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Generate impression based on findings. | Right diaphragmatic hernia repair.VIEW: Chest AP (one view) 03/15/15, 1008 Endotracheal tube tip is above the carina. Feeding tube side-port is at GE junction. Left upper extremity PICC tip is lateral to costal border.Right pleural effusion is slightly larger. Air is again seen in the pleural space. The small right lung is well inflated. Left lung is normal in appearance. Cardiothymic silhouette is normal. | Postoperative changes (expected hydropneumothorax) with no evidence of complication. |
Generate impression based on findings. | Evaluate for small bowel obstruction, history of abdominal distention and uterine malignancy Suboptimal exam due to overlying leads and artifact as well as patient positioning and motion artifact.Right upper quadrant and lower quadrant postprocedural sequela.Small to moderate stool, particularly in right colon. Relative paucity of small bowel gas, gas seen distally in colon. No definitive evidence of bowel obstruction. Colonic diverticula. Gaseous distention of stomach. No free air on upright film.Spinal degenerative disease. Please refer to concomitant chest radiography from same day for additional findings. | Gaseous distention of stomach. Small to moderate stool, particularly in right colon. Relative paucity of small bowel gas, gas seen distally in colon. No definitive evidence of bowel obstruction. Colonic diverticula. |
Generate impression based on findings. | 35 day old former 24 week gestational age patient with increased work of breathing. Is there evidence of atelectasis or pulmonary edema?VIEW: Chest AP (one view) 03/15/15, 1013 Endotracheal tube tip is just above thoracic inlet. Feeding tube tip is distal to the GE junction and not included on the image. Right central line tip is in superior vena cava. A PDA ligation clip is identified.Coarse bilateral lung opacities persist. Hazy opacity is noted diffusely on the right. Lung volumes are large. Cardiac silhouette size is upper limits of normal. | Complications from surfactant deficiency. Probable small layering right pleural effusion. |
Generate impression based on findings. | 61 years old, Male, Reason: evaluate extent of fracture History: R femoral head fracture Pelvis: Redemonstration of a right intertrochanteric fracture with fracture fragments in near-anatomic alignment. Severe osteoarthritis affects the right hip. Moderate osteoarthritis affects the left hip. Moderate degenerative changes affect the lower lumbar spine. No additional fracture or malalignment is noted.Right femur: Redemonstration of a right intertrochanteric fracture with fracture fragments in near-anatomic alignment. No other fractures noted. Severe osteoarthritis affects the right hip. | Intertrochanteric fracture with fracture fragments in near anatomic alignment. No other fractures. |
Generate impression based on findings. | 34 years old, Male, Reason: fracture History: knee pain No fracture or malalignment. Joint effusion is present. | Joint effusion without fracture or malalignment. |
Generate impression based on findings. | Enteric tube replaced Coiled Dobbhoff tube seen, portion of coiled tube not included in field of view, the tip extends retrograde and upward and is located in the gastric fundus. Incompletely imaged air containing small and large bowel, may reflect mild diffuse ileus. IVC filter and right-sided coil embolization material. Improving left basilar/retrocardiac aeration. Blunting of left costophrenic angle suggestive of small pleural effusion. | Dobbhoff tube coiled upon itself as described. |
Generate impression based on findings. | Evaluate for obstruction, history of constipation Moderate to large stool burden, particularly in right abdomen. Mild diffuse nondilated gaseous prominence of small bowel, likely secondary to stool burden/constipation. Rounded radiodensity above left greater trochanter, of uncertain clinical significance, may be located in gluteal soft tissues and reflect a calcified granuloma from prior injection at this site. | Moderate to large stool burden, see above. |
Generate impression based on findings. | Generalized abdominal pain Multiple surgical clips and staples. Cholecystectomy clips. Drainage catheter placement, tip located in left upper quadrant. Prominent air containing small and large bowel, appearance suggestive of postoperative ileus. Bowel displaced into right lower abdomen, may be secondary in part to ascites, also seen is prominent hepatic shadow, suggestive of hepatomegaly. Intrauterine device present. | Bowel gas pattern suggestive of postoperative ileus. Please refer to subsequent CT exam from same day for findings. |
Generate impression based on findings. | 54 years old, Female, Reason: ankle History: Fall with pain on lateral malleolus No widening of the ankle mortise joint during stress view. Obliquely oriented minimally displaced distal fibular fracture is again seen. | No widening of ankle mortise joint during stress view. Distal fibular fracture. |
Generate impression based on findings. | 54 years old, Female, Reason: r/o fx History: pain and ttp on lateral aspect of ankle Left ankle: Obliquely oriented minimally displaced fracture of the distal fibula. The distal fracture fragment is minimally posteriorly displaced. Soft tissue swelling is present along the lateral malleolus. No additional fracture is identified.Left knee: Moderate osteoporosis fracture the knee. Well corticated ossific densities just and over the posterior aspect of the knee, best seen on the lateral view may represent a fabella or intra-articular body. No acute fracture or malalignment.Right knee: Moderate osteoarthritis of the knee. No acute fracture or malalignment. | Obliquely oriented minimally displaced fracture of the distal fibula with adjacent soft tissue swelling. |
Generate impression based on findings. | There is no significant interval change in the ill-defined conglomerate left level 4 lymph nodes measuring 13 x 12 mm. There is an unchanged low attenuation nodule in the right thyroid lobe. The major salivary glands show no focal lesions.The major cervical vessels remain patent. The osseous structures show no focal lesions with mild cervical degenerative changes again seen. The airways are patent. The imaged intracranial structures, paranasal sinuses and mastoid air cells are within normal limits. There is extensive emphysema and multiple micronodules in the imaged portions of the lungs. Please refer to dedicated accompanying CT chest report for further details. | 1.Stable findings in the neck with no significant change in left level 4 lymphadenopathy.2.Unchanged nonspecific right thyroid nodule.3.Extensive emphysema and multiple micronodules. Please refer to accompanying dedicated CT chest report for further details. |
Generate impression based on findings. | Enteric tube repositioning Suboptimal study secondary to motion artifact. Enteric tube seen with tip now in proximal duodenum. Nonobstructive bowel gas pattern. Mildly prominent air containing small and large bowel. Moderate to large tool burden. Please refer to concomitant chest radiography from same day for additional findings. | Enteric tube as above. |
Generate impression based on findings. | 51 years old, Female, Reason: Evaluate for fracture History: pain, difficulty weight bearing Pelvis and hips: Calcifications consistent with phleboliths are present in the pelvis. No acute fracture or malalignment. Mild osteoarthritis of the hips bilaterally.Lumbar spine: The vertebral heights and disk spaces are maintained. No spondylosis or spondylolisthesis. No fracture or malalignment. | No acute fracture or malalignment. |
Generate impression based on findings. | 63 years old, Female, Reason: Eval for dislocation History: Pain The humeral head is situated at the glenoid surface. No evidence of dislocation. Vertically oriented fracture through the greater tuberosity. Previously described transverse fracture of the humeral head is not well seen on this exam. No other fracture identified. | No evidence of dislocation. Vertically oriented fracture through the greater tuberosity. |
Generate impression based on findings. | Hypoxia. 2-year-old former 24 week gestational age patient.VIEW: Chest AP (one view) 03/15/15, 1036 Left upper extremity PICC tip is in superior vena cava. Surgical clips are noted at the GE junction. A gastrostomy tube is present.Air space disease is seen in right upper and left lower lobes. Decreased opacity is present in right lower lobe. Cardiothymic silhouette is normal. | Multifocal opacities may be pneumonia. |
Generate impression based on findings. | 63 years old, Female, Reason: r/o fx- s/p fall History: pain and swelling, unable to move arm Humerus: Comminuted, predominantly transverse fracture of the of the humeral head with minimal medial displacement of the distal fracture fragment. No distal fracture is identified. Left shoulder: Again seen is the comminuted predominantly transverse fracture of the humeral head with a vertically oriented portion of the fracture through the greater tuberosity.Elbow: Well corticated ossification posterior to the elbow joint may be related to prior trauma. No joint effusion or acute fracture is identified. No malalignment. | Comminuted, predominantly transverse fracture of the humeral head with minimal medial displacement of distal fracture fragment. There is a vertically oriented portion of the fracture through the greater tuberosity. |
Generate impression based on findings. | Removal of bullet from left knee.VIEWS: Left knee AP/lateral (two views) 03/15/15 A cast obscures bone detail. The bullet has been removed. Irregularities of the anterior tibial cortex from fracture are again seen. | Removal of bullet. Fracture of proximal tibia. |
Generate impression based on findings. | Enteric tube placement Enteric tube seen extending into gastric fundus, guidewire present. Nonobstructive bowel gas pattern. Pelvis excluded. Incompletely imaged bilateral nephroureteral stents. | Enteric tube as above. |
Generate impression based on findings. | 53 years old, Male, Reason: eval for acute process History: atraumatic pain/swelling Moderate joint effusion without evidence of acute fracture. No malalignment. There are vascular calcifications within the soft tissues of the knee. | Moderate joint effusion without evidence of acute fracture or malalignment. |
Generate impression based on findings. | 42 years old, Male, Reason: eval for postop complications History: pain s/p shoulder surgery 3/2/15 Horizontal lucency of the medial aspect of the proximal diaphysis of the left humerus likely represents a screw tract from prior fixator device. No acute fracture or malalignment. | Horizontal lucency of the left humerus likely represents a screw tract from prior fixator device. No acute fracture or malalignment. |
Generate impression based on findings. | Images are somewhat limited by patient motion. This transitional lumbosacral anatomy, with partial sacralization of L5 vertebra. For the purposes of this exam from the last fully formed disk at the L5-S1.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level. Incidental note is made of trace intrinsic T1 hyperintensity which extends distally from the conus along the dorsal thecal sac, which may represent a fatty filum which measures at most 1 mm throughout its course.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine. The bladder is moderately distended and is somewhat irregularly shaped. The uterus extends significantly cranial to the bladder, with a small amount of T2 hyperintense fluid within the endometrial canal, which most likely is physiologic in a patient of this age. Bilateral ovarian follicles are noted. There is a large amount of air in the presumed distended rectum. | 1. Transitional lumbosacral anatomy noted. It surgeries to be contemplated, correlation with plain films of the entire spine is recommended.2. Incidental fatty filum. Normal conus termination. This has been associated with tethered cord and clinical correlation is recommended.3. No significant spondylotic changes. |
Generate impression based on findings. | There is no significant cervical lymphadenopathy. The reference lymph node in the left level 3 chains measures 3 mm, stable. There are few slightly prominent lymph nodes in the left neck more superiorly which are not enlarged by CT size criteria. There are unchanged mild treatment related findings within the neck. There is no focal mass. The thyroid and major salivary glands are unremarkable.There is mild atherosclerotic ossification of the carotid bifurcations. The major cervical vessels are otherwise patent. There is mild cervical spondyloarthropathy without significant change, worst at C3-4 where there is at most mild spinal canal stenosis. The osseous structures show no focal lesions. The airways are patent. There is pulmonary emphysema and ground glass pleural-based opacity in the left upper lobe adjacent to the major fissure. Please refer to dedicated accompanying CT chest report for further details. | Stable reference level 3 lymph node on the left with no significant cervical lymphadenopathy or mass. |
Generate impression based on findings. | 87 years old, Female, Reason: Evaluate for fracture, joint effusion History: R wrist swelling pain The bones appear diffusely demineralized. Soft tissue swelling is noted about the wrist. No acute fracture or malalignment. Degenerative are of the carpal joints are present. | Soft tissue swelling without acute fracture or malalignment. Degenerative changes of the carpal joints are present. |
Generate impression based on findings. | 53 years old, Male, Reason: eval for acute process History: atraumatic pain No acute fracture or malalignment. The ankle mortise joint is maintained. Mild degenerative changes affect the midfoot. | No acute fracture or malalignment. |
Generate impression based on findings. | 53 years old, Female, Reason: evaluate for fracture History: R wrist pain and bruising Minimally displaced transverse fracture of the ulnar styloid. The distal fracture fragment is minimally medially displaced. Subtle transverse lucency of the distal radius may represent a nondisplaced fracture, or normal variant. Mild to moderate soft tissue swelling is noted about the wrist. | Minimally displaced transverse fracture of the ulnar styloid. Subtle transverse lucency of the distal radius may represent a nondisplaced fracture. If there is clinical concern for distal radius fracture follow-up radiograph in 7 to 10 days recommended. |
Generate impression based on findings. | 82 years old, Male, Reason: patient fell with syncope, tenderness at mid axillary line on L, assess for FRX History: patient fell with syncope, tenderness at mid axillary line on L, assess for FRX Surgical clips project or the mediastinum. Median sternotomy hardware is present and intact. No pneumothorax or large pleural effusions present. No displaced rib fractures seen. | No displaced rib fracture. |
Generate impression based on findings. | 27 years old, Female, Reason: r/o fx History: pain at MCP No acute fracture or malalignment. No significant soft tissue swelling is noted. | No acute fracture or malalignment. |
Generate impression based on findings. | 55 years old, Female, Reason: r/o fracture History: fall and elbow pain Left elbow: There is elevation of the anterior-posterior fat pads indicating a joint effusion. No acute fractures identified, however joint effusion is worrisome for an occult fracture.Right wrist: No acute fracture or malalignment. While corticated ossicle distal to the ulnar styloid may related to prior injury. | No fracture is evident, however elevation of the anterior and posterior fat pads is worrisome for an occult fracture, most likely the radial head. Follow up radiographs in 7 to 10 days is recommended to further evaluate. |
Generate impression based on findings. | 22 years old, Female, Reason: Fx? History: Hand pain s/p trauma No acute fracture or malalignment. There may be mild soft tissue swelling about the thumb. | No acute fracture or malalignment. |
Generate impression based on findings. | 27 years old, Male, Reason: eval for fracture History: knee pain after MVC Right knee: No acute fracture or malalignment. No joint effusion is present.Left knee: No acute fracture or malalignment. No joint effusion is present. | No acute fracture or malalignment. |
Generate impression based on findings. | Female 58 years old; Reason: evaluate for progression or stability of lung nodules History: evaluate for metastatic disease CHEST:LUNGS AND PLEURA: Pulmonary metastatic lung nodules, stable to mildly increased in size. Reference cavitating lung nodule located in the superior segment of left lower lobe measures 0.8 x 0.8 cm, previously measured 0.7 x 0.7 cm. No definite new lung nodule seen. No pleural effusion.MEDIASTINUM AND HILA: Stable heterogeneity of thyroid gland including subcentimeter hypoattenuating nodule in left lobe. Mild calcified coronary artery disease. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Wedge-shaped area of relatively increased attenuation in posterior aspect of right hepatic lobe, image 84 series 3, most likely transient perfusion abnormality.SPLEEN: Status post splenectomy. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild bilateral hydronephrosis. Areas of right-sided renal cortical scarring. Minimal ureteral wall thickening, likely related to patient's neobladder and associated reflux.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval enlargement of soft tissue nodules seen in anterior aspect of left upper quadrant, nodules submitted for reference, measuring 1 x 0.9 cm and 0.9 x 0.8 cm, respectively, previously measured up to 0.7 cm on May 25, 2014 CT study. Findings suspicious for peritoneal metastatic disease. Angular margins of bowel loops located in pelvis suggestive of nonobstructive adhesive disease. Right-sided urostomy. Left-sided colostomy.PELVIS:Pelvic postsurgical sequela present with presacral soft tissue induration/fluid without significant change after accounting for differences in technique, measuring 3.4 x 1 .7 cm, previously measured 3.9 x 1.6 cm. Along the peritoneal reflection in pelvis is increasing soft tissue nodularity, for example, in left deep hemipelvis, nodularity measures 3.2 x 2.5 cm, image 158 series 3, previously measured 1.8 x 0.9 cm.UTERUS, ADNEXA: Surgically absent. BLADDER: Surgically absent. BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Decreased osseous mineralization. Again seen small bowel containing ventral abdominal hernia. | 1. Findings consistent with worsening peritoneal/mesenteric metastatic disease. As described above, increasing pelvic soft tissue nodularity and left upper quadrant soft tissue nodularity, latter without significant change from prior January 8, 2015 CT study but demonstrating interval increase in size from May 25, 2014 exam.2. Pulmonary metastatic lung nodules, several of which are cavitating, stable to mildly increased in size.3. Stable presacral soft tissue attenuation/fluid. |
Generate impression based on findings. | Female 42 years old; Reason: 42 yo F s/p renal txp x 2 presented to OSH with abdominal pain, ?early appendicitis on CT scan, needs repeat imaging to evaluate for evolving appendicitis vs transplant pyelonephritis per transplant surgery recs History: s/p renal txp x 2, acute abdominal pain periumbilical, bilateral LQ, fever ABDOMEN:LUNGS BASES: Small basilar atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left iliac fossa transplant kidney with mild to moderate perinephric stranding, evaluation suboptimal on this noncontrast study, mild fullness of intrarenal collecting system may be physiologic. Possible punctate nonobstructing intrarenal stone. Very atrophic right iliac fossa transplanted kidney. Markedly atrophic native kidneys. Simple small exophytic right renal cyst, image 49 series 3. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Contrast seen in proximal to mid appendix. At level of appendiceal tip is moderate fat stranding. No extraluminal gas or discrete fluid collection delineated. The sigmoid colon, displaced by the patient's enlarged fibroid uterus, travels in this region, multiple diverticula present and there is paracolic fat stranding. Small abdominopelvic ascites.PELVIS:UTERUS, ADNEXA: Enlarged calcification-containing fibroid uterus, measuring 13.5 x 10.7 cm on transaxial imaging. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Increased sclerosis diffusely, likely related to renal osteodystrophy. Asymmetry of rectus muscles with atrophy or resection of right rectus muscle. | 1. Moderate degree fat stranding and inflammation centered at junction of appendiceal tip and sigmoid colon as described. Given patient's reported history of early appendicitis on a prior imaging study, findings favored to represent acute appendicitis with diverticula-laden sigmoid colon secondarily involved. However, acute sigmoid diverticulitis with secondary involvement of the appendiceal tip another consideration. Clinical correlation with patient's clinical symptoms and laboratory values recommended to exclude acute diverticulitis.2. Left iliac fossa transplant kidney with mild to moderate perinephric stranding, not adequately assessed on this noncontrast study, underlying infection not entirely excluded and correlation with patient's clinical history/urinalysis recommended. Mild fullness of intrarenal collecting system may be physiologic. If further evaluation of vasculature is warranted, imaging with dedicated sonography recommended.3. Small abdominopelvic ascites. 4. Enlarged fibroid uterus. |
Generate impression based on findings. | There is right lamina papyracea fracture with air-fluid/blood levels in the right ethmoid sinuses. There is intraorbital fat herniating through the defect with bowing of the right medial rectus muscle into the fracture defect; please correlate clinically for evidence of medial rectus entrapment. There are mildly displaced comminuted right nasal bone fractures and questioned more subtle left-sided fractures (4/93). The right orbital roof and floor are intact. The lateral right orbital wall is intact. The zygomas are intact. There is extensive right periorbital, preseptal soft tissue emphysema and soft tissue swelling. There is soft tissue air extending inferiorly into the anterior masticator and buccal space. Post septal extension of air into the right orbit involves both intraconal and extraconal compartments with air tracking along the lateral aspect of the extraconal compartment through the right superior orbital fissure near the orbital apex. There is no discrete pneumocephalus elsewhere. Disconjugate gaze is noted.There is mild left maxillary sinus mucosal thickening. The cribriform plate, lateral and minimal and fovea ethmoidalis are grossly intact. | 1.Right medial orbital wall blowout fracture with herniation of intraorbital fat and medial rectus into the fracture defect. Please correlate for signs of right medial rectus muscle entrapment.2.Mildly displaced comminuted right nasal bone fractures, with likely more subtle left-sided ones.3.Extensive right periorbital, preseptal and postseptal soft tissue emphysema (both intraconal and extraconal). Soft tissue emphysema extends inferiorly into the right masticator space. Also, small amount of soft tissue emphysema dissects posteriorly along the lateral aspect of the right lateral rectus muscle into the right superior orbital fissure.4.No other discrete foci of pneumocephalus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 36 years old; Reason: s/p EUS with FNA of mediastinal mass. Now with SOB, back pain, unable to take deep breaths. Evaluate for pneumothorax History: SOB, chest tightness, back pain CHEST:LUNGS AND PLEURA: Left greater than right bibasilar consolidation and atelectasis. Small left pleural effusion. Mild biapical scarring/nodularity. Small patchy air space disease/scarring in right middle lobe and lingula. No pneumothorax.MEDIASTINUM AND HILA: Heterogeneously enhancing left posterior mediastinal mass measuring 4.4 x 3 cm. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic segment 2/3 indeterminant 2.3 x 2 cm hypoattenuating lesion. Additional hypoattenuating subcentimeter lesions seen, too small to characterize. Also visualized is a subcentimeter hyperattenuating focus at level of hepatic dome, may be enhancing, also indeterminate on this nondedicated study. Patent portal veins, splenic vein and SMV. SPLEEN: Splenule.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: Distended air and contrast containing stomach, may be due to timing of exam. Left upper quadrant lobulated hypoattenuating mass seen along superiormost lesser curvature of stomach, measuring 5.4 x 4 cm.PELVIS:UTERUS, ADNEXA: Intrauterine device. Rounded adnexal cystic focus seen posterior to uterus, image 167 series 3, measuring 3.6 x 2.1 cm, may be a dominant follicle in the left ovary.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. As seen on prior PET imaging, left posterior mediastinal and upper quadrant masses, correlate with results of FNAB.2. Indeterminate hepatic lesions as above.3. Left greater than right bibasilar consolidation and atelectasis. Small left pleural effusion. Mild biapical scarring/nodularity. Small patchy air space disease/scarring in right middle lobe and lingula. No pneumothorax.4. Rounded adnexal cystic focus seen posterior to uterus, image 167 series 3, measuring 3.6 x 2.1 cm, may be a dominant follicle in the left ovary. |
Generate impression based on findings. | There is a heterogeneously enhancing enlarged right level Ib lymph node measuring 22 x 13 mm on series 6 image 34. There are mildly enlarged bilateral retropharyngeal lymph nodes measuring up to 10 mm. There are an increased number of bilateral cervical lymph nodes which are not enlarged by CT size criteria. The thyroid and major salivary glands are unremarkable. The airways are patent. The major cervical vessels are patent. There is a lucent osseous lesion in the left aspect of the manubrium with cortical disruption along the posterior surface and somewhat along the anterior surface. There is multilevel cervical spondylosis worst at C4-5 where there is a disk extrusion with cranial extension causing at least moderate spinal canal stenosis. The imaged intracranial structures are unremarkable. There is extensive near complete opacification of the left maxillary sinus with bubbly secretions, and bilateral ethmoid sinuses. The imaged portions of the lungs are grossly clear, allowing for mild respiratory motion artifact. | 1.Heterogeneously enhancing enlarged right level Ib lymph node measuring 22 x 13 mm, and enlarged 10-mm bilateral retropharyngeal lymph nodes which are worrisome for metastasis.2.Nonenlarged prominent bilateral cervical lymph nodes which are more numerous than usually seen, nonspecific, but remain suspicious. PET CT may be useful for evaluation if clinically indicated.3.Lucency in the left aspect of the manubrium with cortical disruption worrisome for osseous metastasis.4.Multilevel cervical spondylosis worst at C4-5 with a disk extrusion causing at least moderate spinal canal stenosis; this can be further evaluated on MRI cervical spine as clinically indicated.5.Extensive paranasal sinus opacification may represent sinusitis in the proper clinical setting. |
Generate impression based on findings. | Female 51 years old; Reason: Evaluate for source of abdominal pain including cholecystitis, appendicitis, ovarian torsion - PO and IV contrast please History: Acute R-sided abdominal pain ABDOMEN:LUNGS BASES: Incompletely imaged soft tissue asymmetry in left breast, image 1 series 8, nonspecific. Small atelectasis in lingula. LIVER, BILIARY TRACT: Ill-defined 1.8 x 1.1 cm hepatic segment 4 hypoattenuating focus, indeterminant. SPLEEN: Small splenules. PANCREAS: Small area of decreased hypoattenuation near junction of pancreatic head and uncinate process, image 42 series 8, may reflect focal fatty infiltration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate to marked right sided hydronephrosis with surrounding fluid and stranding and delayed nephrogram. Obstructing 4 mm calculus seen at junction of UPJ and proximal ureter. Subcortical subcentimeter hypoattenuating focus seen in right kidney, too small to characterize but may be a cyst, image 58 series 8. Additional 6 mm nonobstructing calculus seen in right renal lower pole. Evaluation for nonobstructive intrarenal stones in left kidney suboptimal due to presence of contrast, no hydronephrosis seen on left.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No secondary signs of acute appendicitis. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative spinal disease, most pronounced at L5/S1. | 1. Right sided hydronephrosis with obstructing right ureteral stone as described. 2. Indeterminate hepatic segment 4 lesion. 3. Incompletely imaged soft tissue asymmetry in left breast, nonspecific, may be correlated mammographically. |
Generate impression based on findings. | Male 59 years old; Reason: sob, edema on cxr History: sob CHEST:LUNGS AND PLEURA: Postsurgical changes related to bilateral lung transplants. Bilateral right greater than left pleural effusions. Interval decrease in size of right-sided pleural effusion, now moderate in size, with new scattered gaseous foci. Persistent small left pleural effusion. Left to right mediastinal deviation present. Underlying compressive atelectasis present. Interval removal of previously seen left chest tube. Patchy bibasilar air space disease and interstitial thickening also seen, suggestive of pulmonary edema.MEDIASTINUM AND HILA: Sternotomy hardware. Mild mediastinal adenopathy, unchanged. Endotracheal tube seen above carina. Left-sided central venous catheters seen with tips in distal SVC. Trace pericardial effusion. CHEST WALL: Accounting for differences in technique, essentially stable right subpectoral/pectoral hematoma with hyperdense fluid extending intra-thoracically as well. Exact comparison difficult but region measures approximately 14.4 x 9 cm, image 42 series 3. ABDOMEN:LIVER, BILIARY TRACT: Improvement in previously seen midline deviation of liver. Areas of infiltrative hypoattenuation again seen involving right hepatic lobe, differential considerations include sites of infarction versus focal hepatic steatosis. Improvement in perihepatic fluid and previously visualized pneumoperitoneum.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple wedge-shaped areas of hypoattenuation seen on prior contrast-enhanced exam not as well visualized on current noncontrast study. RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Gastrojejunostomy tube in place. Mildly prominent small bowel, may reflect ileus. Underdistention of colon beyond the splenic flexure, making evaluation for underlying wall thickening suboptimal.PELVIS:PROSTATE, SEMINAL VESICLES: Incompletely imaged scrotal edema. BLADDER: Interval removal of previously seen Foley catheter. BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Multilevel degenerative changes of spine. Mild anasarca. Improvement in perihepatic fluid and previously visualized pneumoperitoneum. Again seen right inguinal loculated subcutaneous fluid, correlate with patient's procedural history. | 1. Accounting for differences in technique, essentially stable area of right subpectoral/pectoral hemorrhage, extending into pleural cavity. Interval decrease in size of right-sided pleural effusion with new scattered gaseous foci seen, consistent with hydropneumothorax. Persistent small left pleural effusion. Underlying atelectasis present. Patchy bibasilar air space disease and interstitial thickening also seen, suggestive of pulmonary edema.2. Mild mediastinal adenopathy, unchanged, may be reactive. 3. Improvement in perihepatic fluid and previously visualized pneumoperitoneum.4. Mildly prominent small bowel, may reflect ileus. Underdistention of colon beyond the splenic flexure, making evaluation for underlying wall thickening suboptimal.5. Areas of infiltrative hypoattenuation again seen involving right hepatic lobe, differential considerations include sites of infarction versus focal hepatic steatosis. 6. Multiple wedge-shaped areas of hypoattenuation seen on prior contrast-enhanced exam not as well visualized on current noncontrast study. 7. Again seen right inguinal loculated subcutaneous fluid, correlate with patient's procedural history. |
Generate impression based on findings. | Female 44 years old; Reason: Evaluate for abscess History: s/p parastomal hernia repair, rising WBC and chills Suboptimal study secondary to patient's body habitus, portions of the patient's lateralmost abdomen are not included in the field-of-view. ABDOMEN:LUNGS BASES: Right greater than left atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly prominent small bowel and air and fluid containing colon seen, appearance suggestive of postprocedural ileus at this time. Sites of focally dilated small bowel with intervening gradual tapering, may be related to ileus versus underlying adhesive disease. Mild mesenteric edema.PELVIS:UTERUS, ADNEXA: Nonspecific prominence of endometrial complex, correlate with patient's menstrual history. Ovarian follicles present.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. Postoperative ventral abdominal sequela including midline ventral abdominal postsurgical defect. Locules of gas seen in subcutaneous tissues, particularly in the left lower ventral abdomen and drainage catheter placement noted. Left-sided colostomy. Mild/moderate anasarca. | 1. Suboptimal study secondary to patient's body habitus, portions of the patient's lateralmost abdomen excluded in the field-of-view. 2. Mildly prominent small bowel and air and fluid containing colon seen, appearance suggestive of postprocedural ileus at this time. Sites of focally dilated small bowel with intervening gradual tapering, may be related to ileus versus underlying adhesive disease. Mild mesenteric edema.3. Postoperative ventral abdominal sequela including midline ventral abdominal postsurgical defect. Locules of gas seen in subcutaneous tissues, particularly in the left lower ventral abdomen (at site of previously visualized parastomal hernia) and drainage catheter placement noted. Left-sided colostomy. 4. Nonspecific prominence of endometrial complex, may be physiologic but correlation with patient's menstrual history advised. |
Generate impression based on findings. | Female 62 years old; Reason: evaluate for cause of abdominal pain and distention, chronic constipation 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: Lobulated/scarred contour of kidneys, symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Moderate to severe aortobiiliac atherosclerotic disease. BOWEL, MESENTERY: Average stool burden. No bowel obstruction. Colonic diverticulosis without acute diverticulitis. No secondary signs of acute appendicitis. Tiny hiatal hernia.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Focus of air in bladder, presumably related to recent intervention. BONES, SOFT TISSUES: Decreased osseous mineralization. Mild retrolisthesis of L5 on S1. | 1. Average stool burden. Colonic diverticulosis without acute diverticulitis.2. Focus of air in bladder, presumably related to recent intervention. Correlation with patient's history recommended. |
Generate impression based on findings. | Female 49 years old; Reason: appendiceal rupture History: abdominal pain, nausea, vomiting ABDOMEN:LUNGS BASES: Incompletely imaged lung fields demonstrate numerous pulmonary nodules, without significant change. Stable reference right middle lobe lung nodule measuring 6 x 5 mm, image 15 series 4. Essentially stable reference right lower lobe lung nodule, measuring 11 x 10 mm, image 6 series 4.LIVER, BILIARY TRACT: Innumerable hepatic metastases, demonstrating interval enlargement. Marked diffuse hepatic steatosis, new or progressed from prior study. Reference hepatic dome lesion now measures 2.3 x 2.2 cm, image 12 series 3, previously measured 1.8 x 1.7 cm. Mild interval enlargement of index right hepatic lesion, measuring 8.7 x 7 cm, image 32 series 3, previously measured 7.6 x 6.8 cm. Difficult to ascertain whether there are new liver metastases secondary to apparent increased coalescence of lesions as well as due to absence of IV contrast. Distended gallbladder containing layering sludge.SPLEEN: No significant abnormality noted.PANCREAS: Not well assessed on this noncontrast study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Cecal mass with adjacent mesenteric nodularity increased in prominence, measuring 5.4 x 3.9 cm in coronal plane, image 43, previously measured 5.7 x 3.3 cm. Appendiceal thickening again seen. Marked colonic wall thickening, particularly involving transverse colon and beyond to level of rectum. Peritoneal/omental nodularity, comparison difficult due to absence of IV contrast but appearance similar. No definite extraluminal/free air.PELVIS:UTERUS, ADNEXA: Small pelvic ascites. Bilateral pelvic sidewall soft tissue attenuation increased in prominence. For example, on right side, measures 3.7 x 3.7 cm, image 125 series 3, previously measured 3.7 x 3.1 cm.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance, including sclerotic focus in right iliac wing that may be a metastatic focus. Moderate to severe anasarca. | 1. Findings consistent with acute colitis with marked wall thickening, particularly involving transverse colon and beyond to level of rectum.2. Cecal mass with adjacent mesenteric nodularity increased in prominence. Peritoneal/omental nodularity, likely reflecting carcinomatosis.3. Innumerable hepatic metastases, demonstrating interval enlargement and increased coalescence. Marked diffuse hepatic steatosis, new or progressed from prior study4. Small pelvic ascites. Bilateral pelvic sidewall soft tissue attenuation increased in prominence, worrisome for ovarian metastatic disease. 5. Incompletely imaged lung fields demonstrate numerous pulmonary nodules, without significant change. 6. Stable sclerotic focus in right iliac wing that may be a metastatic focus. |
Generate impression based on findings. | Male 57 years old; Reason: Evaluate for obstruction History: distension, vomiting ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small splenule. PANCREAS: Areas of marked fatty atrophy involving pancreas, primarily uncinate process, pancreatic head and neck. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 1.1 x 0.9 cm right adrenal nodule with associated Hounsfield units of 6 on this noncontrast study, consistent with a lipid rich benign adenoma.RETROPERITONEUM, LYMPH NODES: Mild fat stranding and small fluid seen.BOWEL, MESENTERY: Moderate gastric distention with stomach containing ingested material and air. Moderate to marked luminal narrowing at level of pylorus and proximal duodenum, seen to approximately junction of second/third portions of duodenum. Surrounding fat stranding seen, extending to level of retroperitoneum. Tiny hiatal hernia. Normal appendix.PELVIS:PROSTATE/SEMINAL VESICLES: Prostatic calcification.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Diastases of rectus abdominis muscles. 3.4 cm fat containing umbilical hernia. Multilevel degenerative changes of spine. | 1. Fat stranding about the proximal duodenum and pancreatic head. Findings may reflect acute duodenitis, peptic ulcer disease or acute pancreatitis, although the latter would be unusual in the setting of the patient's reported normal lipase level. Associated gastric distention suggests partial outlet obstruction, at level of pyloroduodenal junction. Further evaluation with endoscopy may be useful and follow up to resolution recommended to exclude underlying neoplasm.2. 1.1 x 0.9 cm right adrenal nodule with associated Hounsfield units of 6 on this noncontrast study, consistent with a lipid rich benign adenoma.3. Small fat containing umbilical hernia |
Generate impression based on findings. | Female 57 years old; Reason: Evaluate for SBO vs post op infection/complication History: feculent emesis ABDOMEN:LUNGS BASES: Small dependent bibasilar atelectasis. Sites of subcentimeter pleural-based nodularity, nonspecific. For example, 4 mm left lower lobe pleural-based nodule, image 7 series 4. LIVER, BILIARY TRACT: Left hepatic lobe radiodensity, suggestive of coarse or dystrophic calcification. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Status post distal pancreatectomy for previously visualized main duct IPMN, associated surgical clips and fluid/stranding seen. Loculated bilobed (versus 2 collections adjacent to one another) fluid collection seen in expected region of pancreatic neck, extending along suture line, component measures approximately 4.6 x 2 .6 cm, image 43 series 3, more laterally located component measures 2.8 x 1.7 cm. Resultant mild narrowing seen near portal vein/splenic vein confluence however portal veins, splenic vein and SMV patent. Upper abdominal mesenteric edema present. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 3.9 cm right renal cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic aortobiiliac disease.BOWEL, MESENTERY: Normal-appearing appendix. Mildly prominent mesenteric lymph nodes, measuring up to 10 mm in left upper quadrant, image 37 series 3.PELVIS:UTERUS, ADNEXA: Calcified fibroid uterus. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multiple skin staples, beneath which is loculated fluid (measuring 2.1 x 0.9 cm on transaxial imaging) and air in subcutaneous tissues. Additional sites of subcutaneous emphysema may reflect sites of prior injection. | 1. Status post distal pancreatectomy for previously visualized main duct IPMN, associated surgical clips and fluid/stranding seen. Loculated bilobed (versus 2 collections adjacent to one another) fluid collection seen in expected region of pancreatic neck, extending along suture line, as described. Resultant mild narrowing seen near portal vein/splenic vein confluence however portal veins, splenic vein and SMV patent. Differential considerations for the fluid collection include postoperative seroma (superimposed infection not excluded, but no rim enhancement or internal gaseous foci seen at this time) and pancreatic fluid leak, correlation with patient's clinical history and continued follow up recommended.2. Mildly prominent presumed mesenteric left upper quadrant lymph node, may be reactive in etiology.3. Multiple skin staples, beneath which is loculated fluid (measuring 2.1 x 0.9 cm on transaxial imaging) and air in subcutaneous tissues. 4. Left hepatic dystrophic calcification. 5. Fibroid uterus. 6. Small dependent bibasilar atelectasis. Sites of subcentimeter pleural-based nodularity, nonspecific. |
Generate impression based on findings. | Female 45 years old; Reason: 45yo F with recent cholecystectomy complicated by cystic artery bleeding with ex lap and indwelling JP drain now with sudden increased in serosanguinous output and abdominal pain, concern for bleeding. History: abdominal pain, increasing serosanguinous drain output ABDOMEN:LUNGS BASES: Small right and trace left bilateral pleural effusions with underlying atelectasis. LIVER, BILIARY TRACT: Status post cholecystectomy. Relatively hyperdense material seen in Morison's pouch and extending superiorly above right kidney, consistent with hematoma, essentially stable accounting for differences in technique and positioning, measuring 5.5 x 4.1 cm, previously measured 5.9 x 3.6 cm. Additional focal area of soft tissue attenuation seen in central abdomen, mildly increased in size, measuring 5.2 x 4.1 cm, previously measured 3.3 x 3.3 cm. Another site of dense fluid is seen near the gallbladder fossa, extending along the inferomedial margin of the liver and into right paracolic gutter. Patent portal veins. Splenic vein attenuated, particularly near splenic hilum, but visualized portions patent otherwise.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: Mild calcified aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Small abdominopelvic ascites, mildly decreased from prior study. Right abdominal approach drainage catheter seen with tip in left abdomen, small hematoma seen at site of catheter entry site (perihepatic, in abdomen). Central abdominal probable hematoma described above. Colonic diverticulosis without evidence of acute diverticulitis, colonic underdistention, making evaluation for underlying wall thickening suboptimal. Scattered areas of pneumoperitoneum, presumably postsurgical/postprocedural in etiology. Moderate to marked diffuse haziness of mesentery.PELVIS:UTERUS, ADNEXA: Intrauterine device.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multiple mid abdominal skin staples, ventral abdominal subcutaneous lobular soft tissue attenuation, located beneath the right sided skin staples and relatively hyperattenuating, likely reflecting hematoma, additional periumbilical skin staples seen. | 1. Status post cholecystectomy and hematomas seen, in Morison's pouch, in gallbladder fossa, in central abdomen and near drainage catheter intraabdominal entry site. If there is clinical concern for active hemorrhage, this would be better assessed with dedicated CT angiography recommended. 2. Small abdominopelvic ascites, mildly decreased from prior study.3. Scattered areas of pneumoperitoneum, presumably postsurgical/postprocedural in etiology.4. Multiple mid abdominal skin staples, ventral abdominal subcutaneous lobular soft tissue attenuation, located beneath the right sided skin staples and relatively hyperattenuating, likely reflecting subcutaneous hematoma.5. Small right and trace left bilateral pleural effusions. |
Generate impression based on findings. | Female 48 years old; Reason: Evaluate for infectious process History: abdominal pain , n/v/d ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Status post distal pancreatectomy and some calcification seen, suggestive of chronic calcific pancreatitis. Chronically thrombosed splenic vein. Varices seen, one of which on the right enters ventral abdominal hernia. Patent portal veins and SMVADRENAL GLANDS: Stable left adrenal nodularity.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid colon diverticulosis without evidence of acute diverticulitis.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Similar in appearance to earlier exam is diastases of rectus abdominis muscles (defect measures 7.8 cm in transverse dimension) containing fat and small and large bowel with superimposed more focally herniating areas also seen. Visualized osseous structures stable in appearance. Mild spinal degenerative disease. | 1. No evidence of small bowel obstruction. 2. Status post distal pancreatectomy and some calcification seen, suggestive of chronic calcific pancreatitis. Chronically thrombosed splenic vein and varices seen. 3. Ventral abdominal hernia formation as above. |
Generate impression based on findings. | Dobbhoff tube placement Dobbhoff tube seen with tip extending just beyond gastroesophageal junction. Nonobstructive gas pattern suggested. Gastric band is seen in a near transversally oriented position, suspicious for slippage. Associated reservoir and tubing incompletely seen. Spinal fixation hardware and neurostimulator device partially visualized. | Enteric tube as above.Appearance suggestive of slipped gastric band, correlation with patient's clinical history recommended and further evaluation with dedicated upper GI may be considered. |
Generate impression based on findings. | Evaluate stool burden, assess for bowel obstruction No evidence of bowel obstruction. Moderate stool burden. Multilevel degenerative changes of spine and scoliosis. Bilateral hip degenerative disease. Decreased osseous mineralization. Vascular calcifications. | 1. Moderate stool burden, no bowel obstruction. |
Generate impression based on findings. | Dobbhoff tube placement Suboptimal exam due to patient motion artifact. Dobbhoff tube located in gastric body. Dilated small bowel with air noted distally in colon, findings suspicious for partial or evolving small bowel obstruction. Enthesophyte formation along left iliac wing. | Enteric tube as above.Dilated small bowel with air noted distally in colon, findings suspicious for partial or evolving small bowel obstruction and continued follow up recommended. |
Generate impression based on findings. | Abdominal distention Upper abdominal surgical clips. Mild gastric gaseous distention. Nonobstructive bowel gas pattern. Intrauterine device present. Please refer to concomitant chest radiography from same day for additional findings. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Dobbhoff tube placement, altered mental status Dobbhoff tube seen with tip extending into distal gastric body, guidewire present and tubing kinked near tip of guidewire. Nonobstructive bowel gas pattern. Similar to prior study is apparent displacement of bowel into lower portion of abdomen, of uncertain clinical significance. Pelvis excluded from field of view. Retrocardiac atelectasis/air space disease. | Enteric tube as above. |
Generate impression based on findings. | Dobbhoff tube placement Dobbhoff tube seen with tip located in gastric fundus. Small residual enteric contrast suggested, may be from patient's recent OPM. Paucity of bowel gas, small air and stool in ascending colon, no definitive evidence of bowel obstruction. Please refer to subsequent chest radiography for additional findings. | Enteric tube as above. |
Generate impression based on findings. | Female 62 years old; Reason: Evaluate for renal calculi, upper urinary tract lesions History: microscopic hematuria ABDOMEN:LUNGS BASES: Small dependent bibasilar atelectasis. LIVER, BILIARY TRACT: Hepatic calcified granuloma. Nonvisualization of gallbladder, presumably related to prior cholecystectomy. Mild intrahepatic biliary duct prominence and common bile duct measures up to 8 mm proximally and tapers distally, likely related to patient's postcholecystectomy state. Additional hypoattenuating lobulated structure lateral to junction of common bile and hepatic ducts and adjacent to postsurgical suture material, image 37 series 9, may be cystic duct remnant. No radiopaque choledocholithiasis. Patent portal veins. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Minimal left adrenal nodularity.KIDNEYS, URETERS: Subcentimeter 7 mm left intrarenal hypoattenuating focus with Hounsfield units of 4 on noncontrast study, 31 HU in the corticomedullary phase and 8 HU in the excretory phase, a cystic/mildly enhancing papillary type renal cell carcinoma is a consideration based on these findings. No filling defect is seen in ureters and delayed phase of imaging. Additional tiny hypoattenuating foci seen in renal lower poles, too small to characterize. No hydronephrosis. No radiopaque renal or ureteral stone seen. RETROPERITONEUM, LYMPH NODES: No enlarged adenopathy.BOWEL, MESENTERY: Small to moderate stool in moderate stool in colon.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Decreased osseous mineralization. | 1. Subcentimeter 7 mm left intrarenal hypoattenuating focus with Hounsfield units of 4 on noncontrast study, 31 HU in the corticomedullary phase and 8 HU in the excretory phase, a cystic/mildly enhancing papillary type renal cell carcinoma is a consideration based on these findings. |
Generate impression based on findings. | Female 43 years old; Reason: 43 year old female, femoral hernia, please evaluate for abnormalities History: hernia ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Patent portal veins and splenic vein. Wedge shaped hypoattenuating defect in hepatic segment 6, image 39 series 3, while may reflect an area of fatty infiltration given appearance of vessels traversing area, location unusual and area of ischemia/evolving infarct a consideration. SPLEEN: Small splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement. RETROPERITONEUM, LYMPH NODES: Markedly attenuated intrahepatic IVC and multiple collateral vessels seen in expected region of infrahepatic IVC. Enlarged azygos vein. BOWEL, MESENTERY: Underdistention of hepatic flexure, making assessment for underlying wall thickening suboptimal. PELVIS:UTERUS, ADNEXA: Dominant right ovarian cystic focus measuring 4.7 x 4 cm, image 75 series 3. Heterogeneous prominence of endometrial stripe. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multiple subcutaneous varices, located in ventral, posterior and inguinal soft tissues. No inguinal or femoral hernia seen otherwise. | 1. Chronically thrombosed infrahepatic IVC. Enlarged azygos vein and multiple collateral vessels seen in expected region of infrahepatic IVC and varices in ventral, posterior and inguinal soft tissues. 2. Wedge shaped hypoattenuating defect in hepatic segment 6, area of ischemia/evolving infarct a consideration. 3. Right adnexal cystic focus measuring 4.7 x 4 cm, may be a dominant follicle. Heterogeneous prominence of endometrial stripe. Correlation with patient's clinical history and further imaging with pelvic sonography for these findings recommended. |
Generate impression based on findings. | Female 63 years old; Reason: s/p Hartmann's, preop evaluation H ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Status post splenectomy, stable splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild prominence of right renal collecting system, nonspecific.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. BOWEL, MESENTERY: Ingested oral contrast seen to level of mid transverse colon, image 60 series 3. Left-sided colostomy present, herniation of nondilated loop of contrast containing small bowel seen in a parastomal hernia. Small 2.4 cm fat containing umbilical hernia, image 94 series 3, loop of small bowel directed towards defect. No evidence of bowel obstruction. Satisfactory opacification of rectal stump achieved with retrograde instillation of rectal contrast, coronal image 68. No extraluminal contrast seen. Left-sided colonic diverticula without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel spinal degenerative disease, grade 1 anterolisthesis of L4 on L5. | 1. No extraluminal enteric contrast seen to suggest a leak. Satisfactory opacification of rectal stump achieved with retrograde instillation of rectal contrast. Ingested contrast did not reach colostomy during course of the exam.2. Small parastomal hernia, no bowel obstruction. 3. Left-sided colonic diverticula without evidence of acute diverticulitis. 4. Mild prominence of right renal collecting system, nonspecific and could reflect sequela of residual ureteral inflammation but improved from previously seen hydronephrosis on 8/27/14 CT study. 5. Small fat containing umbilical hernia. |
Generate impression based on findings. | Female 67 years old; Reason: Evaluate for HCC History: +cirrhosis ABDOMEN:LUNGS BASES: Punctate right lower lobe calcified granuloma. Subcentimeter juxtaphrenic lymph nodes.LIVER, BILIARY TRACT: Status post cholecystectomy. No arterially enhancing focus seen in liver. No hepatic mass delineated.SPLEEN: Measures 9.5 cm in craniocaudal dimension.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable simple right upper pole renal cyst, measuring 2.1 cm. Additional smaller mid pole renal right renal simple cystic focus seen. Additional smaller foci too small to characterize.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. BOWEL, MESENTERY: Left-sided colon diverticulosis without evidence of acute diverticulitis. BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. No evidence of suspicious liver mass. |
Generate impression based on findings. | Male 58 years old; Reason: New diagnosis of mycosis fungoides History: Erythroderma CHEST:LUNGS AND PLEURA: Apical pleural scarring/nodularity. Upper lobe predominant mild emphysematous disease. No pleural effusion. No suspicious lung nodule or mass. MEDIASTINUM AND HILA: Small mediastinal lymph nodes. Reference pretracheal lymph node measuring 0.8 x 0.6 cm, image 27 series 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter periportal lymph nodes. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild adrenal thickening bilaterally.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Tiny hiatal hernia. Underdistention versus mild sigmoid colonic wall thickening, may reflect chronic inflammation.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged 5.1 cm coarse calcification containing prostate. BLADDER: No significant abnormality noted.LYMPH NODES: Mildly prominent bilateral inguinal lymph nodes, measuring up to 1 subcentimeter. BONES, SOFT TISSUES: Multilevel degenerative spinal disease, most pronounced at L5/S1. | 1. Mildly prominent mediastinal and inguinal lymph nodes. No pathologically enlarged adenopathy otherwise.2. Please refer to concomitant CT soft tissues neck exam from same day for additional findings. |
Generate impression based on findings. | Male 60 years old; Reason: Evaluate Type A dissection for change in size over time History: S/p ascending aortic replacement for type A dissection CHEST:LUNGS AND PLEURA: Stable centrilobular and paraseptal emphysema. Status post sternotomy.MEDIASTINUM AND HILA: Esophagus deviated to the left, similar in appearance to prior study. Pleural bleb formation suggested in the medial aspect of right lower lobe, similar in appearance to earlier exam.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Previously seen nonobstructing right intrarenal stone no longer visualized. Stable relatively decreased left renal parenchymal enhancement. Subcentimeter hypoattenuating renal lesions, too small to characterize but without significant change. Probable small complex cyst seen in right renal lower pole, image 206 series 3. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Evaluation suboptimal secondary to moderate to large stool and paucity of intraabdominal fat.PELVIS:PROSTATE, SEMINAL VESICLES: Calcification containing prostate gland.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine, most pronounced in lumber spine and levoscoliosis seen. Marked right-sided hip osteoarthritis present, mild degenerative disease of left hip.VASCULAR: A type A dissection status post repair is identified. The dissection flap arises in the supravalvular aorta and extends into the right brachiocephalic artery, both subclavian arteries, the left common carotid artery and distally into the thoracic aorta and subsequently into the abdominal aorta inferiorly. Mild calcified coronary artery disease. Ascending aortic aneurysmal dilatation without significant change. Proximal descending aorta mildly increased in prominence, measuring 5.2 cm on image 58 series 10618, previously measured 4.4 cm. Interval decrease in amount of peripheral intramural hematoma or thrombus in descending aorta. Stable size of suprarenal abdominal aorta, measuring 4.4 cm, coronal image 36 series 80653. Dissection flap extends into abdominal aorta and into celiac artery which primarily arises from the false lumen. The SMA arises from the true lumen. The left renal artery extends from the false lumen. The right renal artery arises from the true lumen. The dissection flap extends into the left iliac and femoral arteries. Thrombosis of the false lumen of the left external iliac artery is again seen. Contrast opacification of internal iliac artery branches, which arise from the true lumen, on the left are seen. The dissection flap extends into the right common iliac artery, where there is apparent thrombosis of the true lumen, similar in appearance to prior study. The right external iliac artery is thrombosed. The right internal iliac artery branches arise from the false lumen. Reconstitution of right common femoral artery noted. | 1. Type A dissection status post repair without interval change in craniocaudal extent as described. Proximal descending aorta mildly increased in prominence, measuring 5.2 cm, previously measured 4.4 cm, interval decrease in amount of peripheral intramural hematoma or thrombus in descending aorta. Ascending aortic and aortobiiliac luminal measurements otherwise without significant change. 2. Severe emphysema.3. Severe right hip and spinal degenerative disease. |
Generate impression based on findings. | Female 72 years old; Reason: Evaluate for calculi, upper urinary tract lesions History: Microhematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse marked hepatic steatosis, making evaluation for underlying liver lesion suboptimal. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No nonobstructing radiopaque renal stone, no radiopaque ureteral stone. Lobulated right renal parapelvic hypoattenuating lesion most likely a simple parapelvic cyst given Hounsfield units of 8 on unenhanced portion of the exam and Hounsfield units of 16 in corticomedullary phase. Left lower pole 0.7 cm hypoattenuating nonenhancing renal lesion, coronal image 35 series 80292, consistent with a cyst. Additional adjacent subcentimeter punctate hypoattenuating foci in left renal lower pole, axial image 57 series 7, and in right kidney (for example, image 61 series 7) too small to adequately characterize. Portion of distal left ureter not as well assessed in delayed phase, most likely due to underdistention/peristalsis, image 113 series 9. No discrete ureteral filling defect delineated. No significant hydronephrosis or upstream dilatation seen.RETROPERITONEUM, LYMPH NODES: Mild calcified aortic atherosclerotic disease.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroid uterus. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine. | 1. No radiopaque urolithiasis, renal cysts as above.2. Calcified fibroid uterus. 3. Diffuse marked hepatic steatosis |
Generate impression based on findings. | Female 52 years old; Reason: assess for metastatic disease, history of endometrial cancer status post lung resection CHEST:LUNGS AND PLEURA: Enlarging pleural-based left lower lobe lung nodule, measuring 1.2 x 1 cm, image 67 series 5, previously measured 0.7 x 0.6 cm. Unchanged 4 mm left lower lobe lung nodule, image 41 series 5. Additional right posterior pleural-based lung nodule stable, measuring 5 mm, image 39 series 5. Scarring/postprocedural sequela noted in right upper lobe. No pleural effusion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable prominent liver, measuring up to 17 cm in craniocaudal dimension. Hepatic steatosis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Asymmetrically atrophic left kidney, left ureter difficult to trace beyond postsurgical retroperitoneal clips.RETROPERITONEUM, LYMPH NODES: Retroperitoneal surgical clips, presumably related to nodal dissection.BOWEL, MESENTERY: Increased fatty proliferation around rectosigmoid colon and stable rectosigmoid wall thickening, likely secondary to prior radiation therapy.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Interval enlargement of the left lower lobe lung nodule that was discovered new on the earlier 11/8/14 CT exam, nodule now measures up to 1.2 cm, suspicious for pulmonary metastatic disease. Additional subcentimeter lung nodules stable. |
Generate impression based on findings. | Female 63 years old; Reason: 63 yr old female with stage IIIC fallopian tube cancer, '08 TAH/BSO and chemotherapy. S/p 14 cycles cabozantinib. Please assess disease status and compare with baseline scan. CHEST:LUNGS AND PLEURA: Biapical pleural nodularity/scarring. Moderate centrilobular upper lobe predominant emphysema. Scattered bilateral micronodules without significant change. Probable right upper lobe peripheral scarring seen anteriorly, stable in appearance, image 26 series 5. No pleural effusion.MEDIASTINUM AND HILA: Reference left supraclavicular node without significant change accounting for differences in technique, measuring 1 x 0.8 cm, image 5 series 3, previously measured 1.1 x 0.7 cm (decreased in size from 1/27/14 CT study, when measured 2.2 x 0.9 cm). Unchanged small mediastinal and right hilar lymph nodes. Stable subcentimeter right thyroid nodule.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis with focal sparing seen near gallbladder fossa. SPLEEN: Splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortic calcified atherosclerotic disease. Retroperitoneal surgical clips, likely related to prior nodal dissection.BOWEL, MESENTERY: Mild to moderate jejunal wall thickening, for example, image 145 series 3. No significant surrounding fat stranding seen. Alternating areas of mild small bowel dilatation, measuring up to 3.5 cm, and narrowing visualized in multifocal distribution, appearance similar to earlier CT study. Somewhat tethered appearance of small bowel to anterior abdomen. Findings again may reflect underlying nonobstructive adhesive disease. Contrast did not reach level of colon, may be due in part to timing of IV contrast bolus as well as element of partial obstruction. Left-sided colon diverticulosis without evidence of acute diverticulitis. Duodenal diverticulum in third portion of duodenum. Left sided colon diverticulosis without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal postsurgical sequela. Visualized osseous structures stable in appearance from earlier study. Degenerative spinal disease, vertebral disk space narrowing most pronounced at L5/S1. Unchanged decreased osseous mineralization with particularly decreased radiodensity involving lumber spine and thoracolumbar junction, may reflect postradiation sequela.OTHER: Improvement in previously visualized trace pelvic ascites. | 1. Mild to moderate jejunal wall thickening, may be due in part to underdistention and no adjacent fat stranding seen but correlation with patient's clinical history recommended to exclude underlying enteritis. Alternating areas of mild small bowel dilatation, measuring up to 3.5 cm, and narrowing visualized in multifocal distribution, appearance similar to earlier CT study. Somewhat tethered appearance of small bowel to anterior abdomen. Findings again may reflect underlying nonobstructive adhesive disease. Contrast did not reach level of colon, may be due in part to timing of IV contrast bolus as well as element of partial obstruction. 2. Remainder of exam without significant change, including reference left supraclavicular lymph node. |
Generate impression based on findings. | Reason: evaluate for hemorrhagic stroke History: headache similar to headache before last stroke There is redemonstration of an area of hypoattenuation at the interface of the left internal capsule and basal ganglia.Hypodensity in the right middle frontal gyrus with associated volume loss consistent with encephalomalacia. Periventricular and subcortical white matter hypodensities of a moderate degree are present.The CSF spaces are appropriate for the patient's stated age with no midline shift. No new abnormal mass lesions are appreciated intracranially. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Right frontal lobe focus of encephalomalacia is related to a cerebral infarction from last May.2.Chronic lacunar infarction at the left internal capsule related to a prior hemorrhage.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Reason: ICH History: pmh of CVA p/w episode of unresponsiveness, R gaze deviation There is encephalomalacia present along the left temporal lobe and the left parietal lobe. There is associated ex vacuo effect on the left lateral ventricle. This is stable since the prior exam.There is a focus of encephalomalacia present along the left precuneus. This is stable since the prior exam.There is a small focus of encephalomalacia present along the right parietal lobe.This is stable since the prior exam.Small hypodense foci are present in the right mid brain, left cerebellum, the right thalamus as well as in the basal ganglia bilaterally. These are stable since the prior exam.Periventricular and subcortical white matter hypodensities of a moderate degree are present. These are stable since the prior exam.Atherosclerotic calcifications are present along the distal internal carotid arteries.Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is encephalomalacia present along the left middle cerebral artery territory involving left temporal lobe and the left parietal lobe as well as a watershed territory between the left to middle and posterior cerebral arteries.2.There is a small focus of encephalomalacia in the right parietal lobe which is also stable and likely vascular related.3.Punctate lesions in the brain stem, thalami and basal ganglia are suspected to represent lacunar infarcts.4.Periventricular and subcortical white matter hypodensities of a moderate degree are present. At this age these are most likely vascular related.5.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Reason: encephalitis, r/o hemorrhage History: as above There is redemonstration of hypodensity predominantly involving white matter of the right frontal and temporal lobes with extensions into the right external capsule and the posterior limb of the right internal capsule. This is similar in extent compared to yesterday's exam but has progress over the last week.A burr hole is present in the right frontal bone.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Punctate hypodensities are present in the brainstem and cerebellum The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities. The visualized portions of the orbits are intact. The eyeball lenses are thin.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.Progressive white matter lesions involving the right hemisphere is similar in extent compared to yesterday's exam but has progress over the last week. Etiology is uncertain and the findings are not specific for a particular entity. Given its rapid progression and the lack of neoplasm on biopsy, an inflammatory condition including infection may be possible. This would include PML given its dominant white matter involvement.2.Findings suggest chronic lacunar infarctions in the brainstem, right cerebellum.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Reason: lesion History: headache The CSF spaces are appropriate for the patient's stated age with no midline shift. The left lateral ventricle is smaller than the right lateral ventricle.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Reason: evaluate for subacute ischemic stroke History: right leg weakness x 3 days The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin. Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Reason: hx of HOCM with ?subcortical strokes History: gait abnormality 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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact but very small. The right vertebral artery is dominant. The left A1 segment is dominant.The left vertebral artery is hypoplastic distal to the left PICA origin.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. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery is the smaller vertebral artery, however, its origin is not well visualized. | 1.No evidence for intracranial aneurysm nor intracranial cerebrovascular occlusive disease.2.No convincing evidence for cervical cerebrovascular occlusive disease. |
Generate impression based on findings. | Arterial insufficiency. Necrotic toes. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Endstage kidneys.RETROPERITONEUM, LYMPH NODES: Bilateral common femoral lymph nodes. For reference purposes, a right common femoral lymph node measures 12 x 18 mm (image 133; series 80896).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Peritoneal dialysis catheter coiled in the right lower quadrant. PELVIS:UTERUS, ADNEXA: Intrauterine device described previously has been removed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedVasculature: Common iliac arteries, external iliac arteries, and hypogastric arteries are all widely patent.RIGHT LEG: The common femoral artery, SFA, and profunda femoris are patent without significant stenosis. The popliteal artery is calcified and stenotic. Severe calcific atherosclerosis limits evaluation. Within this limitation, both the anterior tibial and peroneal arteries are occluded in the midcalf. Runoff is via a single diseased posterior tibial artery.LEFT LEG: The common femoral artery, SFA, and profunda femoris are patent without significant stenosis. The popliteal artery is calcified and stenotic. Severe calcific atherosclerosis limits evaluation. Within this limitation, both the anterior tibial and peroneal arteries are occluded in the midcalf. Runoff is via a single diseased posterior tibial artery. | Severe infrapopliteal calcific occlusive disease with runoff bilaterally via very diseased posterior tibial arteries. Endstage kidneys. |
Generate impression based on findings. | Male 59 years old Reason: CT venogram to assess portal vein vasculature AND assess volumetrics of the liver to assess for liver size. Assess colon for tumor burden. History: s/p hepatectomy. Please also assess colon for tumor burden. ABDOMEN:LUNG BASES: Cardiomegaly with left atrial enlargement. Small bilateral pleural effusions. Scattered basilar opacities may represent atelectasis or trace aspiration. A pigtail chest tube is present in the right anterior recess.LIVER, BILIARY TRACT: Status-post right hepatectomy with large perihepatic fluid collection measuring 13.1 x 8.4 x 12.6 cm (previously 13 x 11 cm). A surgical drain is appropriately positioned within the collection. There is a smaller fluid collection along the anteroinferior aspect of the left hepatic lobe measuring 4.5 x 4.9 x 2.9 cm (previously 5.6 x 2.9 cm). A percutaneous drainage catheter is positioned within this collection. This is better evaluated on prior MRI and is compatible with a biloma. Trace air within this collection likely related to the drain catheter. A percutaneous left biliary drain is in place without significant residual intrahepatic or extrahepatic biliary ductal dilatation.Stable RFA ablation cavity within the left lobe of liver measures 2.3 x 1.3 cm. No foci of abnormal enhancement are identified within the liver parenchyma on this single phase exam. The main and left portal vein remain patent. The proper and left hepatic arteries are also patent. Moderate ascites.Interval hypertrophy of the left lobe of the liver which now measures 901 cc in volume (previously 491 cc).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Filter is in place within the infrarenal IVC.BOWEL, MESENTERY: Gastrojejunostomy tube is in place. Small esophagogastric varices are seen as well as other small portosystemic collaterals seen in the abdomen. The small bowel is dilated measuring up to 3.7 cm in diameter. There is a transition point in the central pelvis (series 3 image 111) with relative collapse of the distal small bowel. A loop ileostomy is present in the right lower quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Vasectomy clips are noted in the scrotum.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel obstruction and right lower quadrant ileostomy as described above. No evidence of extension of rectal cancer into surrounding pericolonic tissues.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine.OTHER: No significant abnormality noted | 1. Stable postoperative changes from right hepatectomy with stable perihepatic fluid collection status post drain catheter placement.2. Stable biloma adjacent to the left lobe of the liver with drainage catheter and left percutaneous biliary drain catheter in place.3. Small bowel obstruction with transition point in the central pelvis. There remains stool and air within the distal bowel suggesting an early or partial obstruction.4. Interval hypertrophy of the left lobe of the liver which now measures 901 cc in volume (previously 491 cc). |
Generate impression based on findings. | Female 12 years old Reason: eval for fracture/dislocation after twisting right ankle while walking History: pain and swelling right ankleVIEWS: Right ankle AP, lateral and oblique 3/15/15 (3 views) Soft tissue swelling and joint effusion, with no evidence of fracture or malalignment. | Soft tissue swelling and joint effusion as described. |
Generate impression based on findings. | Female 15 years old Reason: injured lt foot fri dancing r/o fx History: swellingVIEWS: Left foot AP, lateral and oblique 3/15/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Female 9 years old Reason: rule out megacolon History: abdominal pain, diarrheaVIEW: Abdomen AP (one view) 3/15/15 at 2127 hrs. Gastrostomy tube and multiple surgical sutures are again noted. Nonspecific bowel distention. No evidence of free air or obstruction. | Nonspecific bowel distention. |
Generate impression based on findings. | malaise and fatigue The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | 10 month old term female with new onset seizure, mild hyperglycemia, and hyponatremia with excessive water intake. There is no evidence of intracranial hemorrhage. 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. | No evidence of intracranial hemorrhage. |
Generate impression based on findings. | There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present throughout.T10/11: Ligamentum flavum thickening and mild bilateral facet hypertrophy without stenosis.T11/12: Disc bulge/protrusion causes slight anterior cord flattening without intrinsic cord signal abnormality. There is also ligamentum flavum thickening and mild bilateral facet hypertrophy. There are no significant stenoses.T12/L1: UnremarkableL1/2: Minimal disc bulge without stenosis.L2/3: Minimal disc bulge without stenosis.L3/4: Mild disc bulge and minimal bilateral facet hypertrophy. There are no significant stenoses.L4/5: Trace anterolisthesis L4 on L5, asymmetric bulge to the left, ligamentum flavum thickening, severe left facet hypertrophy, and moderate right facet hypertrophy. There is mild left neural foraminal stenosis. Reactive edema can be found within the marrow of bilateral facet joints (left greater than right).L5/S1: Mild disc bulge and moderate bilateral facet hypertrophy without stenosis. Reactive edema can be within the marrow of bilateral facet joints (left greater than right). | 1.T11/12: Disc bulge/protrusion causes slight anterior cord flattening without intrinsic cord signal abnormality or stenosis.2.L4/5: Trace anterolisthesis L4 on L5, severe left facet hypertrophy, and moderate right facet hypertrophy. There is mild left neural foraminal stenosis. Reactive edema can be found within the marrow of bilateral facet joints (left greater than right).3.L5/S1: Moderate bilateral facet hypertrophy without stenosis. Reactive edema can be within the marrow of bilateral facet joints (left greater than right). |
Generate impression based on findings. | 17-year-old male with pain to the medial and lateral malleolus.VIEW: Left ankle oblique varus stress view (one view) 3/15/15 Redemonstrated is a curvilinear ossification adjacent to the distal tip of the fibula which may represent a normal variant or an avulsion fracture. No other fractures are identified. The ankle mortise joint is maintained in varus stress view. There is no widening to suggest a ligamentous injury. | The ankle mortise joint is maintained in varus stress. Curvilinear ossification adjacent to the distal tip of the fibula may represent a normal variant or an avulsion fracture. |
Generate impression based on findings. | Injured left hand playing football. Pain and swelling to fifth digit. Question of fracture. Three views of the left hand show no acute fracture or malalignment. There is soft tissue thickening in the base of the fifth digit. | Soft tissue swelling without acute fracture. |
Generate impression based on findings. | Male, 18 years old. Reason: Evaluate for possible GI infection or abnormalities in bowel pattern History: Fever, increased stoolVIEW: Abdomen AP (one view) 3/15/2015, 1231 Gastrostomy tube in place.Nonobstructive bowel gas pattern.Leftward thoracolumbar curve is mildly increased from prior. Bilateral hip joint narrowing. | No evidence of bowel obstruction. |
Generate impression based on findings. | 27 years, Female. Reason: ileus, constipation History: abd pain, nv There is a nonobstructive bowel gas pattern. Cholecystectomy clips project over the right upper quadrant. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | Shortness of breath. Altered mental status The CSF spaces are appropriate for the patient's stated age with no midline shift. There is mild asymmetry of the lateral ventricles the right is smaller compared to the left.Exam is mildly compromised by patient motionNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Exam is mildly compromised by patient motion which may obscure more subtle abnormalities. |
Generate impression based on findings. | All of the paranasal sinuses are clear as are the bilateral mastoid air cells and middle ear cavities and there are no air-fluid levels. The bilateral maxillary sinus ostia are patent as are the bilateral frontoethmoidal and sphenoethmoidal recesses. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is deviated leftward with a left-sided septal spur. Bilateral orbits and the posterior nasopharynx appear unremarkable. | The nasal septum is deviated leftward with a left-sided septal spur. Otherwise negative CT scan of the sinuses. |
Generate impression based on findings. | Motor vehicle accident one week ago with pain to the entire ring finger. Question of fracture. Three views of the right hand show no acute fracture or malalignment. A previously described right fourth metacarpal fracture is healed. | No acute fracture is evident. |
Generate impression based on findings. | Female; 87 years old. Reason: rupture AAA History: possible rupture AAA CHEST:LUNGS AND PLEURA: Moderate upper lobe predominant paraseptal and centrilobular emphysema. Diffuse groundglass opacity, most suggestive of pulmonary edema. Small pleural effusions. Mild nonspecific left basilar atelectasis/consolidation.MEDIASTINUM AND HILA: Mild cardiomegaly. No pericardial effusion. Severe coronary artery calcifications. Postsurgical changes from CABG. Small hiatal hernia.CT Angiogram: Diffuse atherosclerotic changes and calcification are seen throughout the aorta. Right innominate, subclavian and common carotid arteries show normal opacification. No opacification is seen in the left common carotid or left vertebral artery. Left subclavian artery shows atherosclerotic changes but without significant narrowing.Moderate nonspecific mediastinal lymphadenopathy. For future reference, a precarinal lymph node measures 22 mm in short axis (series 11022/30).CHEST WALL: Median sternotomy changes.ABDOMEN:LIVER, BILIARY TRACT: Mild dilation of the common bile duct measuring up to 9 mm, likely normal in this patient status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral cysts. There are two right renal arteries, with an accessory inferior right renal artery supplying the lower pole. Atrophy of the right kidney superior pole, likely secondary to chronic stenosis of the superior right renal artery.RETROPERITONEUM, LYMPH NODES: CT ANGIOGRAM: Marked atherosclerosis of the aorta and its branch vessels. Infrarenal abdominal aneurysm measuring up to 3.7 x 3.7 cm (series 11/117). Origin of the celiac axis appears normal. Marked narrowing is seen at the origin of the SMA, with good peripheral run off. The IMA is well opacified without evident obstruction. Extraluminal contrast pooling at the right lateral aspect of the suprarenal abdominal aorta, compatible with pseudoaneurysm. This is most likely secondary to advanced penetrating ulcer of the abdominal aorta at this location, but may also involve the proximal right superior renal artery, the origin of which is not well visualized.Increased retroperitoneal hemorrhage adjacent to the contrast pooling and extending inferiorly to the left pararenal space, compatible with interval rupture since prior study 3/13/15. On the current exam, contrast appears to be contained within the hematoma.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple small fat-containing ventral hernias.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small, ill-defined hypoattenuating lesion within the uterus near the fundus is most likely due to a fibroid.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. Pseudoaneurysm of the suprarenal abdominal aorta which appears to be contained on the current examination, though there has been interval increased retroperitoneal hemorrhage since 3/13/15. Findings are highly concerning for further impending rupture.2. Occluded left common carotid artery.3. Findings suggestive of mild CHF.4. Nonspecific left basilar atelectasis/consolidation, for which underlying infection cannot be excluded.5. Nonspecific mediastinal lymphadenopathy.6. Atropic right upper pole kidney, secondary to right upper pole renal artery chronic disease. |
Generate impression based on findings. | 17 year-old male with ankle pain after fallVIEWS: Left ankle: AP, oblique, lateral; tibia-fibula: AP, lateral (5 views) 3/15/15 Left ankle: There is a 4-mm curvilinear ossification adjacent to the distal tip of the fibula which may represent a normal variant or avulsion fracture. Moderate soft tissue swelling is noted about the ankle. A moderate joint effusion is present.Left tibia-fibula: Again seen is previously described fibular avulsion fracture. No other fractures identified. | Curvilinear ossification adjacent to the distal tip of the fibula may represent a normal variant or an avulsion fracture. |
Generate impression based on findings. | There are multiple dental caries with scattered periapical lucencies noted. A periapical lucency over ADA #5 is seen with overlying cortical dehiscence. This communicates with a rim-enhancing collection of fluid immediately anterior to the right maxilla measuring 24 x 16 x 12 mm. The overlying subcutaneous soft tissues are thickened with fat stranding. There is moderate mucosal thickening of the underlying right maxillary sinus but the remainder of the sinuses appear normal with patent bilateral ostiomeatal complexes. The salivary glands, thyroid gland, and pharyngeal tissues appear normal. The visualized skull base and orbits appears normal. The visualized cervical spine appears normal. | 1.Periapical abscess of ADA #5.2.Associated right facial abscess. |
Generate impression based on findings. | 58 day old twin ex-37 week female with rib fractures of multiple ages and concern for non accidental trauma. There is no evidence of intracranial hemorrhage. 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. Minimal overlap at the lamboid suture centrally is within normal limits. | No evidence of intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | 66-year-old female with history of right sided throat pain for 1.5 months, evaluate for abscess or mass There is slight asymmetric prominence of the lymphoid tissue at the right base of tongue, which is nonspecific, but may be postinflammatory in etiology. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent and otherwise unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. Several small left parotid lymph lymph nodes are noted. No lymphadenopathy is present. The carotid arteries and jugular veins are patent. Moderate degenerative changes affect the lower cervical spine. | Mild asymmetric prominence of right base of tongue lymphoid tissue which is nonspecific but possibly post inflammatory in etiology without other specific findings to account for patient's symptoms. |
Generate impression based on findings. | Pain to right hip since last night. No trauma. Question of hip fracture. Two views of the right hip show no acute fracture or malalignment. There are vascular calcifications. Mild osteoarthritis affects the right hip.Additional AP view of the pelvis reveals no acute fracture. Mild osteoarthritis affects the left hip. | No acute fracture is evident. |
Generate impression based on findings. | 30 years, Female. Reason: source of worsening abd pain. 30F with LVAD; admitted with neutropenic fever; relapsed AML after chemo; s/p syngeneic SCT x 2 History: neutropenic fever, epigastric and lower abd pain wrapping to back LVAD and sternotomy wires in place. There is a nonobstructive bowel gas pattern. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | Mild mucosal thickening with lobular components can be within bilateral maxillary sinuses. Bilateral ostiomeatal units remain patent.Bilateral sphenoid sinuses and sphenoethmoidal recesses are clear.Mild mucosal thickening can be within a few anterior bilateral ethmoid air cells.Mild mucosal thickening is present within the inferior bilateral frontal sinuses. The left frontoethmoidal recess is narrowed, although the right remains patent.Bilateral mastoid air cells and middle ear cavities are clear and there are no air-fluid levels. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is S-shaped with a large left sided septal spur. Bilateral orbits and the posterior nasopharynx appear unremarkable. | 1.Mild mucosal thickening with lobular components can be within bilateral maxillary sinuses. Bilateral ostiomeatal units remain patent.2.Mild mucosal thickening can be within a few anterior bilateral ethmoid air cells.3.Mild mucosal thickening is present within the inferior bilateral frontal sinuses. The left frontoethmoidal recess is narrowed, although the right remains patent.4.The nasal septum is S-shaped with a large left sided septal spur. |
Generate impression based on findings. | 47-year-old male for pre-LVAD workup LUNGS AND PLEURA: No pleural effusion or pneumothorax. Minimal bibasilar dependent atelectasis. Scattered nonspecific micronodules measuring up to 4 mm (series 6, image 26).MEDIASTINUM AND HILA: Swan-Ganz catheter tip is in the right descending pulmonary artery. Moderate cardiomegaly without pericardial effusion. No coronary artery calcifications. IABP catheter marker is 3 cm below the aortic arch in the descending thoracic aorta.No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary, retrocrural, or cardiophrenic lymphadenopathy. The osseous structures are within normal limits. No suspicious osseous lesions. Left chest wall ICD with leads in the right atrium, right ventricle, and coronary sinus.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hyperattenuating focus in the superior pole left kidney represent a hyperdense or hemorrhagic cyst or calcification. | 1.Moderate cardiomegaly.2.Swan-Ganz catheter tip is in the right descending pulmonary artery. 3.Hyperattenuating focus in the superior pole left kidney may represent a hyperdense or hemorrhagic cyst or calcification, incompletely assessed. |
Generate impression based on findings. | Reason: eval for ICH History: AMS The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Right hip pain and decreased ambulation. Evaluate for occult fracture. CT images of the right hip reveal no acute fracture. Alignment is anatomic. Mild osteoarthritis affects the right hip and right sacroiliac joint.There are vascular calcifications. The urinary bladder is distended. | Osteoarthritis without acute fracture evident. |
Generate impression based on findings. | 13-week-old male with history of BPD and increased work of breathing, concern for pneumoniaVIEWS: Chest AP/lateral (two views) 3/15/15 The cardiothymic silhouette is normal. No pulmonary opacity to suggest pneumonia. Bronchial wall thickening compatible with reactive airway disease/bronchiolitis. | Reactive airway disease/bronchiolitis pattern. |
Generate impression based on findings. | 23 years, Female. Reason: sbo History: worsened abd pain w/nv Slightly above average stool burden. There is a nonobstructive bowel gas pattern. There is mild gaseous distention of the stomach. Cholecystectomy clips are seen in the right upper quadrant. | Slightly above average stool burden. |
Generate impression based on findings. | Reason: Evaluate for posterior circulation occlusion History: Coma with bilateral loss of CN reflexes after GTC, heroin use Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.The patient is status post anterior fusion at C6-7. There there is mild reversal of the normal cervical curvature present. Patient is status post nasogastric and endotracheal intubation.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The right A1 segment is larger than the left A1 segment. There is fetal origin of the right posterior cerebral artery associated with a hypoplastic right P1 segment. The left posterior communicating artery is medium-sized.There is extracranial origin of the left posterior inferior cerebellar artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is poor discrimination of gray and white matter which is a nonspecific finding. It could be within the range of normal.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate partial opacification of the right maxillary sinus status post intubation. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is poor discrimination of gray and white matter which is a nonspecific finding. It could be within the range of normal, however given the patient's clinical history further evaluation with MRI or a follow-up CT of the head may be helpful to further assess this.2.No evidence for aneurysm.3.No evidence for cervicocerebral occlusive disease.4.No evidence for acute intracranial hemorrhage mass effect or edema.5.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Male 38 years old Reason: right sided peri-anal pain, concern for perianal/rectal abscess, fistula History: right sided buttock pain PELVIS:PROSTATE, SEMINAL VESICLES: Fat-containing left inguinal hernia.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Short segment narrowing of the rectosigmoid junction (series 3 image 43). There is no associated wall thickening, no proximal dilatation, or adjacent inflammatory changes. This is nonspecific and may represent normal peristalsis. Extending from the infralevator right perianal region and tracking in the subcutaneous soft tissues of the right gluteal soft tissues is a focus of linear induration compatible with a fistula. There is also induration along the right aspect of the superior gluteal cleft which may represent an additional branch of the fistulous tract, however no drainable fluid collection is evident to indicate an abscess. The appendix is air-filled and and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right sided infra-levator perianal fistula/fistulae as described without drainable fluid collection to indicate an abscess. MRI can be considered for more detailed evaluation. |
Generate impression based on findings. | 90 female with right hip pain after fall. Single view of the pelvis demonstrates a right femoral neck fracture, with superolateral displacement of the distal fracture fragment. There is mild bilateral osteoarthritis of the hip joints. The bones appear demineralized, suggestive of osteopenia.Two views of the right hip demonstrate the aforementioned right femoral neck fracture as well as the aforementioned osteoarthritis of the right hip.Two views of the right femur demonstrate the aforementioned right femoral neck fracture as well as severe osteoarthritis with bone-on-bone joint space narrowing of the right knee. | 1. Right femoral neck fracture as detailed above.2. Mild osteoarthritis of the hips.3. Severe osteoarthritis of the right knee. |
Generate impression based on findings. | 79 years, Male. Reason: ileus vs FOS History: Distention There is diffuse dilatation of the small bowel measuring up to 4 cm in maximal diameter as well as diffuse gaseous distention of the large bowel with the transverse colon measuring up to 12 cm in diameter. These findings may reflect diffuse ileus, colonic pseudoobstruction or distal obstruction. Hardware components of a left hip arthroplasty are in place. Surgical clips are present in the pelvis. | Diffuse dilatation of both large and small bowel, which may reflect diffuse ileus, colonic pseudoobstruction or distal obstruction. |
Generate impression based on findings. | Decrease in the size of the tongue base enhancing lesion now measuring 3.4 x 1.6 cm (series 9 image 14), previously 3.4 x 2.5 cm. There is decrease in the size of the right palatine tonsil enhancing lesion now measuring 2.3 x 2.4 cm (series 9 image 8), previously 2.7 x 3.0 cm. There is also decrease in the mass-effect on the right tongue.Decrease in the size of the previously seen right level 2 lymph node now measuring 1.1 x 2.0 cm (series 9 image 13), previously 2.6 x 3.0 cm. There is also decrease in the size of the left level 2 lymph node now measuring 0.9 x 1.3 cm (series 9 image 14), previously 1.4 x 1.8 cm.Scattered cervical lymph nodes, which are not enlarged by CT size criteria. The parotid, salivary, and thyroid glands are unremarkable. The airway is patent. Lung apices are unremarkable. Degenerative disk disease of the lower cervical spine. | 1.Decrease in the size of the tongue base and right palatine tonsil lesions.2.Decrease in the size of the bilateral cervical lymphadenopathy. |
Generate impression based on findings. | 12-week-old concern for NEC, bloody stoolsVIEWS: Abdomen AP, left lateral decubitus (two views) 3/16/15 NG tube with tip in the gastric antrum.Coarse opacities are present in the lung bases. Persistently dilated loops of bowel without evidence of pneumatosis, free air, or portal venous gas. Barium is noted within the rectum indicating that there is no obstruction. | Persistently dilated bowel loops without obstruction. |
Generate impression based on findings. | 56-year-old male with altered mental status Redemonstrated is a right trans-frontal tract as well as periventricular and subcortical white matter, thalami, basal ganglia, internal capsules, left cerebral peduncle, and pontine hypodensities. No abnormal mass lesions are appreciated intracranially. No acute hemorrhage is identified. No edema is identified within the brain parenchyma. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. | No CT evidence of acute intracranial process that would explain the patient's symptoms. |
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