 1. Streaky left upper lobe opacities are likely post infectious or related to aspiration given their morphology and chronology. Continued follow-up is recommended.2. Unchanged pneumobilia and biliary ductal dilation, presumably postoperative in etiology.3. No convincing evidence of metastatic disease. |
Generate impression based on findings. | Male; 65 years old. Reason: 65M w lymphoma, sepsis unknown source eval for abscess/source, History: ventilatory support, transaminitis, abd distension, known c. diff ABDOMEN:LUNG BASES: Mild to moderate bibasilar atelectasis/consolidation, for which underlying infection cannot be excluded. Small to moderate predominantly anterobasal left pneumothorax. Central venous catheter tips in the SVC.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Diffuse hypoattenuation of the spleen, most compatible with ischemia or infarct.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: New mild, ill-defined but somewhat wedge-shaped areas of hypoattenuation in both kidneys, suggesting infarcts (e.g. series 3/images 74, 92, and 93). Stable small left renal cyst.RETROPERITONEUM, LYMPH NODES: New marked attenuation of the distal celiac trunk and proximal splenic and main hepatic arteries, which could be due to thrombus versus severe vasospasm (series 3/68).BOWEL, MESENTERY: NG tube tip in stomach. Moderate diffuse wall thickening of small and large bowel, most likely related to ischemia. No pneumatosis, portal venous gas, or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air within decompressed bladder due to Foley catheter being in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate diffuse wall thickening of small and large bowel, most likely related to ischemia. No pneumatosis, portal venous gas, or free air. Rectal tube in place.BONES, SOFT TISSUES: Small fat-containing left inguinal hernia.OTHER: Mild ascites. | 1. Bibasilar atelectasis/consolidation, for which underlying infection cannot be excluded.2. Small to moderate left pneumothorax.3. New marked attenuation of the celiac trunk and proximal splenic and hepatic arteries, which may be due to thrombus versus severe vasospasm.4. Diffuse splenic ischemia versus infarct.5. Findings suggestive of small bilateral renal infarcts.6. Diffuse bowel wall thickening, likely due to ischemia. No pneumatosis.7. Mild abdominopelvic ascites, but no evidence of abscess.Findings discussed with physician caring for the patient (pager 7863) at 3:45 p.m. on 3/13/15. |
Generate impression based on findings. | Shoulder pain. Three views of the right shoulder reveal no acute fracture or dislocation. The acromiohumeral distance is decreased. There is mild osteophyte formation at the acromioclavicular joint. There is a downsloping acromion. | 1. Mild AC joint osteoarthritis.2. Decreased acromiohumeral distance is suggestive of a rotator cuff injury. |
Generate impression based on findings. | 79-year-old male with cirrhosis status post pericardial stripping for restrictive pericarditis. Evaluate portal, hepatic vein and TIPS flow. LIMITED EXAM DUE TO PATIENT BODY HABITUS AND OVERLYING CHEST TUBES AND BANDAGES. LIMITED ABDOMENLIVER: Cirrhotic liver morphology with atrophy of the right hepatic lobe measuring 10.5 cm in length. Liver is coarsely echogenic.BILIARY TRACT: Normal echogenicity of the gallbladder. Focal hypoechoic lobulation adjacent to the gallbladder, and mass can't be excluded. No pericholecystic fluid. No gallbladder wall thickening. No evidence of intra or extrahepatic biliary ductal dilatation. PANCREAS: Visualized portions of the pancreas are normal in echogenicity with no evidence of pancreatic ductal dilatation. SPLEEN: Not well assessed measuring 13.6 cm in length. RIGHT KIDNEY: Not well assessed due to overlying bandages and chest tubes. OTHER: Left kidney not well assessed due to overlying bandages and chest tubes. Moderate ascites. | 1. No evidence of TIPS stenosis, however flow is pulsatile. 2. Left portal vein flow is not well assessed due to limitations of the study as noted. 3. Unable to visualize the right hepatic vein however the left and middle hepatic veins are patent with appropriate directional flow. 4. Focal round hypoechoic region adjacent to the gallbladder is nonspecific, cannot completely exclude a mass. If the patient's renal function is adequate, dedicated hepatic CT recommended.5. Cirrhotic liver morphology. Moderate ascites. |
Generate impression based on findings. | Female 52 years old Reason: 52 y.o. w/h/o crohns colitis s/p total proctocolectomy in 2013 with non-healing perinal wound. CT did not show fisutula, but continues to have drainage from external opening. Please perform fistulogram to find true tract. History: discharge from perineal wound, ? fistula Following administration of Omnipaque 350 via a 6-French Foley catheter inserted into the patient's perineal sinus tract, there was prompt opacification of an approximately 7.5 x 1.0 cm tract extending posterosuperiorly. There was no evidence of communication with adjacent bowel to suggest fistula formation. | Sinus tract arising from the perineum without evidence of fistulization as detailed above. |
Generate impression based on findings. | Male 85 years old Reason: evaluate for mets, prostate cancer History: weight loss No abnormal osseous foci are identified to indicate metastatic disease. Full urinary bladder noted, patient was unable to void. | No evidence of bone metastases. |
Generate impression based on findings. | Reason: evaluate for intracranial stenosis MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. No aneurysms are appreciated.There is opacification of the entire left internal artery which changes caliber at the level of the posterior communicating artery due to posterior communicating artery collateral supply. There appears to be a high grade stenosis at the opthalmic segment.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right posterior communicating artery is tiny. The anterior communicating artery is medium-sized. The left A1 segment is not readily identified. There is some supply to lenticulostriate originating from the left A1/A2 junction which receives supply from the right anterior circulation.The right vertebral artery is slightly larger than the left vertebral artery.MRA neck: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. There is high-grade stenosis present at the left internal carotid artery origin with associated string sign which would effectively represent a 99% stenosis by NASCET criteria. It is not clear whether the string sign is due to distal ICA or proximal ICA stenosis or both based on this exam, however, the general morphology suggests distal stenosis. There is opacification of the entire left internal carotid artery which changes caliber at the level of the posterior communicating artery due to posterior communicating artery collateral supply.On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries. | 1.There is a left internal carotid artery string sign present with left internal carotid artery stenosis. It is suspected that there are tandem stenosis, however, the more significant stenosis is not readily identified. The left middle cerebral artery territory is supplied from via the posterior communicating artery. The left anterior cerebral artery territory is supplied via the anterior communicating artery. 2.The left A1 segment is not readily identified. |
Generate impression based on findings. | Male, 63 years old, history of HPV-negative T4N2b Lt oropharynx SCC and T1 concurrent laryngeal SCC. Presumed treatment related findings are seen in the neck including infiltration of the subcutaneous fat and fascial planes as well as hyperemia of the submandibular glands.The nasopharyngeal mucosa is edematous but without evidence of any discrete or measurable tumor. Thickening and ill-defined enhancement within the left oro-pharyngeal mucosal space, although still improved relative to the examination of 8/5/14, has become more prominent when compared to the immediate prior examination of 10/29/14 (see image 32 series 6). Within this tissue, a region of hypoattenuation, perhaps representing necrosis, has increased in size as well. The supraglottic larynx is edematous and diffusely hyperemic likely related to therapy. Mild asymmetric enhancement is seen along the left aryepiglottic fold, and along the hypopharyngeal mucosa on the right (see image 54 series 6).No pathologic adenopathy is detected in the neck by size criteria. A previously referenced left level 2 node cannot be accurately distinguished from the surrounding inflamed tissue.The left internal jugular vein is newly thrombosed from the level of C2 through C3. A right IJ central venous catheter is in place. Cervical vessels otherwise enhance normally.No focal lesions are seen in the salivary glands or thyroid. Lung apices are unremarkable allowing for mild scarring. No concerning or frankly destructive osseous lesions are seen. Multilevel cervical spondylosis is demonstrated, and most severely of fracture dating C5-6 and C6-7 where there are disk osteophyte complex ease and mild to moderate spinal canal stenosis. | 1.Interval increased prominence of thickened enhancing tissue is seen within the left oropharyngeal mucosal space. A region of hypoenhancement internally, which may represent necrosis, has also become larger. The nature of this change is uncertain and, while it could to some degree represent a reaction to therapy, the possibility of progressive disease cannot be excluded.2.Treatment related edema is seen within the supraglottic larynx. Mild asymmetric enhancement of the left aryepiglottic fold and the right aspect of the hypopharyngeal mucosa is of uncertain significance. Continued follow-up is advised.3.No pathologic adenopathy is detected in the neck by size criteria.4.New thrombosis of the left internal jugular vein over a segment spanning C2 and C3. |
Generate impression based on findings. | 49-year-old female patient with abdominal pain and vomiting. Evaluate for intra-abdominal infection. ABDOMEN:LUNG BASES: Again seen are scattered parenchymal cystic changes in the lung bases.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 bilateral native kidneys.Right lower quadrant fossa transplant kidney with no evidence of mass lesion or hydronephrosis. Nephrogram appears within normal limits. Mild adjacent inflammatory changes without loculated fluid collection.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes affect the abdominal aorta and its branches.BOWEL, MESENTERY: Small hiatal hernia. Small amount contrast is seen in the stomach as well as the cecum. No evidence of bowel obstruction. Colonic diverticulosis without CT evidence of diverticulitis.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No acute intra-abdominal abnormalities to account for patient's symptoms.2.Right iliac fossa renal transplant without acute abnormalities. |
Generate impression based on findings. | 60 year-old male with history of head and neck cancer. CHEST:LUNGS AND PLEURA: Fillings defects are present in the right middle and lower lobar pulmonary arteries compatible with acute pulmonary emboli. No evidence of right heart strain. Scattered pulmonary micronodules are present. No suspicious lesions identified. Mild biapical scarring.MEDIASTINUM AND HILA: Right chest port with tip at the cavoatrial junction. There is eccentric mural thrombosis about the left common carotid artery at its origin. The heart size is normal. There is a small pericardial effusion. No mediastinal lymphadenopathy. Thrombus is no longer visualized in the left atrial appendage. Moderate coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable appearing benign hepatic lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal hypodensities, likely cysts.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.A G-tube is present within the stomach.BONES, SOFT TISSUES: Mild multilevel degenerative changes.OTHER: No significant abnormality noted. | 1. Right middle and lower lobar acute pulmonary emboli.2. No evidence of metastatic disease.3. Left atrial appendage thrombosis is no longer visualized.Findings discussed with Kimberly Salminen on 3/13/15 at 1700. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with moderate global volume loss much greater than expected for patient's stated age. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is an 11-mm enlarged right node of Rouviere which is partially visualized, which may be reactive. There is scattered trace mucosal thickening in the ethmoid air cells and. There is a mucosal retention cyst in the left maxillary sinus. Left sphenoid again demonstrates a nonenhancing T2 hyperintense and T1 hypointense irregularly-shaped lesion. There again is nonaggressive in appearance with unchanged differential. | No acute intracranial abnormality. |
Generate impression based on findings. | Reason: head and neck cancer/ screening for protocol History: see above CHEST:LUNGS AND PLEURA: Mild volume loss in the left lower lobe with dependent atelectasis.No suspicious nodules.MEDIASTINUM AND HILA: Calcified lymph nodes compatible with previous infection.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: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant abnormalities. |
Generate impression based on findings. | Female, 49 years old, history of left retromolar trigone cancer; pT3N0 SCC of the soft palate s/p palatectomy and left maxillectomy by Dr. Portugal (2/20/2015) with positive margin of the mass, and left lymph node dissection which was negative; chemoradiation not started yet. Brain: No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal or calvarial metastatic disease. Neck: Exam is limited by streak artifact from dental fillings. Interval postsurgical changes of the palatectomy and left maxillectomy. There is nonspecific heterogeneous enhancing soft tissue filling the left maxillary osseous defect with mild effacement of the left retromaxillary fat plane, measuring 1.8 x 1.1 cm (coronal image 52). Nonspecific enhancing tissue in the left inferior meatus which silhouettes the left inferior turbinate. There is increased left maxillary sinus mucosal thickening without enhancement. The fat along the left mandibular foramen is not as well seen compared to prior study, although is noted to be relatively diminutive bilaterally; continued attention on subsequent imaging. Previously mentioned soft tissue thickening along the left buccal space is difficult to assess due to streak artifact.There are now multiple necrotic left level IB lymph nodes in almost a nodal conglomerate, largest measuring 1.1-cm in the short axis (series 9 image 14, previously 0.8-cm) and 0.9 cm in the short axis (series 9 image 16, previously 0.6-cm). Nonspecific enhancement and effacement of the fat plane along the left cervical vessels, likely post neck dissection sequela.Major cervical vessels are grossly patent. Mild degenerative changes of the lower cervical spine. Lung apices are clear. | 1.Nonspecific heterogeneous enhancing soft tissue at the surgical bed, with may be postoperative. Also enhancing tissue along left inferior meatus, which could be correlated with direct inspection. Continued follow-up is recommended.2.Multiple necrotic left level 1B lymph nodes, new from prior study.3.Expected interval postoperative changes.4.No evidence of intracranial or calvarial metastasis. |
Generate impression based on findings. | 37-year-old male patient with recent travel abroad present to new left lower abdominal pain that radiates centrally. Abdominal pain is associated with eating. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Multiple punctate hypodensities in the liver parenchyma adjacent characterize and likely represent cysts. No CT evidence of cholelithiasis or cholecystitis.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No intra-abdominal abnormalities to account for patient's symptoms. |
Generate impression based on findings. | Reason: hx of lung nodule seen on CXR, please evaluate, hx of bladder cancer History: see above LUNGS AND PLEURA: Interval resection of a left upper lobe nodule with residual postsurgical scarring.Small residual left pleural effusion.No suspicious nodules.MEDIASTINUM AND HILA: Asymmetric thyroid enlargement.No significant lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. | Postsurgical findings the left hemithorax with small residual pleural effusion. No sign of recurrent tumor. |
Generate impression based on findings. | Status post MVC. Question of dynamic subluxation. Flexion and extension imaging of the cervical spine reveals no atlantoaxial instability. No acute fracture is evident. Vertebral body heights are maintained. | No acute fracture or instability is identified. |
Generate impression based on findings. | Male, 17 months old. Concern for non accidental trauma, eval for corner fracture VIEWS: Right wrist PA, lateral, oblique (3 views) 3/13/2015, 1602 Corner fracture of the distal radius, best seen on the lateral view involving the anterior and posterior aspects of the bone.No additional fractures or dislocations identified. | Corner fracture of the distal radius as detailed above. |
Generate impression based on findings. | 15-year-old male with injury and point tenderness to midshaft of ulnaVIEWS: Left forearm; AP and lateral. Left elbow; AP, oblique, lateral (5 views) 3/13/15 Left Forearm: No fracture or malalignment. No significant soft tissue swelling.Left elbow: No fracture or malalignment. No significant soft tissue swelling or joint effusion. There is a bone island in the lateral condyle of the humerus. | No fracture or malalignment. |
Generate impression based on findings. | Male; 52 years old. Reason: Pt s/p kidney transplant now s/p transplant nephrectomy. Now with PTLD. Evaluate for any metastatic disease History: as above Motion artifact mildly limits examination. The lack of oral contrast limits sensitivity for bowel pathology.CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Mediastinal lymphadenopathy in the left paratracheal space. For future reference, a left paratracheal lymph node measures 18 x 14 mm (3/24).Retrocrural lymphadenopathy, grossly stable since 2/24/15. For future reference, a retrocrural lymph node measures 25 x 19 mm (series 3/97) (remeasured on the current contrast enhanced examination).CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly, similar to prior study.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable mild right adrenal thickening.KIDNEYS, URETERS: Postsurgical changes from right iliac fossa surgery with fluid, hemorrhage, and air within the surgical bed. Right pelvic surgical drain in place. Stable appearance of bilateral atrophic native kidneys with multiple small hypoattenuating lesions.RETROPERITONEUM, LYMPH NODES: BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Right iliac lymphadenopathy, grossly stable since prior study. For future reference, a right iliac lymph node measures 24 x 19 mm (series 3/159).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild pelvic ascites, likely postsurgical. | 1. Mediastinal, retrocrural, and right iliac lymphadenopathy, suspicious for PTLD.2. Postsurgical changes in right iliac fossa. |
Generate impression based on findings. | 30 year old female with right heart failure, liver failure LIMITED ABDOMENLIVER: Normal echogenicity of the liver measuring 20.7 cm in length. No focal hepatic lesions. BILIARY TRACT: Status post cholecystectomy. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity. SPLEEN: Status post splenectomy. RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 14.3 cm in length. No hydronephrosis or shadowing calculi are noted. OTHER: Left kidney not well assessed however measuring 12.8 cm in length and is increased in echogenicity with no definite hydronephrosis or shadowing calculi. | 1. Patent hepatic inflow and outflow vasculature with no evidence of thrombus. 2. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction.3. Hepatomegaly. |
Generate impression based on findings. | Patient status post fall Persistent mild and more moderate fifth and sixth thoracic vertebral compression fractures similar to 2013. Overall alignment and remaining vertebral body heights are otherwise preserved. Mild to moderate degenerative changes involving the lower levels also similar. | Unchanged T5 and T6 compression fractures |
Generate impression based on findings. | Left wrist: Pain with palpation and rotation. Pain in the ulnar aspect of the wrist. Evaluate for fracture. Sacrum/coccyx: Pain after collision with car, thrown about 3-5 feet. Evaluate for fracture. Left hip: Pain. Left hand: Pain at the base of the fifth metacarpal bone. Evaluate for fracture of the fifth digit. Three views of the left hand show no acute fracture or malalignment.Three views of the left wrist reveal no acute fracture or malalignment.Two views of the sacrum/coccyx reveals no acute fracture.Two views of the left hip reveals no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | Female 43 years old Reason: evaluate for kidney stones History: flank pain, passing stones ABDOMEN: Exam is limited secondary to lack of intravenous and oral contrast. Lack of intravenous contrast makes evaluation of solid organ and vascular pathology suboptimal. Lack of oral contrast makes evaluation of pathology suboptimal. Within these limitations, these observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild right pyelocaliectasis is unchanged. No left hydronephrosis. No definitive obstructing calculus. Nonobstructing renal stones bilaterally with the largest in the left kidney measuring up to 6 mm as noted previously. Chronic cortical scarring of the left kidney.RETROPERITONEUM, LYMPH NODES: IVC filter is unchanged. The inferior vena cava below the level of the filter is markedly atretic. This finding in conjunction with the numerous subcutaneous collateral vessels indicates chronic caval occlusion.BOWEL, MESENTERY: Tubular structures lateral to the right kidney which likely represent varices are also stable. BONES, SOFT TISSUES: Subcutaneous varices in the right abdomen as noted previously.OTHER: No significant abnormality notedPELVIS: UTERUS, ADNEXA: Enlarged uterus which may be secondary to fibroids. BLADDER: No significant abnormality notedBONES, SOFT TISSUES: Surgical fixation hardware/metallic screws. Numerous pelvic calcifications (all measuring less than 5 mm in diameter) thought to represent phleboliths appear relatively stable but given the multiplicity of these, a tiny ureteral calculus remains a possibility. | No substantial interval change. Bilateral renal calculi. Mild right pelvocaliectasis. Probable infrarenal chronic caval occlusion. |
Generate impression based on findings. | Hemoptysis, cough and COPD. History of latent TB per electronic record.. LUNGS AND PLEURA: Severe emphysema. Suture line from wedge biopsy at the right apex. Debris in the trachea and mainstem bronchi. Lateral intercostal herniation involving the periphery of the right upper lobe between the right ribs 5 and 6 laterally unchanged. New calcified well circumscribed nodules (right upper lobe 5/33, right middle lobe 5/57 for example). Though these are statistically most likely benign granulomas, given the absence of granulomas elsewhere such as in the spleen, additional considerations may include lesions of thyroid, prostate or sarcomatous origin, though these are considered much less likely than granulomatous.MEDIASTINUM AND HILA: Mild coronary artery calcifications. Normal heart size. No pericardial fluid. No lymphadenopathy. Abundant mediastinal fat in the posterior compartment noted, unchanged.CHEST WALL: T7 compression fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Probable peripelvic cyst left kidney, incompletely assessed. | No findings to account for the patient's source of hemoptysis. Emphysema. Two new calcified micronodules in the right lung statistically most likely represent healed granulomas in the absence of known neoplasm. |
Generate impression based on findings. | Shoulder pain. Interval continued healing of the humeral neck fracture with gross anatomic preservation of alignment and interval increasing callus formation. The fracture line is less distinct. There is downward displacement of the humeral head. | Healing right humeral neck fracture. |
Generate impression based on findings. | Male, 60 years old, with nasopharyngeal carcinoma, base nasopharyngeal carcinoma. Baseline images prior to starting systemic therapy. Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. A mucus retention cyst in the left maxillary sinus is unchanged. Opacification of the left mastoid air cells and middle ear cavity has progressed.Neck:Nasopharyngeal mucosal tissue loss is seen which likely reflects interval surgery. There remains nonspecific hypoattenuation with marginal enhancement extending through the left nasopharynx to the level of the carotid canal, of uncertain significance. Apart from this, no definite measurable tumor is seen. The clivus subjacent to the resection bed shows a slightly permeated appearance. Also noted is new permeation and fragmentation of the anterior arch of C1 and the odontoid process (image 21 series 8).Images through the remainder of the neck are at least moderately degraded by motion artifact. Within this limitation, no large masses are observed. No pathologic adenopathy is detected by size criteria.The salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally, where not obscured by motion artifact. Biapical lung scarring is unchanged. Except as above, no additional destructive osseous lesions are noted. | 1.Findings are seen related to presumed interval resection of a nasopharyngeal tumor. There is mucosal tissue loss at this location. The left residual nasopharynx is hypoattenuating with some marginal enhancement which could be entirely post-treatment in nature, but continued observation is recommended.2.The clivus subjacent to the resection bed is irregular and slightly permeated, but the significance of this is uncertain and it may be related to surgery.3.New fragmentation and a permeative texture of the anterior arch of C1 and the odontoid process are seen. Findings could reflect neoplastic involvement or perhaps radiation osteonecrosis. These findings were discussed with Dr. Lim-Siewert at 5:20 p.m. on 3/13/15.4.Fairly limited examination of the remainder of the mucosal spaces due to motion artifact, however no large masses are suspected. No pathologic adenopathy is detected in the neck by size criteria. |
Generate impression based on findings. | Intraparenchymal hemorrhage. There is redemonstration of a large intraparenchymal hematoma in the left insula and frontal parietal operculum, without significant interval change when allowing for differences in slice selection and angulation. Again measures 3.8-cm transverse by 5.0-cm AP by 2.9 cm CC, unchanged from remeasurement. Again noted is a hematocrit effect. There is mild surrounding hypodense vasogenic edema and mass effect with partial effacement of the left lateral ventricle, similar to prior. There is minimal rightward midline shift.There are a few small lucencies within the left frontal and parietal bones, some of which represent arachnoid granulations. In addition, there is a small partially lytic lesion in the right paramedian parietal calvarium with an extra-axial calcified component. The ventricles and sulci are stable. There is no new intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No significant interval change in large left frontal parenchymal hematoma with localized mass effect and minimal midline shift. |
Generate impression based on findings. | Rib/shoulder pain status post fall. There is increased density extending from the medial humeral head to the groove of the biceps tendon along with discontinuity of the cortex along the lateral border and slight cortical offset.Additionally, there is a defect of the inner humeral head with a fragmented component; this appears more chronic and could be related to avascular necrosis. | Subtle discontinuity and cortical offset of the humeral head with abnormal density is concerning for an acute fracture. Additional inner humeral head defect is also abnormal though may be more chronic in etiology, possibly due to AVN. Given findings, CT of the shoulder may be considered for further evaluation. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal mucosal thickening in a right anterior ethmoid air cell. The remaining imaged paranasal sinuses and mastoid air cells are clear. There is mild soft tissue thickening of the subgaleal left parietal scalp. The skull is intact. | Mild left parietal subgaleal scalp hematoma without skull fracture or intracranial hemorrhage.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | The sagittal reformatted images demonstrate mildly exaggerated lordosis. There is 2 mm retrolisthesis of C3 on C4, C4 on C5, and C5 on C6. The vertebral body heights are well-maintained. There is loss of disk height at C3-4 through C5-6 levels. There is a tiny osseous fragment anterior/inferior to the C6 vertebral body with well-corticated margins, probably representing sequela of old injury versus normal variant limbus vertebra. There is near complete osseous fusion of the left C2-3 facet joint.There is no acute fracture.There is mild asymmetry of C1 and C2, likely positional.There is a small disk osteophyte complex at C5-6 abutting the right ventral aspect of the thecal sac. There is moderate stenosis of the right C4-5 and left C5-6 neural foramina. The visualized intracranial structures and lung apices appear normal. There is a mildly air distended thoracic esophagus partly imaged. | Multilevel cervical spondylosis without significant spinal canal stenosis and variable neural foraminal stenoses as described above. |
Generate impression based on findings. | There is minimal right maxillary sinus mucosal thickening with periapical lucency surrounding a right maxillary molar tooth again seen. Multiple other dental caries and periapical lucencies of the mandibular and maxillary teeth are similar to prior study. Due to increased field of view, there is now visualization of contiguity of the abnormal is surrounding the right mandibular molar with the mandibular canal is seen on 80644/73. There is minimal posterior ethmoid sinus mucosal thickening as well. The remaining paranasal sinuses are clear. The sphenoethmoidal and ostiomeatal units are clear. There is mild mucosal thickening along the infundibula. The lamina papyracea and ethmoid roofs are symmetric and intact. There is minimal leftward nasal deviation with tiny osseous septal spur on the left. There are bilateral middle turbinate concha bullosa with the mucosal retention cyst on the right.Soft tissue attenuation in the external auditory canals likely represents cerumen. There is scattered right mastoid opacification. Cervical spondylotic changes are noted. | 1.Minimal right maxillary sinus mucosal thickening with adjacent stable right maxillary molar periapical lucency.2.Extensive dental disease again seen. Dental exam correlation is suggested, if not already obtained. Please note that due to increased field of view on the current exam, there is contiguity of periapical lucency with the superior margin of the right mandibular canal, and correlation with physical exam is recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is an unchanged right transfrontal ventricular shunt catheter terminating in the right frontal horn. The lateral and third ventricular caliber is mildly smaller. There is persistent asymmetry with smaller right lateral ventricle as compared to the left.There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is no midline shift or herniation. There is mild bilateral maxillary sinus mucosal thickening. The skull and extracranial soft tissues are unremarkable. | Unchanged right transfrontal ventricular shunt catheter terminating in the right frontal horn with mildly smaller lateral and third ventricular caliber. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild maxillary and ethmoid sinus mucosal thickening, as well as minimal right mastoid opacification. The skull and extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is a stable 5-mm ovoid fatty attenuation likely representing a xanthogranuloma of the choroid plexus in the left occipital horn on series 5 image 16. The ventricles and basal cisterns are normal in size and unchanged. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is disconjugate gaze again seen. | No acute intracranial hemorrhage or mass effect. No evidence of disproportionate ventricular dilatation. |
Generate impression based on findings. | History of brain surgery as child for tumor, now breast cancer, +headache. There is a subcentimeter focus of hyperattenuation in the anterior left pontomedullary junction. There is a cystic area that measures up to approximate 4 cm in the left parietal lobe that appears to communicate with the left lateral ventricle and associated with region cerebral volume loss. There is thinning of the overlying calvarium. There is a small hypoattenuating defect anterior to this lesion, which may represent cystic encephalomalacia. The ventricles are otherwise normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is a right maxillary sinus retention cyst. | 1. Nonspecific subcentimeter focus of hyperattenuation in the anterior left pontomedullary junction. Differential considerations include acute hemorrhage, cavernous malformation, or neoplasm, for example. A brain MRI without and with contrast would be useful for further characterization.2. A cystic area that measures up to approximate 4 cm in the left parietal lobe that appears to communicate with the left lateral ventricle and associated with region cerebral volume loss likely represents a porencephalic cyst. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is diffuse volume loss with unchanged prominent ventricular system and marked nonspecific periventricular and subcortical white matter hypoattenuation. There is a stable small right cerebellar hemispheric lacunar infarct. There is no midline shift or herniation. There is a partial empty sella of incidental note. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No significant change in marked age-indeterminate small vessel ischemic changes without acute intracranial hemorrhage. CT is insensitive for detection of early nonhemorrhagic stroke. |
Generate impression based on findings. | There is no suspicious intracranial enhancement, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses are clear. There is minimal scattered bilateral mastoid air cell opacification. The skull and extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage. CT is insensitive for detection of early nonhemorrhagic stroke and metastatic disease. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is minimal nonspecific periventricular white matter hypoattenuation, likely age indeterminate small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is bilateral temporomandibular joint degenerative disease. | Minimal small vessel ischemic changes without acute intracranial hemorrhage or mass effect. CT is insensitive for detection of early nonhemorrhagic stroke. |
Generate impression based on findings. | Low back pain, history of psoriasis, evaluate signal in the joints. The margins of the sacroiliac joints are well-defined. There is sclerosis along the iliac margin of the right SI joint, which could conceivably represent the sequela of prior sacroiliitis or be degenerative in etiology. Alternatively, this may reflect Paget's disease of the right innominate bone, as the cortex and trabecula of the right innominate bone appear slightly pronounced relative to the left innominate bone. Severe degenerative disk disease affects the visualized lower lumbar spine. | Sclerosis along the iliac margin of the right sacroiliac joint may reflect sequela of prior sacroiliitis or be degenerative in etiology or perhaps reflect Paget's disease. Currently, the SI joint margins are well defined. Degenerative disk disease affects the lower lumbar spine. |
Generate impression based on findings. | Finger trauma and cellulitis (left first finger). Fracture? Evaluation of fine detail is slightly limited by overlying bandage. There is diffuse soft tissue swelling. Irregularity of the soft tissues dorsal to the middle phalanx may represent ulceration. I see no fracture. There is a boutonniere deformity of the finger which can be seen in patients with central slip extensor tendon injuries. Mild osteoarthritis affects the interphalangeal joints. | Soft tissue swelling, boutonniere deformity, and other findings as described above; I see no fracture. |
Generate impression based on findings. | Patient with trauma to left medial ankle. Check for fracture. There is diffuse soft tissue swelling, but I see no underlying acute fracture. Mild osteoarthritis affects the ankle joint. There is thickening and ossification of the distal Achilles' tendon indicating chronic tendinopathy that appears to have progressed slightly when compared with the prior study. | Soft tissue swelling and degenerative changes as described above without fracture evident. |
Generate impression based on findings. | No history of trauma. Pain at fifth metatarsal with walking. Tender to palpation here. Rule out fracture of fifth metatarsal or other lateral tarsal metatarsal issue. I see no fracture or other specific findings to account for the patient's fifth metatarsal pain. There is mild deformity of the fourth metatarsal head which may reflect old trauma or simply osteoarthritic changes. There is suggestion of a cavus deformity of the foot, although this would be better assessed with weight-bearing views if clinically warranted. Small metallic densities in the medial soft tissues of the ankle presumably represent surgical clips. | No specific findings to account for the patient's fifth metatarsal pain. Other findings as above. |
Generate impression based on findings. | Pain in right knee, fall, evaluate for fracture. I see no fracture. Moderate to severe osteoarthritis affects the knee. An ossicle along the superolateral margin of the patella likely represents a normal variant bipartite patella or less likely a loose body in the joint. There is a small joint effusion. Arterial calcifications are noted posteriorly. | Osteoarthritis and other findings as above without fracture evident. |
Generate impression based on findings. | Fell off last two stairs 36 hours ago. Generalized pain from his knee down to his foot. Evaluate for an acute process. Three views of the left ankle reveal an approximately 1 cm triangular density lateral to the body of the talus and anterior/inferior to the fibular tip which likely represents an avulsion fracture. We see no definite donor site and this may arise from the lateral process of the talus or the distal fibula. There is overlying soft tissue swelling. There is bone formation along the lateral aspect of the distal fibular tip which may reflect old trauma.Two additional views of the left tibia/fibula and three views of the left foot show intact bones of the tibia, proximal fibula, midfoot, and forefoot. | Findings compatible with a lateral ankle avulsion fracture as described above. Further evaluation with CT may be considered if clinically warranted. |
Generate impression based on findings. | Status post fall on 3/12/2015. Evaluate for an acute process. Four views of the left knee show a small joint effusion and mild osteoarthritis of the knee, but we see no fracture. | Small joint effusion without fracture evident. |
Generate impression based on findings. | Pain and swelling to the middle finger. Patient states the swelling is due to her finger getting pulled. Three views of the left middle finger reveal soft tissue swelling about the base of the finger. No acute fracture is evident. | Soft tissue swelling but no acute fracture evident. |
Generate impression based on findings. | Pain. Question of humeral head fracture. There is flattening of the superior aspect of the humeral head and sclerosis of the medial aspect suspicious for avascular necrosis. We see no discrete fracture on this single view. There is mild osteophyte formation along the inferior glenoid. | Osteoarthritis and findings suspicious for AVN. We see no fracture on this single view. If further imaging is clinically warranted, CT or MRI may be considered. |
Generate impression based on findings. | Fell with injury to wrist. Pain and swelling. Three views of the left wrist show soft tissue swelling along the ulnar aspect of the wrist without acute fracture evident. Alignment is within normal limits. | Soft tissue swelling without acute fracture evident. |
Generate impression based on findings. | Generalize hip pain, started two days ago. Patient also fell, however hip pain started before. Evaluate for fracture. Two views of the right hip show no acute fracture. Mild osteoarthritis affects the hip. A sclerotic focus within the femoral neck presumably represents a benign bone island. | Mild osteoarthritis without fracture evident. |
Generate impression based on findings. | 14-year-old male with left shoulder pain, history of fall.VIEWS: Left clavicle: AP and axial; left shoulder: internal and external rotation. (Four views) 3/13/15 Step-off of the superior border of the lateral aspect of the clavicle likely represents an acute minimally displaced fracture. Apparent bridging across the fracture likely represents acutely displaced cortex. No other fractures are noted. No malalignment of the joints of the shoulder. | Acute minimally displaced left lateral clavicle fracture.These findings were discussed between the on call resident and ER physician at 1826 on 3/13/15. |
Generate impression based on findings. | Coronal T2 weighted images are limited by patient motion. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is slight pointing of the right cerebellar tonsil which extends 5 mm below the level of the foramen magnum, with moderate crowding. The midline structures and craniocervical junction are otherwise within normal limits. There is minimal mucosal thickening in the maxillary sinuses.CERVICAL SPINE | 1. Low-lying right cerebellar tonsil which is slightly pointed appearance, with moderate crowding of structures. Findings are suggestive of possible mild Chiari one malformation. Please correlate clinically. Otherwise, unremarkable noncontrast MRI brain.2. Motion limited MRI of the cervical spine with no evidence of cord abnormality. Mild spondylotic changes at C5-C6 as detailed above, resulting in mild central spinal canal stenosis and mild-moderate left foraminal narrowing.. |
Generate impression based on findings. | Leg pain. Patient with likely cellulitis, question of osteomyelitis. Two views of the right tibia and fibula show diffuse soft tissue swelling. There is chronic appearing periosteal reaction and endosteal scalloping involving the fibula of uncertain etiology and significance, but does not have the typical appearance of osteomyelitis. | Soft tissue swelling without specific radiographic evidence of osteomyelitis. If clinically warranted, further evaluation with MRI may be considered. |
Generate impression based on findings. | Plantar foot puncture wound, deep with concern for osteomyelitis. Foul smell and drainage. Three views of the right foot show mild soft tissue swelling and irregularity along the base of the forefoot which may represent the site of the puncture wound. We see no specific radiographic features of osteomyelitis. Plantar calcaneal spurs and small osteophytes are noted. | Soft tissue swelling without specific radiographic evidence of osteomyelitis. If clinically warranted, MRI may be considered for further evaluation. |
Generate impression based on findings. | 42 year-old female with history of shortness of breath, presyncope and elevated d-dimer. PULMONARY ARTERIES: Technically adequate study to the level of the segmental branches. No evidence of acute pulmonary embolus. Apparent filling defects in the left lower lobar arteries is likely the result of motion artifact from ventricular pulsation.LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. No significant coronary artery calcifications. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. | 1. No evidence of acute pulmonary embolus.2. Cholelithiasis.Findings discussed with Dr. Padela at 1100 on 3/14/15.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 5-year-old male with coughing and high feversVIEWS: Chest AP/lateral (two views) 3/13/15 at 5:25 p.m. The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. Mild bronchial wall thickening is compatible with reactive airway disease/bronchiolitis. No pneumonia. No pneumothorax or pleural effusion. | Bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | Female; 52 years old. Reason: Evaluate for tuboovarian abscess, other intraabdominal pathology/malignancy History: bloating, lower abdominal pain, cervical motion tenderness, fevers ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild dilation of the common bile duct measuring up to 8 mm with distal smooth tapering and no distal obstructing lesion evident. This is likely normal in this patient status post cholecystectomy.SPLEEN: Multiple small splenules.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The cecum is located to the left of the midline, likely due to partial malrotation. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Anteverted uterus. No adnexal masses evident.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 | No acute abdominopelvic abnormality evident. |
Generate impression based on findings. | Fell yesterday with pain to right hip joint. Question of fracture. Two views of the right hip show an intertrochanteric fracture with the fracture fragments in near anatomic alignment. Severe osteoarthritis affects the hip. | Intertrochanteric fracture. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. Right occipital lobe encephalomalacia, compatible with prior infarct. Generalized cerebral volume loss. Hypoattenuation of the periventricular and subcortical white matter, right greater than left, compatible with chronic small vessel ischemic disease. No evidence of hydrocephalus. Small mucous retention cyst in the left maxillary sinus. Otherwise paranasal sinuses and imaged mastoid cells are clear. The imaged portions of the orbits are intact. The osseous structures are unremarkable. | 1.No evidence for acute intracranial abnormality. CTs not sensitive for detection of acute nonhemorrhagic ischemia.2.Right occipital lobe encephalomalacia, compatible with prior infarct.3.Periventricular and subcortical white matter chronic small vessel ischemic disease. |
Generate impression based on findings. | 4-year-old female with cough and fever.VIEW: Chest AP (one view) 3/13/15 Interval removal left upper extremity PICC. The cardiothymic silhouette is normal. Surgical clips are noted in the upper abdomen. Overall low lung volumes. Mild peribronchial wall thickening is suggestive of bronchiolitis/reactive airway disease pattern. No pleural effusion or pneumothorax. No pulmonary opacity to suggest pneumonia. | Mild bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | 5-year-old male with VP shunt, vomiting, and headache.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 3/13/15 A right frontal ventriculostomy catheter is present with tip near the midline. The shunt exits via a burr hole and traverses the right occiput, right neck, anterior chest wall, anterior abdominal wall, and enters the abdomen, with tip in the posterior left midabdomen. The tip is in a different position than on the prior exam. No discontinuity or kinking is present. The strata valve is set at a performance level 1.5. No acute cardiopulmonary abnormality. Nonobstructive bowel gas pattern. | No extracranial VP shunt complications. |
Generate impression based on findings. | 53-year-old male with history of AML and fever. LUNGS AND PLEURA: Moderate centrilobular predominant emphysema and bronchial wall thickening. Diffuse and symmetric ground glass opacities, interlobular septal thickening, and septal lines most notably in the lower lobes, new from prior. Small bilateral pleural effusions. Calcified left lower lobe granuloma.MEDIASTINUM AND HILA: The heart size is normal with small pericardial effusion. Mild coronary artery calcifications. Central venous catheter with tip in the SVC. Mildly enlarged mediastinal lymph nodes.CHEST WALL: Degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Diffuse symmetric ground glass opacities, interlobular septal thickening and septal lines most notably in the lower lobes with small bilateral pleural effusions superimposed on moderate emphysema suggestive of pulmonary edema. Opportunistic infection is considered less likely.2. Small pericardial effusion. |
Generate impression based on findings. | Evaluation is limited due to lack of contrast. There is a prominent tubular soft tissue structure which extends from the upper esophagus to the left of midline anteriorly, to the skin surface, with a few foci of adjacent subcutaneous emphysema consistent with recent surgery. This is presumably the "spit fistula". An endotracheal tube is in place, with its tip above the level of carina. There is partial visualization of two right-sided chest tubes. There is no evidence of large air or fluid collection within the neck.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are grossly unremarkable. There is no abnormal soft tissue mass.GLANDS: The submandibular, sublingual, and parotid glands have an unremarkable noncontrast appearance. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified. There are partially visualized prominent mediastinal lymph nodes which are nonspecific but may be reactive. OTHER: There is a right-sided central venous catheter entering the right internal jugular vein, as well as a separate smaller caliber right subclavian vein catheter. Postoperative changes are seen from extensive sinus surgery, including bilateral antrostomies and middle turbinectomies. There is partial opacification of the sphenoid sinuses. There is moderate-severe fluid opacification of right mastoid air cells, although the right middle ear is clear. There is mild atherosclerotic calcification of the carotid bifurcations and along the aortic arch as well as origin of great vessels. There is prominent intracranial internal carotid artery calcifications. There multilevel cervical spondylotic changes which are moderate in degree. There is bilateral dependent atelectasis. | 1. Expected postoperative changes from spit fistula. No evidence of focal fluid collection or abscess, although evaluation is somewhat limited due to lack of contrast.2. Nonspecific moderate-severe fluid opacification of right mastoid air cells and partial opacification of sphenoid sinuses. Please correlate clinically. |
Generate impression based on findings. | 14-year-old male with history of gunshot wound.VIEWS: Left Tibia-fibula: AP and lateral; Left knee: AP and lateral; Left femur: AP and lateral (6 views) 3/13/15 Left Knee: An 11-mm bullet is present in the anterior soft tissues of the knee inferior to the patella. Subcutaneous gas and significant soft tissue swelling is present in the area. Cortical irregularity and discontinuity of the tibial tuberosity is concerning for fracture. Irregularity of the tibial tuberosity suggests there may be a fracture at the insertion of the patella tendon.Left femur: No femoral fracture is identified. The femoral head is well seated in the acetabulum.Left tibia-fibula: Cortical irregularity of the tibial tuberosity suggestive of fracture. | Bullet is present in the anterior soft tissues of the knee, inferior to the patella. Fracture of the tibial tuberosity. |
Generate impression based on findings. | 53-year-old male with history of hypoxia. Only limited views of the chest without contrast were obtained secondary to IV malfunction and hence this study is nondiagnostic. No evidence of acute abnormality on the limited views of the chest. | Non-diagnostic exam. |
Generate impression based on findings. | Male; 50 years old. Reason: evaluate for obstruction History: abdominal pain ABDOMEN:LUNG BASES: Mild bibasilar dependent subsegmental atelectasis. Stable right upper lobe nodule measuring 4 mm (series 4/6). Stable right lower lobe pleural-based nodule measuring 5 mm (series 4/14). Small cluster of micronodules in the right lower lobe are partially visualized and most likely postinfectious or inflammatory (series 4/1). LIVER, BILIARY TRACT: Mild pneumobilia. Common bile duct stent in place. No focal liver lesion. Main portal vein and branches are patent. Gallbladder is contracted.SPLEEN: No significant abnormality notedPANCREAS: Since prior MRI, there is new multiloculated fluid and fatty stranding anterior to the pancreatic body extending to the anterior peritoneum and superiorly around the gastric antrum. For future reference, a collection just anterior to the pancreas measures 2.4 x 2.5 cm on image 44, series 3, and a collection just superior to the gastric antrum measures 4.3 x 2.8 cm on image 28. The findings are most suspicious for acute pancreatitis with acute peripancreatic fluid collections. There is gastric antrum wall thickening, which is likely reactive. Another less likely consideration would be perforation of the gastric antrum given reported recent endoscopy, but there is no contrast leak or free air seen. As noted on prior MRI, there is no pancreatic stent visualized.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastric antrum wall thickening as noted above. Colonic diverticulosis.BONES, SOFT TISSUES: Small fat containing ventral wall hernia.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Stable prostatomegaly.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Findings most suspicious for acute pancreatitis with acute peripancreatic fluid collections. Gastric antrum wall thickening is likely reactive. Another less likely consideration would be gastric antral wall perforation given reported recent endoscopy, but there is no contrast leak or free air. Correlation with patient's clinical history/laboratory values recommended. |
Generate impression based on findings. | Chest pain, enteric tube placement Enteric tube seen extending below level of hemidiaphragms, tip located in gastric body. Incompletely imaged diffuse bowel gaseous distention, small and large bowel involved, findings may reflect ileus but distal colonic obstruction another differential constriction. Pelvis excluded from submitted image. | Enteric tube and incompletely imaged stable bowel gas pattern as above. |
Generate impression based on findings. | Abdominal pain, nausea, emesis, status post Roux-en-Y gastric bypass and now with obstructive symptoms Suboptimal exam due to patient motion artifact. Moderate to large amount of enteric contrast seen. Nonobstructive bowel gas pattern. Right upper quadrant surgical clips, compatible with prior cholecystectomy. | Nonobstructive bowel gas pattern. Please refer to recent CT imaging from 1 day prior for additional findings. |
Generate impression based on findings. | 59-year-old female with history of LVAD. Evaluate for pulmonary hemorrhage. LUNGS AND PLEURA: Diffuse ground glass and reticular opacities with associated interlobular septal thickening present in the middle and upper lobes bilaterally with relative sparing of the bases. No significant pleural effusions.MEDIASTINUM AND HILA: The heart size is markedly enlarged with LVAD present. There are extensive coronary artery calcifications and postsurgical changes from CABG and stent placement. There is no significant pericardial effusion. Moderate calcifications of the thoracic aorta.CHEST WALL: Left-sided AICD with leads in the expected location. Mild multilevel degenerative disease affects the thoracic spine. Post median sternotomy with incomplete fusion.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Extensive atherosclerotic calcifications of the abdominal aorta and its branches. Small narrow necked fat-containing ventral hernia with scattered hyperattenuating regions which may represent small areas of fat necrosis. | Diffuse ground glass and reticular opacities with associated interlobular septal thickening present in the middle and upper lobes bilaterally with relative sparing of the bases. No significant pleural effusions. This pattern is not typical of cardiogenic edema given its distribution and lack pleural effusions. Pulmonary hemorrhage and drug reaction are considered more likely, with infection being less likely. |
Generate impression based on findings. | 14-year-old male status post trauma with hematoma and tenderness to palpation of the lumbar spine.VIEWS: Lumbar spine: AP, lateral, L5-S1 lateral; Pelvis: AP; Chest AP (5 views) 3/13/15 at 10:20 p.m. Chest: The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No pneumonia. Irregularity of the left third rib represents a normal variant.Pelvis: No acute fracture or malalignment. The round smooth femoral heads are well directed into a well formed acetabulum.Lumbar spine: No acute fracture or malalignment. The vertebral heights and disk spaces are preserved. No spondylolysis or spondylolisthesis. | No fracture or malalignment. No acute cardiopulmonary abnormality. |
Generate impression based on findings. | No evidence of acute intracranial bleed. Generalized cerebral volume loss. Periventricular and subcortical white matter hypoattenuation compatible with age indeterminant small vessel ischemic disease. No evidence of mass, mass-effect, or hydrocephalus. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. | 1.No evidence for acute intracranial abnormality. 2.Periventricular and subcortical white matter age indeterminant small vessel ischemic disease. |
Generate impression based on findings. | There is redemonstration of focal T2 hyperintense signal within the cord at the T11-T12 level, consistent with probable syrinx. Additional ill-defined hyperintensity just cranial to this level at the T10 and T11 levels on sagittal STIR images is similar to that on the prior postoperative exam, without convincing correlative abnormality on prior axial imaging, and may be artifactual. The distal spinal cord and conus are otherwise within normal limits.There has been no significant interval change in complete effacement of the CSF throughout the thoracic thecal sac and perhaps slight increased visualization of ventral CSF space at the cervical thoracic junction. There remains extensive heterogeneous signal within the dorsal epidural fat at the operative levels of T3 through T8, likely representing postoperative fluid and/or blood products extending up to the C6-C7 level. There is focal T2 hypointense signal likely representing epidural blood products on the left at the C7-T1 level, unchanged.The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. | No evidence of cord compression. Essentially stable postoperative changes with continued complete effacement of the CSF space in the thecal sac along the thoracic spine with perhaps slight improved visualization of ventral CSF space at the cervical thoracic junction. |
Generate impression based on findings. | No evidence of acute intracranial hemorrhage. No evidence of mass, mass effect, or hydrocephalus. Mild patchy ethmoid air cell mucosal thickening. The imaged portions of the orbits are intact. The osseous structures are unremarkable. | No acute intracranial abnormality. |
Generate impression based on findings. | Right lower quadrant abdominal pain, assess for small bowel obstruction Mildly prominent bowel with air seen distally in portions of transverse and descending colon. No definitive evidence of bowel obstruction. Incompletely basilar atelectasis. | No definitive evidence of bowel obstruction. |
Generate impression based on findings. | 60-year-old female with history of altered mental status and weakness. Evaluate for malignancy. LUNGS AND PLEURA: Linear opacities in the right lower lobe likely represents scarring. Mild bibasilar subpleural atelectasis. No suspicious pulmonary nodules are identified.MEDIASTINUM AND HILA: A subcarinal mediastinal lymph node measures 16 mm (41/4). Other scattered enlarged mediastinal lymph nodes are noted. The heart size is normal. Bilateral prominent hilar lymph nodes. Small sliding hiatal hernia.There is a partially imaged large eccentric occlusive filling defect within the right internal jugular vein compatible with thrombus.CHEST WALL: Mild multilevel degenerative disease affects the thoracic spine. Small epidermal inclusion cyst in the left breast.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1. Partially imaged large eccentric occlusive filling defect within the right internal jugular vein compatible with thrombus of unknown chronicity.2. Mediastinal/hilar lymphadenopathy as above is nonspecific, but may be reactive or metastatic in etiology. Continued followup is recommended. |
Generate impression based on findings. | Worsening abdominal pain Coiled enteric tube seen with tip located in right mid abdomen, exact location difficult to ascertain based on this imaging exam alone but may be located in jejunum, proximal portion of tube appears to extend laterally towards the left, correlate with patient's clinical history, uncertain whether this reflects percutaneous placement/overlying catheter tubing. Multiple cyst gastrostomy tubes seen in left abdomen. Pelvic drainage catheter present. Dilated centrally located small bowel, measuring up to 3.5 cm with relative paucity of gas seen distally in colon. If there is clinical concern for free air, this would be better assessed with upright or left lateral decubitus imaging. | Dilated proximal small bowel seen centrally in abdomen with paucity of gas seen distally, suspicious for developing small bowel obstruction and correlation with patient's clinical history and continued followup recommended.Enteric tube as described, see above. |
Generate impression based on findings. | Female; 42 years old. Reason: assess for intraabdominal process History: abdominal pain, recent surgery ABDOMEN:LUNG BASES: Contrast opacifies the distal esophagus, suggestive of gastroesophageal reflux.LIVER, BILIARY TRACT: Status post cholecystectomy. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of partial colectomy with anastomotic suture line near hepatic flexure. Interval resolution of bowel wall thickening about the anastomotic site with decreased adjacent mesenteric fat stranding. Mild residual mesenteric fatty stranding persists. No evidence of bowel obstruction or free air. BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall including midline incision. Residual fluid within the incision has mildly increased superiorly with a 2.1 x 3.4 cm fluid collection now seen and most likely due to seroma (series 3/65); infection of this fluid collection cannot be excluded.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild nonspecific pelvic ascites, most likely physiologic. | 1. Decreased inflammatory changes at right upper quadrant colonic anastomosis. 2. Small incisional seroma, for which infection cannot be excluded. |
Generate impression based on findings. | Reason: Abscess? History: Swelling on right face, concern for abscess Small fluid collection measuring 0.8 x 0.6-cm adjacent to the right maxillary alveolar process with rim enhancement. There is periapical and periradicular lucency of the adjacent tooth number 5 with dental caries and right maxillary cortical loss anteriorly. There is also soft tissue swelling extending from the nasal ala down to the mandible. Scattered bilateral cervical lymph nodes that are not pathologic by CT size criteria. Tooth number 4 is absent with focal sclerosis in the shape of the dental root compatible with condensing osteitis or postprocedural change. Left upper premolar 14 has abrupt truncation at the crown, compatible with fracture or postprocedural change. Lucency surrounding the remaining root with cortical erosion of the left maxillary alveolar process. There is also dental caries of the right posterior mandible molar and tooth number 3.Age indeterminant small vessel ischemic disease of the right external capsule. The imaged orbits are unremarkable. Mild mucosal thickening of the right maxillary sinus. Narrowing at the right hiatus semilunaris from mucosal thickening. Right osteomeatal complex is patent. Left ostiomeatal complex is narrowed from bony anatomy. The cribriform plate, fovea ethmoidalis and lamina papyracea appear normal. The nasal turbinates and nasal septum are normal. Heterogeneity of the partially imaged right thyroid lobe. Parotid and submandibular glands are unremarkable. Mild cervical spondylosis. | 1.Small fluid collection adjacent to the right maxillary alveolar process with rim enhancement, consistent with abscess. There is periapical and periradicular lucency of the adjacent upper premolar 5 with dental caries and right maxillary cortical loss anteriorly. 2.Left upper premolar 14 has abrupt cut off of the crown, compatible with fracture or postprocedural change. Lucency surrounding the remaining root with cortical erosion of the left maxillary alveolar process.3.Heterogeneity of the partial imaged right thyroid lobe. Correlate with thyroid function test. |
Generate impression based on findings. | Abdominal pain, placement of nasojejunal tube Nasojejunal tube seen with tip just proximal to or at level of ligament of Treitz. Large stool burden, no bowel obstruction. | Enteric tube as above. |
Generate impression based on findings. | Assess for Dobbhoff tube placement Nonvisualization of a Dobbhoff tube. Percutaneous gastrostomy seen to left of midline at level of patient's L1 compression deformity, small air suggested in underdistended stomach. Nonobstructive bowel gas pattern. Additional multilevel degenerative disease of spine seen, decreased osseous mineralization diffusely. Lower lung fields not well assessed. Amorphous radiodensity seen in region of left breast/chest, correlate with patient's clinical and procedural history/physical exam. | Percutaneous gastrostomy as above. |
Generate impression based on findings. | Beam hardening artifact at the level of the shoulders limits evaluation. The scout lateral view and the sagittal reformatted images demonstrate normal alignment of the cervical spine, with straightening of the normal cervical lordosis. The vertebral body and disk space heights are well-maintained.There is no acute fracture. There is a focal linear lucency through the right pedicle of C2 as seen on 80233/66-68. The margins appear well corticated. There is also a small focal nonspecific lucency in the right lateral C3 vertebral body.At C1-C2, there is a normal relationship of the dens with the arch of C1.The axial images do not demonstrate any significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis. There is calcification of the ligamentum flavum at the upper thoracic levels.The visualized intracranial structures and lung apices appear normal. Incidental note is made of partial effacement of the left piriform sinus secondary to a medialized left carotid artery, which is a normal variant. There is mild mucosal thickening in the partially visualized maxillary sinuses. | 1. No acute fracture or subluxation.2. Probable developmental variant versus less likely sequela of chronic fracture involving right pedicle of C2. |
Generate impression based on findings. | Female; 44 years old. Reason: assess for stone, hydro History: flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Stable hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or hydroureter. No perinephric fat stranding. No definite ureteral calculi, evaluation of the distal ureters is mildly limited by multiple pelvic bowel loops and phleboliths.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without diverticulitis.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: Diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No hydroureteronephrosis or perinephric stranding. No obstructing calculi evident, though evaluation of the distal ureters is mildly limited by multiple pelvic bowel loops and phleboliths. |
Generate impression based on findings. | Dobbhoff tube placement Dobbhoff tube seen with tip directed towards gastric fundus. Moderate stool burden. No bowel obstruction. Extensive and severe vascular calcifications, postprocedural coil placement seen in lower abdomen. Mild to moderate cardiomegaly. | Enteric tube as above. |
Generate impression based on findings. | Male; 31 years old. Reason: nephrolithiasis vs. SBO? History: LLQ abdominal pain, radiates to L flank, h/o Crohn's and nephrolithiasis ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 6 mm left mid ureteral calculus causing mild upstream hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post total proctocolectomy with right sided ileostomy. Questionable presacral space fluid collection versus unopacified bowel loops.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. 6 mm obstructing left mid ureteral calculus causing mild upstream hydroureteronephrosis.2. Questionable presacral space fluid collection versus unopacified bowel loops. Recommend clinical correlation, and further assessment with CT with p.o. contrast can be performed if clinically indicated, discussed with ED at 9 a.m. on 3/14/15. |
Generate impression based on findings. | 74-year-old male with history of AML, ILD and new chest radiograph findings. LUNGS AND PLEURA: There is extensive interlobular septal thickening, bronchiectasis, and peripheral honeycombing as well as severe emphysema. There are new subpleural nodules in the lateral aspect of the left upper lobe measuring 1.6 x 1.3 cm, and in the medial aspect measuring 1.8 x 1.6 cm. Honeycombing along the posterior aspect of the right lobe is now partially opacified. There is a wedge-shaped opacity along the medial aspect of the right middle lobe containing air bronchograms.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. There are severe aortic and coronary artery calcifications. There are scattered enlarged mediastinal lymph nodes with a left paratracheal node measuring 14 mm which has increased when compared to prior.The esophagus is patulous. CHEST WALL: There is severe multilevel degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Extensive atherosclerotic calcifications of the abdominal aorta and its branches. Scattered splenic and hepatic micro-calcifications, likely the sequela of prior granulomatous disease. | 1. Interval increase in diffuse bilateral patchy groundglass opacities and discrete subpleural nodules superimposed on severe emphysema and ILD with wedge shaped consolidation in the right middle lobe and consolidation along the posterior aspect of the right lower lobe. Given the chronology, these findings are favored to represent multifocal infection, possibly fungal and/or bacterial in etiology given patients clinical history of AML. Metastatic disease is also possible but considered less likely in the absence of a known primary cancer.2. Patulous esophagus.3. Severe atherosclerotic vascular disease. |
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