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Generate impression based on findings. | 41-year-old female with history of chest pain. PULMONARY ARTERIES: No evidence of acute pulmonary embolus.LUNGS AND PLEURA: Linear opacities in the right base likely representing scarring. There is mild bibasilar atelectasis. MEDIASTINUM AND HILA: Mild cardiomegaly. No evidence of pericardial effusion. No significant coronary artery calcifications. No mediastinal lymphadenopathy. Diffusely enlarged thyroid gland.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of acute pulmonary embolus.2. Diffusely enlarged thyroid gland. A dedicated ultrasound may be considered if clinically warranted.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female, 10 months old. Evaluate tube placement, possible aspiration History: intubationVIEW: Chest AP (one view) 3/15/2015, 1513 Endotracheal tube with tip directed toward the right mainstem bronchus. Enteric tube with distal sideport at or slightly above the level of the GE junction.The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.Patchy bilateral opacities.Incompletely visualized dilated loops of bowel. | Patchy bilateral opacities may represent aspiration or atelectasis.Endotracheal tube with tip directed toward the right mainstem bronchus. Enteric tube with distal sideport at or above the level of the GE junction. These have both been corrected on subsequent imaging. |
Generate impression based on findings. | Left foot pain on the medial dorsal aspect. Three views of the left foot reveal no acute fracture or malalignment. There is joint space narrowing of the first metatarsophalangeal joint. | Osteoarthritis without acute fracture. |
Generate impression based on findings. | Knee pain. Evaluate for bony abnormality. Four views of the right knee reveal no acute fracture or malalignment. There is tricompartmental osteophyte formation and mild joint space narrowing. | Moderate osteoarthritis without acute fracture. |
Generate impression based on findings. | 53 years, Male. Reason: Evaluate for stool, gas History: RUQ pain Nonobstructive bowel gas pattern with above average stool burden. Patient status post right lower lobectomy. Superior and inferior endplate depression of thoracolumbar vertebral bodies suggestive of sickle cell anemia. | Nonobstructive bowel gas pattern with above average stool burden. |
Generate impression based on findings. | Previous identified brain metastases are not well identified with noncontrast CT technique. Multiple small punctate foci of hyperdensity, presumably representing calcifications, are present involving multiple cortices, and correlate with previously demonstrated foci of susceptibility effect. The ventricles and sulci are normal in size. There is no mass effect or midline shift. There is no evidence for acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. The patient is intubated. | No CT evidence for acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. Known metastases not visible by noncontrast head CT technique. |
Generate impression based on findings. | 11 day old former 24 week twin gestation with bilious emesis.VIEW: Abdomen AP (one view) 03/16/15, 0727 Feeding tube tip is in stomach. Umbilical venous line tip is at junction of inferior vena cava and right atrium. Coarse opacities are present in the bases.Bowel gas pattern remains disorganized. No gas is seen on the right. A few of the loops appear to be fixed. The loops are less distended than on the prior exam. No pneumatosis intestinalis, portal venous gas, free peritoneal air is identified. | Probable NEC; fixed left sided bowel loops. |
Generate impression based on findings. | Line placementVIEW: Chest AP and abdomen AP ET tube tip at the right mainstem bronchus. The umbilical venous catheter tip in the right atrium. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Diffuse lung haziness bilaterally without focal lung opacity. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | The umbilical venous catheter tip in the right atrium. Malpositioned ET tube. |
Generate impression based on findings. | Male 56 years old Reason: evaluate for acute intraabdominal process History: abdominal pain, persistent nausea/vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Stable prostatic calcifications.BLADDER: There is persistent moderate to marked distention of the bladder, however the previously noted bladder wall thickening has improved. This remains compatible with intravesicular obstruction.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable moderate to marked bladder distention compatible with chronic bladder outlet obstruction. Previously noted bladder wall thickening has improved. No additional findings to account for the patient's abdominal pain. |
Generate impression based on findings. | PICC placement. 10 day old former 24 week twin gestation.VIEW: Chest AP (one view) 03/15/15, 2204 Endotracheal tube tip is below thoracic inlet left upper extremity PICC has its tip in right atrium. Feeding tube tip is distal to GE junction and not included on image. Umbilical line remains in place.Lung volumes are large. Coarse opacities are present bilaterally. Interstitial emphysema continues. Cardiac silhouette is mildly enlarged. | Probable PDA on a background of complications from surfactant deficiency. |
Generate impression based on findings. | 85 years, Male. Reason: r/o obstruction History: emesis There is a nasogastric tube with its tip projecting over the antrum of the stomach. Moderate degenerative changes of the lower lumbar spine. Retrocardiac opacity suggest atelectasis/consolidation. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | 61-year-old male with history of pleural effusions. PULMONARY ARTERIES: No evidence of acute pulmonary embolus.LUNGS AND PLEURA: The right bronchus intermedius is completely obstructed by tumor and debris resulting in right middle and lower lobe atelectasis. There is a large right pleural effusion also contributing to diffuse compressive atelectasis. Large right lower lobe mass measures 6.8 x 4.8 cm causing localized mass effect on the left atrium and adjacent pulmonary vasculature. Right pleural metastases.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Mild coronary artery calcifications. There are enlarged mediastinal and hilar lymph nodes with reference right hilar node measuring 19 mm, previously 14 mm (image 140 series 7). Referenced precarinal lymph node measures 10 mm from a previous a 10 mm (image 68 series 7).CHEST WALL: Right pleural based mass invading into the adjacent rib measures 7.1 x 3.2 cm.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is an incompletely imaged large mass arising in the area of the upper pole of the left kidney which may represent a metastasis or a synchronous primary tumor. | 1. No evidence of acute pulmonary embolus.2. Complete obstruction of the bronchus intermedius by tumor/debris resulting in right middle and lower lobe atelectasis. Additionally, large right pleural effusion has increased in size.3. Overall increase in tumor burden.4. Large mass in the right perirenal space is incompletely imaged and would be better evaluated on dedicated abdominal imaging. Differential should include metastatic disease or a synchronous primary tumor.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 54-year-old female with left shoulder and hand pain status post MVC. Three views of the left shoulder demonstrate normal anatomic alignment. There is no evidence of acute fracture or significant degenerative disease. No significant soft tissue swelling.Three views of the left hand and wrist in normal anatomic alignment without significant soft tissue swelling or acute fracture. | No evidence of acute fracture or malalignment in the left shoulder or hand. |
Generate impression based on findings. | Male, 17 years old. Reason: post cast films History: knee painVIEWS: Left knee AP, lateral, oblique (3 views) 3/15/2015, 1836 Overlying casting material limits fine osseous detail.A nondisplaced fracture is again seen along the medial femoral metaphysis.Alignment is anatomic | Nondisplaced fracture of the medial femoral metaphysis. Status post casting. |
Generate impression based on findings. | 14-year-old male with gunshot woundVIEWS: Left femur: AP, lateral; right femur: AP, lateral; right knee: AP, lateral; left knee: AP, lateral; pelvis: AP; chest: AP (10 views) 3/15/15 Chest: The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No pneumothorax or pleural effusion. No lung opacities.Pelvis: No fracture or malalignment. No subcutaneous emphysema or projectile fragment is noted.Left knee: No fracture or malalignment. Scattered foci of gas are noted in the posterior soft tissues of the knee.Right knee: A bullet is situated in the soft tissues posterior to the distal femur. Soft tissue swelling is noted without evidence of fracture. Scattered gas foci are noted within the posterior soft tissues of the knee. A marker is placed at the location of the entrance wound.Right femur: No fracture or malalignment. Again noted is previously described bullet in the posterior soft tissues.Left femur: Significant soft tissue swelling and foci of gas are noted following the fascial planes of a left thigh due to a through-and-through ballistic injury. No evidence of fracture or malalignment. | Through-and-through ballistic injury of the soft tissues of the left thigh with bullet situated in the posterior soft tissues of the right knee. No evidence of fracture. |
Generate impression based on findings. | 44 year old with history of right lumpectomy with sentinel node biopsy in January 2011 for IDC. Status post chemotherapy, hormonal therapy and radiation therapy. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There are stable postsurgical changes in the right breast including volume loss, architectural distortion, increased density and surgical clips.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. In view of dense breast tissue and history of breast cancer in young age, breast MRI may be useful for annual screening. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | VSD repairVIEW: Chest AP Multiple mediastinal surgical clips are present. Cardiothymic silhouette at the upper limits of normal. Minimal perihilar atelectasis not significantly changed. No focal lung opacity. No pleural effusion or pneumothorax. | Minimal perihilar atelectasis not significantly changed. |
Generate impression based on findings. | 28-year-old female with left ankle pain status post fall two days prior. Three views of the left ankle demonstrate no evidence of fracture or malalignment. There is no significant soft tissue swelling.Three views of the left foot are unremarkable. No acute fracture or malalignment. | There is no acute fracture or malalignment. |
Generate impression based on findings. | 27-year-old male with pain of the left fifth digit after injury today. Three views of the left fifth digit demonstrate a linear ossific density tiny along the dorsal fifth proximal interphalangeal joint, consistent with a tiny avulsion fracture. Alignment is anatomic. There is mild soft tissue swelling.Three views of the left hand demonstrate the aforementioned avulsion fracture of the left fifth PIP joint. Remainder of the hand is unremarkable. | Tiny avulsion fracture along the dorsal fifth proximal interphalangeal joint. |
Generate impression based on findings. | 57-year-old male with right wrist pain. Two views of the right forearm demonstrate marked abnormality of the distal radius and ulna which are better delineated on the accompanying right wrist radiographs from the same date. There is significant soft tissue swelling of the dorsal aorta the lower aspect of the right wrist. No acute fracture is identified.Views of the left ankle, with stress, redemonstrate a comminuted fracture of the distal fibula, in near-anatomic alignment. Stress views of the left ankle are negative for medial joint space widening. | 1.Severe degenerative changes of the right wrist, which are better delineated on the accompanying right wrist radiographs.2.Comminuted distal left fibular fracture. No evidence of medial joint space widening on stress views. |
Generate impression based on findings. | Reason: Evaluate for fracture or other trauma History: Found down; comatose The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine.The patient is status anterior fusion at C6-7.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to neural foramina. There is a small central disk protrusion present at this level and associated with some effacement spinal fluid ventral posterior the spinal cord.At C4-5 there is no significant compromise to the neural foramina. There is a disk bulge present this level with some effacement of spinal fluid ventral and posterior to spinal cord appeared there is also left facet hypertrophy present.At C5-6 there is a broad-based disk extrusion present associated with effacement of spinal fluid ventral posterior to spinal cord and some flattening of the spinal cord. There is a moderate degree of spinal stenosis present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. The patient is status anterior fusion at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. | 1.There are multilevel degenerative changes present in the cervical spine worse at C5-6 where there is suspicion for a moderate degree of spinal stenosis. If clinically appropriate MRI cervical spine may help further evaluate this.2.The patient is status post anterior fusion at C6-7. |
Generate impression based on findings. | 29-year-old male status post anterior shoulder dislocation reduction. The humeral head articulates with the glenoid. There is a chronic Hill-Sachs deformity and a Bankart fracture, present dating back to remote films in 2012. | Glenohumeral joint in anatomic alignment. No acute fracture identified. Chronic Hill-Sachs deformity and Bankart fracture, unchanged. |
Generate impression based on findings. | 23-year-old female with pain and swelling of the right elbow. Three views of the right elbow demonstrate swelling of the soft tissues posteriorly, which may relate to known intramuscular hemangioma, or other superficial process, such as bursitis. There is no significant joint effusion, acute fracture, or malalignment evident. | Mild posterior soft tissue swelling. No evidence of septic joint as clinically queried. |
Generate impression based on findings. | Increased oxygen requirementVIEW: Chest AP Posterior spinal fusion rods again noted. The vagal stimulator device is in place. Cardiothymic silhouette normal. The left lung atelectasis has improved in the interval. Minimal patchy atelectasis left lower lobe. No large pleural effusion or pneumothorax. | Left lung atelectasis improved in the interval. |
Generate impression based on findings. | 45 year old female with third digit pain. Three views of the left hand demonstrate a well-corticated ossicle along the volar aspect of the second proximal interphalangeal joint, likely representing a sesamoid or accessory ossicle. No acute fracture or malalignment. | No acute fracture or malalignment is evident. |
Generate impression based on findings. | Male, 17 years old. Reason: knee pain History: knee painVIEWS: Right knee AP, lateral, oblique (3 views) 3/15/2015, 1543 Exam limited by suboptimal positioning.Undertubulation and demineralization, likely related to disuse.A small cortical step-off at the medial aspect of the distal femoral metaphysis. No additional fractures identified.Alignment is anatomic | Nondisplaced fracture of the medial aspect of the distal femoral metaphysis. |
Generate impression based on findings. | Male 33 years old Reason: evaluate for acute appendicitis History: RLQ abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Benign perfusion defect along the ligamentum teres. No focal parenchymal lesion or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Underdistended bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The appendix is air-filled and within normal limits. No evidence of appendicitis. Long segment narrowing of the descending colon with submucosal fatty proliferation compatible with chronic inflammation. No evidence of active inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Slightly narrowed descending colon with submucosal fatty proliferation compatible with chronic inflammation. No evidence of acute inflammation.2. No evidence of appendicitis or other findings to account for the patient's right lower quadrant pain. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (2/18/15, 2/24/15), ultrasound images of right breast(2/24/15), images from ultrasound guided biopsy of right breast and post-procedural right mammographic images (3/2/15) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images (11/8/12, 12/17/10) are available. DIGITAL MAMMOGRAPHIC IMAGES (2/18/15, 2/24/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a new irregularly shaped, ill-defined mass, measuring approximately 2 cm, at posterior right 12 o'clock position. No calcifications are associated with this mass.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND IMAGES OF RIGHT BREAST(2/24/15):A hypoechoic mass with thick echogenic rim is visualized at right 12 o'clock position, 5 cm from nipple, in the right breast, corresponding to the mass seen on the mammogram. The mass measures 18 x 11 mm including the echogenic rim.In the right axilla, there is one benign appearing lymph node.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POST-PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (3/2/15):Ultrasound guided biopsy was performed for the right 12 o'clock mass with appropriate needle placement. A marker clip was placed within the mass. Post-procedural right mammograms show the marker clip placed at the mass.Per outside report, the pathology result was malignant; invasive ductal carcinoma, grade 3. | Biopsy proven IDC in the right breast. In view of dense breast tissue and presence of high grade carcinoma, breast MRI might be useful for pre-operative assessment.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 71-year-old male. Metastatic glucagonoma to liver. s/p Therasphere administration. CHEST:LUNGS AND PLEURA: Stable scattered calcified and noncalcified micronodules, likely postinflammatory.Near complete resolution of the right lower lobe ground-glass and airspace opacity, likely represents resolving infection and/or aspiration.MEDIASTINUM AND HILA: Decreased size of previously prominent anterior mediastinal lymph node. No new lymphadenopathy.Normal heart size without pericardial effusion.Severe coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Surgical clips in the dome of the liver. Post-surgical findings of cholecystectomy. Multiple hepatic metastases are mildly decreased in size and show marked decrease in enhancing component. Reference lesions as follows:1. Caudate lobe lesion is 3.5 x 3.8 cm, previously 3.5 x 4.4 cm (series 9, image 40)2. Right hepatic lobe lesion is 2.5 x 2 cm, previously 3 x 2 cm (series 9, image 44)3. Segment 8 lesion is 1.8 x 1.4 cm, previously 1.8 x 1.2 cm (series 9, image 25). SPLEEN: No significant abnormality notedPANCREAS: Severe pancreatic atrophy with unchanged ductal dilatation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple parapelvic cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the bowel. No small bowel obstruction.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | 1. Significantly decreased enhancing component of the multiple hepatic metastases.2. Near complete resolution of the right lower lobe ground-glass and airspace opacities that likely represents resolving infection and/or aspiration. |
Generate impression based on findings. | 32-year-old male with pain to right second digit, open wound over PIP joint. Three views of the right hand demonstrates normal anatomic alignment. No evidence of acute fracture or significant soft tissue swelling. | No evidence of acute fracture or malalignment. |
Generate impression based on findings. | Female 53 years old; ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: There is a 2.4 x 1.7 cm hypoattenuating lesion in the right hepatic lobe which is incompletely evaluated on this noncontrast study but does not meet criteria for a simple hepatic cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No renal stones, hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple calcifications within the pelvis likely represent phleboliths. Moderate pelvic free fluid. | 1.No renal stones. No specific cause for patient's hematuria is identified.2.2.4-cm hypoattenuating lesion in the right hepatic lobe which does not meet criteria for a simple hepatic cyst. If needed, further evaluation with contrast enhanced cross-sectional imaging would be helpful. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Negative unenhanced brain CT. Specifically, there are no CT findings to explain the patient's symptoms. |
Generate impression based on findings. | 52-year-old male with URI symptoms, right pleuritic chest pain, evaluate for infectious process/acute chest LUNGS AND PLEURA: Bibasilar atelectasis and scarring. No pleural effusion or pneumothorax. Postsurgical changes of a right lower lobectomy. No focal consolidation. No suspicious nodules or masses. Scattered nonspecific micronodules. Debris is noted within the trachea which may represent secretions or aspirated material.MEDIASTINUM AND HILA: Small focus of air in the right mediastinum (series 4, image 49) appears to be a loculated air collection near the prior surgical site; unclear if this is extraluminal or contained within the esophagus. No pneumothorax is evident. Pneumomediastinum cannot be entirely excluded. The blood pool is hypodense relative to cardiac muscle suggestive of anemia. The pulmonary artery measures 3.2 cm and may be suggestive of pulmonary artery hypertension, incompletely assessed without IV contrast. The ascending aorta measures 3.7 cm.Mild cardiomegaly. No pericardial effusion. CHEST WALL: Mildly prominent axillary lymph nodes. No significant cardiophrenic, retrocrural, or subpectoral lymphadenopathy.No suspicious osseous lesions. Osseous changes reflecting sickle cell disease..UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Increased attenuation of the liver is likely related to iron deposition.. Hypodense, 9-mm, lesion in the peripheral right lobe of the liver (series 3, image 78) is too small to further characterize. Small amount of perihepatic ascites. Prominent perihepatic, gastrohepatic ligament, and para-aortic hyperattenuating lymph nodes are noted also likely related to iron deposition. Splenic calcified and atrophic likely secondary to autoinfarction. | 1.The pulmonary artery measures 3.2 cm and may be suggestive of pulmonary artery hypertension or less likely, could be enlarged from a pulmonary embolism. If there is clinical suspicious of pulmonary embolism, a CT PE or VQ scan may be obtained.2.Small loculated air collection in the right mediastinum adjacent to the prior surgical site. Pneumomediastinum from a small air leak cannot be entirely excluded. If the patient remains symptomatic, a follow-up CT is recommended with IV and oral contrast (specify for esophageal opacification in order). 3.Small perihepatic ascites. |
Generate impression based on findings. | There are multiple dental caries with scattered periapical lucencies noted. There is cortical dehiscence of two adjacent roots of ADA #13 with an adjacent ill-defined rim-enhancing collection immediately inferior to the left zygoma measuring 17 x 13 x 12 mm. The overlying subcutaneous soft tissues are thickened with fat stranding. There is complete opacification of the left maxillary sinus and extensive opacification of the left ethmoid air cells including mucosal thickening in the sphenoid and frontal sinuses. The salivary glands and pharyngeal soft tissues appear normal. The visualized skull base and orbits appear normal. The visualized cervical spine appears normal. | 1.Periodontal disease with bony dehiscence over ADA #13 roots.2.Associated left facial phlegmon.3.Complete opacification of the left maxillary sinus and extensive opacification of the left ethmoid air cells including mucosal thickening in the sphenoid and frontal sinuses. |
Generate impression based on findings. | 52-year-old female with pleuritic chest pain PULMONARY ARTERIES: Adequate pulmonary artery opacification without evidence of pulmonary embolus to the segmental level. Pulmonary artery measures 2.9 cm and the aorta measures 3.6 cm.LUNGS AND PLEURA: No pleural effusion or pneumothorax. Scattered nonspecific micronodules. No suspicious nodules or masses. The airways are patent. Minimal dependent bibasilar atelectasis. Stable nodular subpleural thickening in the upper lobes consistent with scarring. Stable benign right upper lobe micronodule.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: No axillary, retrocrural or cardiophrenic lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Multiple hepatic cysts unchanged. Additional subcentimeter hypoattenuating hepatic foci are too small to further characterize are unchanged, and are also likely cysts. Small hiatal hernia. | No evidence of pulmonary embolus to the segmental level.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 44-year-old male with history of right knee pain; GSW in 1991. A large focus of ossification is present in the posterior joint, likely a loose body. There is severe right knee osteoarthritis, including marked medial joint space narrowing and osteophyte formation. No acute fracture or malalignment. No significant joint effusion. Multiple metallic fragments correlate with stated history of prior gunshot wound. | Severe osteoarthritis. Large ossicle within the joint, posteriorly. |
Generate impression based on findings. | Male, 17 years old. Reason: knee pain History: knee painVIEWS: Right femur, AP, lateral (2 views) 3/15/2015, 1542 Postsurgical changes of varus derotational osteotomy at the proximal femur.Diffuse osseous mineralization, likely from disuse.A small cortical step off is noted at the medial aspect of the distal femoral metaphysis. No other fractures identified. | Cortical step-off at the medial aspect of the distal femoral metaphysis, compatible with a fracture. See subsequent knee radiograph for additional images. |
Generate impression based on findings. | 54 year old with history of stereo biopsy of left breast, of which results included FEA and ADH, presents for annual mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Percutaneously placed two clips are present in the left breast. No residual calcifications are present near the clips. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient and her husband. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male, 17 years old. Reason: Right Leg pain History: Pain with knee palpationVIEWS: Pelvis AP, frogleg (2 views) 3/15/2015, 1525 GJ tubing partially visualized.Postsurgical changes of varus derotational osteotomy bilaterally.Diffuse osseous demineralization.No acute fractures. The femoral heads are directed into the acetabula. | Postsurgical changes with no acute fracture or dislocation. |
Generate impression based on findings. | 19 year-old female with back and left flank pain. Four views of the lumbar spine demonstrate normal anatomic alignment. There is no evidence of acute fracture. No significant degenerative disease. | No evidence of acute fracture or malalignment. |
Generate impression based on findings. | 23-month-old male with left leg injury following fall from slide and collision with another child while playing at park.VIEWS: Left tibia-fibula: AP and lateral (two views) 3/15/15 Minimally displaced predominantly obliquely oriented fracture through the tibial diaphysis. A large amount of soft tissue swelling is noted No other fractures are identified. | Soft tissue swelling and minimally displaced spiral fracture of the tibial diaphysis. |
Generate impression based on findings. | 47 year-old female with right upper extremity numbness and tingling, radiculopathy, and right shoulder pain. Three views of the cervical spine demonstrate mild disk space narrowing at C4-5 and C5-6. There is no evidence of acute fracture or malalignment. | Mild disk space narrowing in the lower cervical spine without acute fracture or malalignment. |
Generate impression based on findings. | Female, 12 years old. Evaluate bowel gas pattern, presence of obstruction History: abdominal pain, tympaniVIEW: Abdomen AP (one view) 3/16/2015, 0401 Nonobstructive bowel gas pattern.Large stool burden. | No evidence of obstruction. Large stool burden. |
Generate impression based on findings. | 39-year-old female with history of sinus tachycardia and shortness of breath. Evaluate for PE. PULMONARY ARTERIES: No evidence of acute pulmonary embolus.LUNGS AND PLEURA: Moderate-sized left pleural effusion with associated atelectasis/consolidation of the left lower lobe. The of density pleural fluid collection has increased when compared to prior. Chronic appearing interstitial opacities and bronchiectasis in the right lung stable compatible with patient's prior history of ARDS. Focal ground glass opacities have nearly completely resolved. Left infradiaphragmatic inflammatory changes and loculated fluid collection; unable to clearly delineate the left hemidiaphragm in some areas and intrapleural extension cannot be excluded.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. No evidence of right heart strain. No significant coronary artery calcifications. The pulmonary artery is at the upper limits of normal. No mediastinal lymphadenopathy.There is moderate attenuation of the left external jugular vein at its anastomosis with the left subclavian vein which results in opacification of numerous vessels in the upper chest and neck. This is favored to represent a chronic process or possibly congenital.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Large midline fluid collection containing foci of gas density and drainage catheters representing patient's known pseudocyst; infection cannot be differentiated for an uninfected collection. Additionally, there is a focus of extraluminal air along the left anterior aspect of the cyst/lesser curvature which is incompletely imaged, but stable when compared to prior body CT. Additionally there is a left infradiaphragmatic fluid collection, which may or may not involve the pleural space. Status post cholecystectomy. | 1. No evidence of acute pulmonary embolus.2. Moderate left pleural effusion has increased in density with associated left lower lobe atelectasis/consolidation. Unable to exclude left pleural fistulization.3. Left infradiaphragmatic fluid collection, likely representing extension of pancreatic disease; fistulization to the left pleural space cannot be excluded. An ultrasound and/or contrast enhanced chest/abdomen CT is recommended to evaluate anatomic delineation of the diaphragm.Findings discussed with Dr. Deboer at 1030 on 3/16/15.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: Signs of CVA History: new seizures after drug abuse 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 mucosal thickening in the right maxillary sinus and partial opacification of 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. | The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is appropriate. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. | Normal brain MRI. Specifically, there are no MRI findings of corpus callosal dysgenesis. |
Generate impression based on findings. | Reason: vessel patency History: L sided weakness Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing at the origin of the left vertebral artery associated with atherosclerotic calcifications. There is a high grade stenosis at the origin of the right vertebral artery.Airspace opacties are present in the upper lung fields.There are degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at C3-4, C4-5, C5-6 and and C6-7 associated with narrowing of the spinal canal and multilevel neural foramina encroachment. There appears to be a moderate degree of spinal stenosis at C3-4.Brain CTA: There is a 4-mm wide necked aneurysm present along the horizontal portion of the cavernous segment of the left internal carotid artery.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is hypodensity involving gray and white matter along the medial aspect of the right temporal lobe including the hippocampus, parahippocampal gyrus, fusiform gyrus, lingual gyrus and calcarine cortex. There is also hypodensity involving the or superior aspect of the right cerebellar hemisphere compared there is a hypodense focus involving right thalamus measuring 12 mm in diameter and another one measuring 5 mm. one of these extends to the right cerebral peduncle medially.Atherosclerotic calcifications are present along the distal internal carotid arteries.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 sphenoid sinus opacities in the right nasal cavity. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.RVA origin stenosis.2.Subacute infarctions involving right PCA and right superior cerebellar artery territories.3.Subacute lacunar infarcts involving the right thalamus and medial aspect of the right cerebral peduncle.4.No evidence for hemorrhagic conversion.5.There is upper lung field airspace disease present please refer to chest x-ray from 3/14/15 for further comments.6.There is a 4-mm right cavernous internal carotid artery aneurysm present.7.There are multilevel degenerative changes present in the cervical spine worse at C3-4 where there are findings suspicious for moderate spinal stenosis. There is multilevel neural foramen encroachment present as well. |
Generate impression based on findings. | Exam is significantly limited by streak artifact from dental fillings and poor contrast opacification. Interval surgery with extensive anatomical distortion involving the right submental space, floor of the mouth, and right lateral tongue. This is the first postoperative study and will serve as a new baseline. There are postoperative changes of right neck dissection. Large right level 2 lymph node seen on preoperative study has been resected. No new cervical lymphadenopathy by CT size criteria.Right maxillary mucus retention cyst. Opacification of the left maxillary sinus with air-fluid level suggestive of active sinusitis. Imaged orbits are unremarkable. Imaged mastoid air cells are clear. Patient is status post tracheostomy. Moderate to severe degenerative disk disease of the cervical spine. | 1.First postsurgical study with extensive anatomic distortion. This will serve as a new baseline.2.Resection of the pathological right level 2 lymph node. No new cervical lymphadenopathy is identified. |
Generate impression based on findings. | Female 41 years old; Reason: r/o acute process History: abd pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes in the stomach with a surgical staple line. There is a hiatal hernia. There is a catheter type device encircling the fundus of the stomach with its port in the left lower abdominal wall.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Please see aboveBONES, SOFT TISSUES: There is scoliosis of the lumbar spine.OTHER: No significant abnormality noted. | 1.Postsurgical changes in the stomach with a new hiatal hernia.2.Recommend upper GI for further evaluation of the gastric band and stomach. |
Generate impression based on findings. | Female 85 years old; Reason: please r/o pyelonephritis and abnormal kidney pathology History: hx of multiple myeloma here with fever, nausea/vomiting, +UA ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver is normal morphology. The gallbladder is distended.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right kidney is edematous with moderate perinephric inflammation. There is mild to moderate hydronephrosis. There is an obstructive 8mm proximal ureter calculus.There are several other nonobstructive right renal calculi contained within the renal pelvis.There are few scattered left renal calculi.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Submucosal mass within the stomach measures 3.7 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroids.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.Right hydronephrosis due to an obstructing 8mm proximal ureter stone.2.Soft tissue mass in the stomach |
Generate impression based on findings. | There is an NG tube and a tracheostomy. There are post-operative findings related to recent bilateral mandibular osteotomies with mandibular distractors in place. Streak artifact in these regions limits soft tissue evaluation. There is no evidence of gross focal fluid collection within these limitations. There is mild swelling of the bilateral cheek soft tissues. There is no evidence of lymphadenopathy within the imaged upper neck. The nasopharynx, orbits, and imaged intracranial structures appear to be unremarkable. There is fluid within the bilateral mastoid air cells and middle ears. | Post-operative findings related to recent bilateral mandibular osteotomies. Streak artifact in these regions limits soft tissue evaluation, however, there is no evidence of gross focal fluid collection within these limitations. |
Generate impression based on findings. | Female 77 years old; Reason: concern for bowel ischemia vs diverticulitis or other infectious etiology History: abdominal pain, nausea, vomiting, lactic acidosis ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver has normal morphology. Nonspecific subcentimeter hypodense lesion noted at the fundus. Gallbladder has calcifications at its fundus. No intra-or extrahepatic biliary ductal dilatation. Hepatic and portal veins are patent.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: Calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No bowel obstruction or a focal inflammatory change.2.Calcifications of the gallbladder fundus, if patient has right upper quadrant pain, consider ultrasound. |
Generate impression based on findings. | 59-year-old female with history of chest pain and shortness of breath. PULMONARY ARTERIES: No evidence of acute pulmonary embolus.LUNGS AND PLEURA: Diffuse subsegmental basilar predominant atelectasis.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. No evidence of right heart strain. There is no mediastinal lymphadenopathy. Severe coronary artery calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1. No evidence of acute pulmonary embolus.2. Basilar interstitial opacities compatible with atelectasis.3. Severe coronary artery calcifications.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 55 year-old with history of right lumpectomy for breast cancer in 1999, status post radiation and chemotherapy. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. No significant change in post operative distortion, density, volume loss and dystrophic calcification in the lumpectomy bed of the right breast. Normal-sized lymph nodes project in the left axillary region, though the area is partially obscured by the AICD generator. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 1-day-old female. Evaluate UVC placement and lungs.VIEW: Chest and abdomen AP Nasogastric tube with tip in the gastric body. UVC with tip in the splenic vein.The aortic arch, cardiac apex, and stomach are left sided. The cardiothymic silhouette is normal. No pulmonary opacities. Portal venous gas is likely iatrogenic from UVC insertion. Disorganized, nonobstructive bowel gas pattern. | UVC tip is likely in splenic vein. |
Generate impression based on findings. | 58 year old female status post right mastectomy in 2004 for IDC with DCIS, presents today for routine follow up. Patient received radiation, chemotherapy, and hormonal therapy (Femara). No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. A stable intramammary lymph node is noted within the far posterior, medial left breast.Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 85 years, Male. Reason: dobhoff History: dobhoff Pelvis is not included in the field-of-view and there is retained contrast in the right hemicolon. There is a Dobbhoff tube with its tip projecting over the proximal stomach, just distal to the gastroesophageal junction. There is a G-tube projecting over the left upper quadrant. Retrievable IVC filter is unchanged in position. Retrocardiac opacity and left pleural effusion are noted. | Dobbhoff tube with its tip projecting over the proximal stomach, just distal to the gastroesophageal junction. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left benign breast stereotactic guided biopsy in 1993. Personal history of basal cell carcinoma of the face. Family history of breast cancer diagnosed in maternal aunt at age 40. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Benign calcifications in both breasts, including arterial calcifications, are stable. Asymmetries in both breasts are also stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign-appearing lymph nodes project over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 18 year-old male with right upper quadrant pain. Evaluate for appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction or intrinsic bowel abnormality. No free mesenteric fluid. No evidence for appendicitis or diverticulitis. No abnormal free fluid collections are seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction or intrinsic bowel abnormality. No free mesenteric fluid. No evidence for appendicitis or diverticulitis. No abnormal free fluid collections are seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No abnormality seen and no findings seen to account for patient's symptomatology. |
Generate impression based on findings. | Female 76 years old Reason: new EC fistula, evaluate area that is fistulizing to skin CHEST:LUNGS AND PLEURA: Stable subpleural reticular changes in the left upper lobe and slightly increased perihilar cystic changes in the right upper lobe.MEDIASTINUM AND HILA: A right paratracheal lymph node is not significantly changed since 2010 measuring 11 mm in short axis (series 3 image 28) previously 12 mm.CHEST WALL: Right-sided PICC with tip in the superior vena cava.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: Indeterminant subcentimeter hypodense focus in the interpolar region of the right kidney is too small to fully characterize but is new compared to prior. Unchanged punctate left renal calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post surgical changes from left lower quadrant small bowel resection and anastomosis. Multiple loops of small bowel adjacent to the resection site abut the anterior abdominal wall suggestive of adhesive disease. Large focus of extra-abdominal and intra-abdominal inflammatory changes in the left lower quadrant and the fascial planes of the abdominal wall are not clearly seen in this region. There is a large heterogenous collection in the subcutaneous soft tissues of the left anterior abdominal wall containing indurated soft tissue/phlegmon, air, and high density material compatible with extravasated oral contrast. In aggregate the subcutaneous collection measures approximately 4.2 x 10.3 cm. Findings are compatible with a enterocutaneous fistula with extensive surrounding inflammatory changes. The exact origin of the enterocutaneous fistula is uncertain.In addition to the subcutaneous findings, there is a small fluid collection tracking inferiorly from the region of the fistula along the surface of the sigmoid colon measuring 2.3 x 1.1 cm in maximum dimension (series 3 image 165).BONES, SOFT TISSUES: Degenerative changes affect the thoracolumbar spine. No focal lytic or blastic lesion.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: There is an indurated tract contain small foci of gas extending from the left anterosuperior aspect of the bladder extending to the sigmoid colon (series 3 image 171). While this air may relate to placement of the Foley catheter, this raises the possibility of an colovesicular fistula which can be further evaluated with cystography.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes with enterocutaneous and possible colovesicular fistulae as described above.BONES, SOFT TISSUES: Diffuse soft tissue edema.OTHER: No significant abnormality noted. | 1.Small bowel enterocutaneous fistula in the left lower quadrant with extensive subcutaneous left lower quadrant complex collection consisting of inflamed soft tissue, extravasated oral contrast, and air. There is an additional small internal fluid collection tracking from the area of the fistula inferiorly along the sigmoid colon.2.Findings suspicious for an colovesicular fistula as described. This can be further evaluated with cystography as clinically warranted.3.New hypodense subcentimeter right renal lesion is too small to fully characterize, however as it is new from the prior exam, continued follow-up is recommended. |
Generate impression based on findings. | Reason: status post embolic coil occlusion of an anterior communicating artery, 3T Scanner History: 6 month follow up 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.The diameter of the anterior communicating artery has increased from just over 2 mm to just under 3 mm in diameter. This is most prominent at the location of the aneurysm coils and suggests an early recanalization at the aneurysm base apparently covered by coils.There is asymmetry in the A1 segments right larger than left. The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. | 1.Findings are suggestive early recanalization into the aneurysm coils at the base of the ACOMA aneurysm by approximately a millimeter. |
Generate impression based on findings. | Reason: pt assaulted this AM, struck on left mandible and unable to move jaw History: pain and decreased ROM There is a comminuted fracture of the left mandible at the junction of the body and the ramus with a cortex width's displacement (4mm) of the fractured ends. Fracture transverses the alveolar space of the left third molar, which is impacted and oriented horizontally. An obliquely oriented fracture through the right body of the mandible is seen, which passes between the right lower premolars with violation of their alveolar spaces. No evidence of tooth fracture or dislocation. There is overlying soft tissue swelling.Gas is seen along the fascial planes of the left neck, likely related to trauma. The orbits are unremarkable. Paranasal sinuses and mastoid air cells are clear. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli. There is mild leftward deviation of the nasal septum. The cribriform plate, fovea ethmoidalis and lamina papyracea appear normal. Limited view of the intracranial structures is unremarkable. Ossicles noted anterior to the atlas. | Right and left mandibular fractures as above.Findings discussed with Dr. Shappell 3/16/2015 9:45AM |
Generate impression based on findings. | 25-year-old male with right lower quadrant pain. Rule-out appendicitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. Stomach, small bowel and colon show no intrinsic abnormalities. Appendix is well seen and filled with air and orally administered contrast material without evidence of appendicitis. No free mesenteric fluid. Scattered slightly prominent mesenteric lymph nodes are seen in the mesentery, not meeting size criteria for lymphadenopathy, of uncertain significance. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of obstruction. Stomach, small bowel and colon show no intrinsic abnormalities. Appendix is well seen and filled with air and orally administered contrast material without evidence of appendicitis. No free mesenteric fluid. Scattered slightly prominent mesenteric lymph nodes are seen in the mesentery, not meeting size criteria for lymphadenopathy, of uncertain significance.BONES, SOFT TISSUES: Bilateral small inguinal hernias containing only mesenteric fat.OTHER: No significant abnormality noted | 1. No evidence for appendicitis. 2. Scattered slightly prominent mesenteric lymph nodes of uncertain significance. 3. Small bilateral inguinal hernias containing only mesenteric fat. |
Generate impression based on findings. | 85 years, Male. Reason: s/p dobhoff, eval for kink History: dobhoff Study is limited because the pelvis is not included in the field-of-view and there is retained contrast in the right hemicolon. There is a Dobbhoff tube which has been advanced in the interval and its tip is projecting over the proximal body of the stomach.. Again seen is a G-tube projecting over the left upper quadrant. Retrievable IVC filter is unchanged in position. Retrocardiac opacity and left pleural effusion are unchanged. | Dobbhoff tube has been advanced and its tip projects over the proximal body of the stomach. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in sister in her 40s. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A few scattered benign calcifications are stable. Asymmetries in the right breast are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 85 years, Male. Reason: dobhoff History: dobhoff Pelvis is not included in the field-of-view and there is retained contrast in the right hemicolon. There is advancement of the Dobbhoff tube with its tip projecting over the proximal body of the stomach. Again seen is a G-tube projecting over the left upper quadrant. Retrievable IVC filter is unchanged in position. Retrocardiac opacity and left pleural effusion are unchanged. | There is advancement of the Dobbhoff tube with its tip projecting over the proximal body of the stomach. |
Generate impression based on findings. | 28 years, Female. Reason: Evaluate stool, bowel gas pattern for obstruction History: abdominal pain. Nonobstructive bowel gas pattern. Average stool burden. Visualized lung bases are unremarkable | Nonobstructive bowel gas pattern. Average stool burden. |
Generate impression based on findings. | Status post trauma to right lower extremity one month ago with residual pain in a likely resolving hematoma. Two views of the right tibia/fibula reveal no acute fracture or malalignment. There is osteoarthritis of the knee. No soft tissue swelling is seen. Vascular calcifications are noted. | No acute fracture is evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A few scattered benign calcifications are present in both breasts. Small focal asymmetry in the left upper outer quadrant, posterior depth.No suspicious masses or areas of architectural distortion are present. | Small focal asymmetry in the left upper outer quadrant, for which comparison with priors performed at an outside hospital is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Left-sided low back pain. Question of etiology. Five views of the lumbar spine reveal no acute fracture. There is degenerative disk disease with joint space narrowing and anterior osteophyte formation at L3/L4, L4/L5, and L5/S1. | Degenerative changes of the lower lumber spine as described above. |
Generate impression based on findings. | 64-year-old male with GI bleeding, mass confirmed to be tumor on biopsy, for evaluation of metastasis from colon cancer Limited study due to respiratory motion.LUNGS AND PLEURA: Small bilateral pleural effusions with adjacent atelectasis. Focal peripheral consolidation in the left upper lobe (series 4, image 78) may represent focal infection or infarct. No suspicious nodule or mass. Scattered nonspecific micronodules.MEDIASTINUM AND HILA: Blood pool is hypodense relative to the cardiac muscle suggestive of anemia. Scattered subcentimeter mediastinal lymph nodes. Mild cardiomegaly. No pericardial effusion.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Bullet fragment within the T12-L1 vertebral level on the right.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Punctate metallic density adjacent to the spleen may represent additional fragments. | 1.Bilateral pleural effusions with adjacent atelectasis.2.Focal peripheral consolidation in the left upper lobe may represent infection or less likely an infarct. No suspicious nodule or mass |
Generate impression based on findings. | 28 year-old female with indeterminate left breast lesion on screening MRI. BRCA gene mutation positive. Family history of breast carcinoma in her mother at age 53, maternal great aunt at age 40, and maternal cousin at age 22, as well as her paternal great aunt at age 79. On subtraction images, there is redemonstration of a small enhancing mass measuring 0.7 cm at the two o'clock position of the left breast. This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 12 cores were obtained and they were sent to Pathology with an accompanying history sheet.Post procedural MR images show a small hematoma at the biopsy site. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral mammogram, CC and ML views, to locate the percutaneously placed clip. The clip is placed at 2 o'clock position with no evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Happ under direct supervision of Dr. Schacht who was present throughout the procedure. | Successful MR guided core needle biopsy of the left breast 2 o'clock enhancing lesion. Successful clip placement. Pathology is pending.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 68 year old female with invasive SCC of the lip There are post-treatment findings in the left neck and maxillofacial region, including left upper lip resection, partial maxillectomy with an associated left oroantral fistula, neck dissection, and radiation therapy. There is unchanged non-specific ill-defined tissue within the left infratemporal fossa, left retro-maxillary region and level II, and anterior to the mandible bilaterally as well as anterior to the hyoid that was hypermetabolic on prior PET. There is a 5 mm peripherally enhancing lesion in this region not present on the 10/23/2014 neck CT. There is new erosion of the angle and body of the left mandible. The thyroid and remaining major salivary glands are unchanged. There is atherosclerotic calcification of the bilateral carotid bulbs, right greater than left, as well as a retropharyngeal right internal carotid artery. The internal carotid arteries are patent. There are degenerative changes of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. There are multiple unchanged < 4mm nodules within the lung apices. | 1.Multiple regions of unchanged non-specific soft tissue within the left infratemporal fossa, left retro-maxillary region and level II, and anterior to the mandible bilaterally as well as anterior to the hyoid that were hypermetabolic on prior PET. A small enhancing nodule anterior to the hyoid was not present on the prior CT neck and is most compatible with tumor. 2.New erosions of the angle and body of the left mandible. 3.Unchanged < 4 mm pulmonary nodules are non-specific and will be further characterized on the dedicated CT chest report. |
Generate impression based on findings. | 60-year-old male with history of left iliac stent. Evaluate aorta, assess for claudication. Appropriate directional flow is visualized within the abdominal aorta with the following measurements:Proximal Aorta: 2.8-cm x 2.2 cm x 2.7 cm.Mid aorta: 1.8-cm x 2.2 cm x 1.8 cm.Distal aorta: Mildly ectatic infrarenal abdominal aorta measuring 2.7-cm x 2.4 cm x 2.7 cm.Right common iliac artery: 0.9 cm x 1.0 cm x 0.9 cm.Left common iliac artery: Stent is noted with vessel caliber of 1.0-cm x 1.1 cm x 1.0 cm with appropriate flow distal to the stent.OTHER: Atherosclerotic calcification is noted in the visualized abdominal aorta. | Atherosclerotic calcification in the abdominal aorta. No evidence of aneurysm or claudication. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral benign breast biopsies. Family history of breast cancer diagnosed in sister and maternal aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A few scattered benign calcifications in both breasts are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Obscured mass in the right central outer breast, mid depth.No suspicious microcalcifications or areas of architectural distortion are present. | Obscured mass in the right central outer breast, mid depth, for which additional views, including spot compression views are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Male 58 years old Reason: asymptomatic left external iliac artery aneurysm History: asymptomatic left external iliac artery aneurysm, 1 year surveillance ANGIOGRAPHY: The thoracic aorta is normal in size and contour. There is a common origin of the celiac axis and superior mesenteric artery. Celiac axis otherwise has conventional anatomy. The abdominal aorta is tortuous but normal in caliber. The ostia of the aortic branch vessels are widely patent. Redemonstration of a thrombosed saccular aneurysm arising from the superior aspect of the left common iliac artery. This measures 2.0 x 1.6 cm (series 8 image 45), previously 2.1 x 1.5 cm. The right iliac vessels are unremarkable.CHEST:LUNGS AND PLEURA: Unchanged left lower lobe calcified granuloma. No focal consolidation, pleural effusion, or pneumothorax.MEDIASTINUM AND HILA: Patulous esophagus without internal fluid or debris. No mediastinal or hilar lymphadenopathy.CHEST WALL: Multiple healing left-sided rib fractures.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Inter-position of the colonic hepatic flexure between the right lobe of the liver and the abdominal wall. Uncomplicated diverticulosis of the rectosigmoid colon.BONES, SOFT TISSUES: Severe degenerative changes affect the lumbar spine resulting in mild, multilevel spinal stenosis.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Uncomplicated colonic diverticulosis.BONES, SOFT TISSUES: Severe degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted | 1.Stable saccular aneurysm arising from the distal left common iliac artery with measurements as described.2.Uncomplicated colonic diverticulosis. |
Generate impression based on findings. | Female 75 years old; Reason: gi bleed , r/o GAVE History: gi bleed ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral subcentimeter hypoattenuating renal lesions, which are too small characterize. Hyperattenuating lesion within the midpole of the left kidney which does not demonstrated convincing enhancement and may represent a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Moderate arteriosclerosis of the abdominal aorta and branch vessels.BOWEL, MESENTERY: Moderate hiatal hernia. Duodenal diverticulum noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without CT evidence of diverticulitis. There is a focal area within the descending colon, which is hyperattenuating on noncontrast images (series 3, image 104), and demonstrates possible subtle puddling on venous phase images (series 10, image 102/3). This is equivocal for GI bleed. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Focus equivocal for GI bleed within the descending colon as detailed above. |
Generate impression based on findings. | 50-year-old female presents for annual follow up of right breast, and short-term follow-up of left breast calcifications. History implants. Family history of breast carcinoma in her mother at age 79. Three standard views of both breasts, and 2 spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral retropectoral saline implants are present.A loosely grouped cluster of calcifications is again noted within the upper outer left breast, unchanged from prior examination. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | Left breast calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Patient reports milky discharge; stopped nursing in 7/2012. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Clinical correlation is recommended for her reported nipple discharge. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Previously demonstrated right hemispheric extra-axial collection has resolved. No evidence of acute interval hemorrhage. No midline shift. Periventricular and subcortical hypoattenuation is unchanged from the prior exam likely reflecting moderate age indeterminate small vessel ischemic disease. Prominent ventricles and sulci unchanged suggestive of mild atrophy. The visualized paranasal sinuses and mastoid air cells are clear. | Previously demonstrated right hemispheric extra-axial collection has resolved. No evidence of acute interval hemorrhage. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast benign biopsy. Family history of breast cancer diagnosed in paternal aunts at age 35, 45, and 52 and paternal cousins. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable 1 cm benign intramammary lymph node in the left upper outer quadrant. Benign calcifications in both breasts are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | Stable benign intramammary lymph node and benign calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female; 44 years old. Reason: evaluate for diverticulitis History: abdominal pain and bloody diarrhea ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A few mesenteric lymph nodes in the right lower quadrant are slightly more prominent than on prior study. Though they are not pathologically enlarged by CT size criteria, this change raises the question of mild mesenteric lymphadenitis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Possible mild mesenteric lymphadenitis, but otherwise unremarkable examination. |
Generate impression based on findings. | Female, 4 years old. Reason: r/o pna History: first time wheezerVIEWS: Chest AP/lateral (two views) 3/16/2015, 0259 The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.Peribronchial thickening and increased lung volumes compatible with reactive airway disease or bronchiolitis.No focal pulmonary opacities, pleural effusions, or pneumothorax. | Reactive airway disease/bronchiolitis pattern. No evidence of pneumonia. |
Generate impression based on findings. | 48 year-old female. History of Hodgkin's lymphoma with increasing abdominal pain. CHEST:LUNGS AND PLEURA: Mild centrilobular and paraseptal emphysema. Stable right middle lobe micronodule. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Stable mediastinal and left hilar lymphadenopathy. Reference right azygos lymph node measures 2 x 1.6 cm (series 3/15), previously 2 x 1.6 cm (remeasured). Reference left hilar conglomerate lymphadenopathy measures 2 x 4.2 cm (series 3/41), previously 2 x 4.2 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Bilobar diffuse liver lesions have significantly increased in size and number, compatible with progression of hepatic metastases. Reference lesion in the right hepatic lobe measures 2.6 x 4.9 cm (series 3/82), previously 2.5 x 3.5 cm.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: Grossly stable retrocrural, retroperitoneal, and gastrohepatic lymphadenopathy. Reference precaval lymph node measures 1.3 x 2.3 cm (series 3/12 5), previously 1.3 x 2.3 cm (remeasured). Reference left para-aortic lymph node measures 2.3 x 2.3 cm (series 3/108), previously 2.3 x 2.3 cm (remeasured).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable fat-containing umbilical hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Significantly increased number and size of diffuse hepatic metastases.2. Stable lymphadenopathy in the chest and abdomen. |
Generate impression based on findings. | 68 years, Female. Reason: abdominal pain, no bowel movement x 2 days History: as above Above average stool burden distributed throughout the colon. Spinal fixation hardware in place. The stomach is mildly distended with gas. Partially imaged pacemaker lead. There is a nonobstructive bowel gas pattern. | Above-average stool burden. |
Generate impression based on findings. | 22 year-old female with multiple lacerations to the hand after punching glass. Three views of the left hand/wrist demonstrate normal anatomic alignment without acute fracture. No radiopaque foreign body is present.Three views of the right hand/wrist demonstrate normal anatomic alignment without acute fracture. No radiopaque foreign body is present. | No acute fracture, malalignment, or radiopaque foreign body. |
Generate impression based on findings. | 71 years, Male. Reason: s/p colectomy. ?ileus History: nausea There is diffuse gaseous distention of the small bowel measuring up to 3.8 cm in diameter. This may reflect a postoperative ileus, although distal obstruction is not excluded. Pneumoperitoneum is presumably postoperative in etiology, clinical correlation is recommended. Sternotomy wires in place. Moderate degenerative changes of the hips and lower lumbar spine. | 1.Diffuse gaseous distention of the small bowel may represent postoperative ileus, although distal obstruction is not excluded.2.Pneumoperitoneum is presumably postoperative in etiology, clinical correlation is recommended. |
Generate impression based on findings. | Male, 10 years old. Reason: evaluation for possible fracture History: pain and swelling; limpingVIEWS: Left knee AP, lateral, oblique (3 views) 3/16/2015, 0338 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | No acute intracranial hemorrhage, extra axial fluid collection, mass effect, or herniation. No hydrocephalus. There is a chronic right MCA infarct with associated volume loss and ex vacuo dilatation of the right frontal horn.Several small polyps versus mucosal retention cysts are again seen within both maxillary antra. The visualized paranasal sinuses and mastoids/middle ears are otherwise grossly clear. | No evidence of intracranial hemorrhage, mass, or cerebral edema. Non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in mother at age 84. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female, 5 years old. Reason: r/o pna History: cough and sickle cell ptVIEWS: Chest PA/lateral (two views) 3/16/2015, 0347 The cardiomediastinal silhouette is normal.Mild peribronchial thickening and increased lung volumes compatible with reactive airway disease or bronchiolitis.No focal pulmonary opacities, pleural effusions, or pneumothorax. | No evidence of acute chest syndrome. |
Generate impression based on findings. | Reason: 3T Scanner, s/p aneurysm coiling, remaining unruptured aneurysm History: Confusion, disorientation 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.The patient is assess embolic coil in collusion of an anterior communicating artery aneurysm. There is no evidence for recurrence.There is redemonstration of a left M1 segment aneurysm which is directed posteriorly and inferiorly and is unchanged when compared to the prior exams in terms of size. | 1.No evidence for anterior communicating artery aneurysm recurrence.2.Stable left middle cerebral artery 2-mm aneurysm. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast benign biopsy. Two standard digital views of both breasts, additional left MLO view, and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. An X-shaped biopsy clip in the central right breast is unchanged in position. A few scattered benign calcifications are stable. Two new focal asymmetries are seen in the right upper outer quadrant, mid and posterior depth.No suspicious masses, microcalcifications or areas of architectural distortion are present. Normal-appearing lymph nodes project over both axillae. | Two focal asymmetries in the right upper outer quadrant, mid and posterior depth, for which additional views, including spot compression views are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Male, 6 years old. Reason: r/o pna History: cough and feverVIEWS: Chest AP/lateral (two views) 3/16/2015, 0615 The cardiomediastinal silhouette is normal.Mild peribronchial thickening and increased lung volumes compatible with reactive airway disease or bronchiolitis.No focal pulmonary opacities, pleural effusions, or pneumothorax. | Bronchiolitis/reactive airway disease pattern. No evidence of pneumonia. |
Generate impression based on findings. | Male 65 years old Reason: h/o AAA including femoral anuerysms; please also eval for ascending aortic aneurysm ANGIOGRAPHY: The ascending thoracic aorta is upper limit normal in size measuring 3.9 cm in diameter. Minimal atherosclerotic disease affects the aortic arch. The descending thoracic aorta is normal in caliber. The celiac axis is widely patent with normal morphology. Unchanged fusiform aneurysm of the right hepatic artery measuring 5 mm in maximum diameter (series 9 image 169), previously 5 mm. The origins of the superior mesenteric artery and bilateral renal arteries are widely patent. Infrarenal abdominal aortic aneurysm status post aortobifemoral endograft repair. Aneurysm sac measures 4.0 x 3.4 cm in maximum axial dimension (series 9 image 210), previously 3.8 x 3.1 cm. The inferior mesenteric artery is occluded by the stent graft. Stable left common iliac aneurysm status post stent graft placement. Patient is status-post coil embolization of left internal iliac artery. Also there are areas of focal ectasia in the proximal left superficial femoral artery measuring up to 1.4 cm in diameter (series 9 image 337), previously 1.4 cm. Stable right common iliac aneurysm status post stent graft placement. Partially thrombosed aneurysm of the proximal right internal iliac artery measures 4.0 x 3.5 cm (series 9 image 263), by similar measurement technique this previously measured 3.7 x 3.3 cm. The right external iliac is normal in size. Focal fusiform aneurysm of the proximal right common femoral artery measures 2.2 x 2.6 cm (series 9 image 80), by similar measurements on the prior exam this measured 2.3 x 2.5 cm. Soft tissue density surrounding the right CFA likely related to prior pseudoaneurysm. CHEST:LUNGS AND PLEURA: Severe emphysematous changes. No focal parenchymal lesion.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant loop ileostomy. No evidence of obstruction.BONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatic hypertrophy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable infrarenal abdominal aortic aneurysm status post stent graft placement without evidence of endo- leak.2.Stable left common iliac aneurysm status post stent graft placement. 3.Stable right common iliac aneurysm status post stent graft placement.4.Minimal interval increase in size of partially thrombosed right internal iliac artery aneurysm with measurements as described.5.Stable right common femoral artery aneurysm.6.Borderline aneurysmal ascending thoracic aorta. |
Generate impression based on findings. | 58 year old with history of three left breast benign biopsies. Family history breast cancer in sister at age of 38 and maternal grandmother. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Three marker clip are present in the left breast. Multiple benign calcifications are unchanged in both breasts. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: 1.65mm in depth melanoma of posterior back, needs lymphoscintigraphy for sentinel node biopsy RADIOPHARMACEUTICAL: The posterior right shoulder/back area was prepared in a sterile manner. A total of 0.5 mCi Tc-99m filtered sulfur colloid was injected in four peri-lesional sites. Two adjacent foci of increased activity are noted in the right axilla, representing the sentinel node(s). These regions were marked with an indelible marker. | Two adjacent sentinel lymph nodes identified in the right axilla. |
Generate impression based on findings. | ARDS. 2-year-old former 24 week gestational age patient.VIEW: Chest AP (one view) 03/16/15, 0819 Left upper extremity PICC tip is in superior vena cava. Surgical clips are noted at the GE junction.Cardiothymic silhouette is normal. Patchy bilateral air space disease continues. No pneumothorax or pleural effusion is seen. | Unchanged bilateral opacities. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional cleavage view of both breasts (nine total images) were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Several subcentimeter focal asymmetries in left breast are new compared to prior.No suspicious microcalcifications are present. Benign appearing lymph nodes project over both axillae. | Several new focal asymmetries in the left breast, for which additional spot compression views and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EA - Additional Mammo/Ultrasound Workup Required. |
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