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Generate impression based on findings. | 57-year-old male with pain in the left ankle, remote trauma. Three views of the left ankle demonstrate a comminuted fracture of the distal fibula, in near anatomic alignment. Mild periosteal reaction indicates likely subacute nature of the injury. There is no significant soft tissue swelling. Vascular calcifications are present in the posterior leg. | Comminuted fracture of the distal fibula. |
Generate impression based on findings. | Fracture.VIEWS: Left wrist PA/lateral (two views) 03/16/15 The cast has been removed. Sclerosis and periosteal reaction are present at the fracture site. | Continued healing of a buckling fracture of the distal radius. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, additional MLO of both breasts, additional one CC view of the right breast and two CC views of the left breast were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered benign calcifications, including arterial calcifications, 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: NSA - Screening Mammogram. |
Generate impression based on findings. | 57 yo male with right wrist pain and swelling. Three views of the right wrist demonstrate marked abnormality of the distal radius and ulna, including ulnar translocation of the lunate, marked radioscaphoid joint space narrowing and proximal migration of the capitate. There is scapholunate advanced collapse, which may be posttraumatic in nature. There is significant soft tissue swelling of the dorsal and volar aspects of the right wrist. No acute fracture identified. | Severe degenerative changes of the right wrist as detailed above. |
Generate impression based on findings. | 8-week-old female with known rib fracture, concern for other fractures.EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 3/16/15 Views of the right and left humerus, right and left forearms, and right and left femurs have overlying lines, tubes or material which limits evaluation of fine bone detail. Redemonstrated are right lateral rib fractures of ribs 2 through 7. Posterior rib fractures of ribs 6 through 10. These fractures are in various states of healing. No other fractures identified. Contrast is noted within the renal collecting system and bladder. | Redemonstration of multiple rib fractures, posterior and lateral, in various states of healing. No other fractures are identified. |
Generate impression based on findings. | Possible nonaccidental trauma. Bilateral subdural hematomas.EXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 03/15/15 An umbilical hernia is seen.Physiological periosteal reaction is present in the femurs and tibias. The cranial sutures appear slightly wider than expected for age. No acute or healing fracture is seen. | Equivocal cranial suture widening. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral benign breast biopsies in the 1980s. Family history of breast cancer diagnosed in mother at age 71. 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. Circular skin markers were placed over both breasts. A linear scar marker was placed over the left breast. Stable post biopsy architectural distortion are present in both breasts.No suspicious masses or microcalcifications 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. | Eight week old female with history of traumaVIEW: Chest and abdomen AP Aortic arch, cardiac apex, and stomach are left-sided. There are at least 4 posterior rib fractures on the right, ribs 6 through 10. There are least 5 right lateral rib fractures, ribs 3 through 7. The cardiothymic silhouette is normal. Vague pulmonary opacity silhouettes the right cardiac border which may represent contusion. No pneumothorax. Nonspecific disorganized bowel gas pattern. No evidence of pneumatosis, free air, or portal venous gas. | Multiple posterior and lateral right rib fractures. |
Generate impression based on findings. | 46-year-old female with lung adenocarcinoma with extrinsic compression of the right mainstem bronchus now with persistent fevers LUNGS AND PLEURA: New right pleural effusion with adjacent compressive atelectasis. New multifocal predominantly perihilar opacities compatible with multifocal infection. Increased adjacent septal thickening. Right lower lobe medial basal segment is collapsed.MEDIASTINUM AND HILA: Low-density blood pool relative to cardiac muscle is suggestive of anemia.The heart size is normal. Moderate pericardial effusion is increased.Subcarinal node or conglomerate lymph nodes appear increased in size. There is associated compression of the bronchus but appears increased compared to the prior exam.Reference right paratracheal lymph node series 3, image 30) measures 2.7 cm, previously 2.4 cm.CHEST WALL: Degenerative changes affect the thoracic spine. No suspicious osseous lesions. No axillary, retrocrural, or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Gallstones are present. Unchanged nodularity of the left adrenal is noted. | 1.New multifocal consolidation in a perihilar distribution most compatible with multifocal infection in the absence of clinical signs of pulmonary hemorrhage.2.Increased mediastinal and right hilar lymphadenopathy.3.Increased compression of the right bronchus intermedius which is now occluded with variable aeration of the distal airways.4.Mild pulmonary edema versus lymphatic thickening from infection.5. Increased pericardial fluid. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right benign breast biopsies in 1996 and 2002. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. 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: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male; 65 years old. Reason: evaluate for dissection History: chest pain CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCT angiogram:Mild atherosclerosis of thoracic aorta and its branch vessels, including the coronary arteries. Normal contrast opacification of the aortic arch branch vessels. No aneurysm or dissection of the thoracic aorta.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Small, round focus of arterial hyperenhancement in the right lobe of the liver near the dome with surrounding hyperattenuation, most likely due to a small AVM with shunting. No suspicious hepatic lesions.SPLEEN: Small splenic cystic lesion, most likely benign in etiology.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CT angiogram:Mild atherosclerosis of abdominal aorta and its branch vessels. Normal contrast opacification in the celiac artery, SMA, and bilateral renal arteries. There is mild narrowing at the origin of the IMA but with normal runoff. An atherosclerotic plaque of the right common iliac artery demonstrates penetration of contrast material (series 10/222). No aneurysm or dissection of the abdominal aorta.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.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: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Small fat-containing inguinal hernias.OTHER: No significant abnormality noted | No acute aortic dissection. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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. Two ovoid masses in the left upper outer breast. Asymmetry in the right upper outer breast, posterior depth with anterior linear branching calcifications.No suspicious masses, microcalcifications or areas of architectural distortion are present. | Right breast asymmetry and suspicious calcifications and left breast masses, for which comparison with priors recommended. If the prior studies cannot be submitted then the findings will require additional diagnostic evaluation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | The patient is status post right thyroid lobectomy. No concerning lesions are seen in the surgical bed. There are no thyroid nodules in the left thyroid lobe. There is no significant cervical lymphadenopathy. The salivary glands and pharyngeal soft tissues appear normal. The vasculature of the neck appears normal. The visualized paranasal sinuses are normal. The partially visualized skull base and orbits appear normal. The lung apices are clear. There is degenerative disease of the cervical spine, worst at C6/C7. | Findings status post right thyroid lobectomy without additional abnormalities. |
Generate impression based on findings. | 73 year old female status post right mastectomy in 2009 for ILC, presents today for routine follow up. 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 composed of scattered fibroglandular density, unchanged in pattern and distribution. Multiple round markers have been placed on cutaneous lesions overlying the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the 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: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 6-month-old male with history of pulmonary hypertension in respiratory distressVIEW: Chest AP (one view) 3/16/15 Tracheostomy tube tip is at the level of the thoracic inlet. Feeding tube tip in proximal sidehole is is in the gastric body. The cardiothymic silhouette is normal. Persistent coarse diffuse bilateral pulmonary opacities. New increasing pulmonary opacity which may represent atelectasis and/or pneumonia in the right and left lower lobe. | Increasing right and left lower lobe opacities on the background of chronic lung disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of chronic nipple inversion on the left. Patient reports bilateral nipple tenderness for one month. Personal history of squamous cell carcinoma diagnosed at the age of 39. Two standard digital views and additional MLO and CC 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. Innumerable bilateral benign calcifications are stable. Stable circumscribed subcentimeter mass in the right lower inner is also stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign appearing lymph nodes project over both axillae. | Stable innumerable benign calcifications and circumscribed right breast mass. 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. | Reason: pt struck repeatedly to right face History: pain to right face from mandible up to temporal area There are no fractures identified involving the maxillofacial bones.The skull base foramina are intact.The orbits are intact with no abnormal mass lesions in either orbit. There is no abnormal enhancement of the optic nerves. The visualized eyeballs are intact lacrimal glands are unremarkable. Extraocular muscles are intact. The suprasellar cistern is unremarkable.Visualized portions of the mastoid air cells and middle ears are clear. The visualized portions of the paranasal sinuses are clear. The visualized intracranial structures are within normal limits.There are dental caries present especially along the patient's molars. Some periapical lucencies are present along left sided mandibular premolars and molars.There is a small opacity in the right external auditory canal which could represent some cerumen but is nonspecific | 1.There is no evidence for maxillofacial fracture appreciated. 2.There are dental caries and periapical lesions present especially on the patient's molars. |
Generate impression based on findings. | Reason: History of plasmacytoma and persistent monoclonal protein; annual follow-up. SKULL: No discrete myelomatous lesions.CERVICAL SPINE: The lower cervical spine is not clearly visualized due to overlying anatomy, but we see no myelomatous lesion.THORACIC SPINE: The bones appear demineralized but no focal lesions are identified.LUMBAR SPINE: No discrete myelomatous lesions are seen. Moderate facet joint osteoarthritis affects L5/S1.RIBS: No discrete myelomatous lesions.PELVIS: The bones are slightly demineralized but no discrete myelomatous lesions are seen. Mild osteoarthritis affects the hips.UPPER EXTREMITY: Right humerus: No discrete myelomatous lesion.Left humerus: Again seen is a mixed lucent/sclerotic lesion in the proximal left humeral metaphysis corresponding to the patient's biopsy proven malignancy. Previously seen periosteal reaction along the malignancy has matured and the lesion appears similar in size to the prior study.Right forearm: No discrete myelomatous lesions.Left forearm: A small lucency in the lunate likely represents a cyst. No discrete myelomatous lesions.LOWER EXTREMITY:Right femur: No discrete myelomatous lesions.Left femur: No discrete myelomatous lesions.Right tibia/fibula: No discrete myelomatous lesions.Left tibia/fibula: No discrete myelomatous lesions. | Lytic lesion in the proximal left humerus as described above. No new lesions are identified. |
Generate impression based on findings. | 66 year old female status post right lumpectomy in 2004 for breast carcinoma,presents today for routine follow up. Patient received radiation. History of additional benign right breast biopsy. No current breast complaints. Family history of ovarian carcinoma in her mother at age 69. Three standard views of both breasts, and a laterally exaggerated right craniocaudal view, 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. A linear marker has been placed on a scar overlying the upper outer right breast with expected underlying postsurgical changes including clips. A ribbon clip is noted within the central upper right breast, from prior benign biopsy. Scattered benign calcifications are present bilaterally. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. | 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. | 22-day-old male with sepsisVIEW: Chest and abdomen AP The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No pulmonary opacities. No pleural effusion or pneumothorax. Disorganized, nonobstructive bowel gas pattern. No pneumatosis, portal venous gas, or free air. | Normal examination. |
Generate impression based on findings. | 8-week-old female with low hemoglobin, abdominal pain, and rib fractures CHEST:LUNGS AND PLEURA: Small right pleural effusion with adjacent compressive atelectasis and consolidation. No pneumothorax, or left pleural effusion.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. The thymus is normal.CHEST WALL: Multiple bilateral rib fractures in various states of healing are again demonstrated. Right posterior rib fractures appear more acute in etiology, and may be related to right pleural effusion and consolidation. These right posterior rib fractures extend from ribs 6 through 9. Left posterior rib fractures which appear subacute, ribs 7 and 8. Left lateral healing rib fractures extend from ribs 3 through 8. Right lateral rib fractures extend from ribs 3 through 7.ABDOMEN:LIVER, BILIARY TRACT: No evidence of liver laceration or hematoma. No significant abnormality.SPLEEN: The spleen is normal.PANCREAS: No significant abnormality notedADRENAL GLANDS: The kidneys appear normal.KIDNEYS, URETERS: The kidneys enhance symmetrically without evidence of abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A small, wide mouth, bowel containing umbilical hernia is present.BONES, SOFT TISSUES: No fractures are noted within the abdomen or pelvis.OTHER: 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 fractures are noted within the abdomen or pelvis.OTHER: No significant abnormality noted | 1.Multiple bilateral rib fractures in various states of healing. 2.The most acute appearing rib fractures are right posterior rib fractures. 3.Small right pleural effusion and adjacent consolidation and compressive atelectasis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in paternal grandmother and great aunt at age 45. 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 extremely dense, which lowers the sensitivity of mammography. 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. The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional cleavage view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | 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. | 68-year-old male with metastatic prostate cancer, rising PSA and increasing pain. Assess for disease progression. CHEST:LUNGS AND PLEURA: Multiple scattered small micronodules are seen throughout both lungs.. The referenced right upper lobe nodule previously reported as 6 mm has decreased in size (series 5, image 53) and now measures 3 mm,, and remainder of the small micronodules are either stable or some slightly smaller as well. These nodules have increased in size on October 2014 may have represented inflammatory nodules or metastatic disease that has not responded. The inflammatory changes with probable mucoid impaction have continued to resolve over the last two years. MEDIASTINUM AND HILA: Slightly prominent mediastinal lymph nodes are unchanged in size and number. The referenced subcarinal lymph nodes (series 3 Image 58) measures 2.8 x 1 .7 cm, previously 2.8 x 1.7 cm. The prior referenced right hilar lymph nodes (series 3 , image 68) measures 2.7 x 1 .6 cm, previously 2.4 x 1.7 cm. No other changes are seen.CHEST WALL: Sclerotic and some mixed lytic lesions are seen in the thoracic for tubal body similar distribution, although the lytic components in the T9 vertebral body may be slightly increased. Scattered punctate sclerotic foci are seen elsewhere in change. Old healed rib fractures are unchanged.ABDOMEN:LIVER, BILIARY TRACT: Prior noted low density near water density benign cysts are unchanged. However there are several new solid lesions now seen in the liver most indicative of metastatic disease. Reference lesion for future comparison measurements is a lesion in segment 7 (series 3, image 91) measuring 2.5 x 2 .0 cm, which is new since 10/28/14.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: While the previously referenced large left periaortic lymph node (series 3 come image 145) has decreased in size measuring 4.1 x 3.2 cm compared with 5.0 x 4.1 cm, other lymph nodes have increased in size. For example at that same level in the right posterior caval space (series 3 come image 141) an enlarged node now measures 2.9 x 2 .4 cm, compared with 1.9 x 1.6 cm previously. In addition, new anterior caval/aortic lymph nodes are seen (series 3, image 159.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Left common iliac mass has slightly decreased in size (series 3,image 176) measuring 5.3 x 3 .7 cm, previously 5.7 x 4.1-cm. Previous measured left external iliac lymph node (series 3, image 194) is minimally changed, measuring 2.3 x 2 .2 cm, previously 2.2 x 2.0 cm. Prior measured right external iliac lymph node (series 3, image 198) has not significantly changed measuring 1.6 x 1 .3 cm, previously 1.4 x 1.3 cm. Other scattered pelvic lymph nodes are also unchanged in size.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lysis and sclerosis of the sacrum and right superior pubic ramus appear similar in appearance and distribution. No new foci of abnormalities is seen to suggest additional sites of metastatic disease, however nuclear medicine bone scan is a more sensitive indicator of extent of metastatic disease. Orthopedic hardware again seen in the right femur.OTHER: No significant abnormality noted | 1. Decreasing size of small scattered pulmonary parenchymal lung nodules since 10/28/14 CT examination. In light of other inflammatory disease in the chest that is been resolving, it is uncertain whether these nodules represent inflammatory disease that is resolving or may have represented metastatic disease. 2. Stable appearance to the nonspecific mildly enlarged mediastinal lymph nodes. 3. Mixed response to retroperitoneal and pelvic lymph nodes with some lymph nodes smaller in size and others larger in size. Please see above measurements. 4. Similar distribution and appearance to skeletal metastatic lesions compared with 10/28/14, however nuclear medicine bone scan is more sensitive indicator of activity of metastatic bone disease. |
Generate impression based on findings. | Evaluate for episode of unresponsiveness with R gaze deviation, concern for verterobasilar insufficiency although seizure most likely History: pls see above 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 redemonstration of 50% stenosis at the origin of the left ICA with smooth narrowing extending approximately 10 mm in length. The stenosis begins approximately 8 mm from the origin of the left internal carotid artery. There are associated atherosclerotic calcifications as well as hypodense. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. There is approximate 40% narrowing at the origin of the right internal carotid artery. Atherosclerotic calcifications are present at the carotid bifurcations.The common carotid arteries are very tortuousThere is a high-grade stenosis present at the origin of the right vertebral artery. The right vertebral artery has a tortuous proximal andThere is no significant stenosis along the course of the left vertebral artery. Atherosclerotic calcifications are present at the carotid bifurcations.The multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at C4-5, C5-6, C6-7 and C7-T1 associated with loss of disk space height and narrowing of the neural foramina bilaterally.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.There is a 50% stenosis present along the distal portion of the right vertebral artery near the vertebrobasilar junction. Additional 50% stenosis is present at the right vertebral artery as it enters the posterior fossa.The anterior communicating artery and the posterior communicating arteries are identified and are intact. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is small. The right A1 segment is larger than the left A1 segment The anterior communicating artery is fenestrated.Atherosclerotic calcifications are present along the distal internal carotid arteries.Atherosclerotic calcifications are present along the distal vertebral arteries.There multiple foci of narrowing of the pericallosal arteries left more than right.CT head:There is encephalomalacia present along the left temporal lobe and the left parietal lobe. There is associated ex vacuo effect on the left lateral ventricle.There is a focus of encephalomalacia present along the left precuneusPunctate hypodense foci are present in the right mid brain and in the right thalamus as well as in the basal ganglia bilaterally. Another small hypodensity is redemonstrated in the right cerebellar hemisphere.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.Overall there is no significant interval change. 2.50% stenosis at the origin of the left internal carotid artery.3.High-grade stenosis at the origin of the right vertebral artery with tandem intracranial RVA stenoses.4.There is encephalomalacia present along the left middle cerebral artery territory involving left temporal lobe and the left parietal lobe as well as a watershed territory between the left to middle and posterior cerebral arteries.5.Punctate lesions in the brain stem, thalami and basal ganglia are suspected to represent lacunar infarcts and are stable since the prior exam.6.Periventricular and subcortical white matter hypodensities of a moderate degree are present. At this age these are most likely vascular related7.distal atherosclerotic changes are present especially along the left pericallosal artery |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional left MLO view 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. Focal asymmetry in the left upper outer breast is unchanged. 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. | There is post treatment change with loss of the fat planes in the parapharyngeal soft tissues, right greater than left. Additionally, there is mild edema of the supraglottic larynx and hyperemia of the mucosa of the tongue. No discrete mass is identified.A prevascular lymph node appears to have a fatty hilum and is stable from the CT dated 6/2014. A number of additional, non-pathologically enlarged lymph nodes are seen bilaterally. The salivary glands appear normal without discrete mass.There is nonspecific but persistent soft tissue attenuation in the bilateral anterior superior nasal cavity. There is mild, scattered mucosal thickening in the maxillary sinuses, otherwise the partially visualized paranasal sinuses are clear. The partially visualized skull base and orbits appear normal. There is paraseptal emphysema, a few apical bullae, and nonspecific ground glass opacity in the right lung apex which is better characterized on the concurrent CT chest. Right chest wall port is noted. Mild degenerative disease affects the cervical spine. | 1.Expected posttreatment changes without discrete mass or lymphadenopathy.2.Soft tissue occlusion of the bilateral anterior superior nasal cavity, persistent from the prior examinations. Further evaluation with direct visualization is recommended. |
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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign-appearing lymph nodes project over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 4-month-old male with desaturationsVIEW: Chest AP (one view) 3/16/15 The cardiothymic silhouette is normal. Increased right upper lobe , right lower lobe, left upper and lower lobe opacities which may represent atelectasis or pneumonia. | New bilateral pulmonary opacities may represent atelectasis and/or pneumonia. |
Generate impression based on findings. | Thumb pain. Three views of the left thumb show interval resection of the trapezium bone. A small lucency within the base of the left first metacarpal is likely postsurgical.Three views of the right thumb show normal appearing bones. | Postoperative changes as described above. Normal appearing right thumb. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in sister at age 53 and maternal aunt in her 50s. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A circular skin marker was placed over the right breast.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | No acute intracranial hemorrhage is identified. Encephalomalacia of the left basal ganglia and left corona radiata with ex vacuo dilatation of the left ventricle. There is also encephalomalacia of the bilateral inferior frontal lobe and left anterior temporal lobe. These findings are unchanged from prior study. No evidence of intracranial mass or mass effect. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. Left cataract surgery. The osseous structures are unremarkable. | 1.No evidence for acute intracranial abnormality. CT is not sensitive for detection of acute nonhemorrhagic ischemia. If there is high clinical suspicion of stroke, consider MRI.2.Prior ischemic injuries as above. |
Generate impression based on findings. | Low back pain. Five views of the lumbar spine show severe degenerative disk disease at L4/L5 and L5/S1. There is moderate degenerative disk disease at L1/L2 and L3/L4. There is multilevel facet joint osteoarthritis, particularly affecting the lower lumbar spine. There is a slight rightward curvature of the lumbar spine. There is partial sacralization of L5 with hypertrophy of the left transverse process. Atherosclerotic calcifications are noted. | Degenerative disk disease and facet joint osteoarthritis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast cyst removed 25 years ago. Family history of breast cancer and ovarian cancer diagnosed in mother at age 70. 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 linear scar marker was placed over the left upper breast.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. Family history of breast cancer diagnosed in sister. 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. Subcentimeter circumscribed benign masses in both upper breasts/low axillae are stable. Benign calcifications 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. | Female, 2 years old. Limp.VIEWS: Left tibia/fibula AP, lateral (2 views) 3/16/2015, 1032 The osseous structures and joint spaces are normal.No significant joint effusions or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Female, 2 years old. Limp and foot pain VIEWS: Left foot, AP, lateral (2 views) 3/16/2015, 1033 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Reason: cause of profound hypoxia. No hx of lung dz known History: hypoxic respiratory failure LUNGS AND PLEURA: Diffuse interlobular and intralobular septal thickening with a background of groundglass opacity which increases towards the dependent portions of the lung. Mild bronchiectasis is noted in the lung bases. No pleural effusion or pneumothorax. There is an 8mm lung nodule along the right minor fissure (series 5, image 141).ET tube is approximately 5 cm above the carina. Mild mosaic attenuation of the parenchyma.MEDIASTINUM AND HILA: Main pulmonary artery upper normal in size. Prominent mediastinal lymph nodes measuring up to 1.3 cm (series 4, image 36). Severe coronary artery calcification. Moderate cardiomegaly. No pericardial effusion.NG tube is in the stomach. ICD with leads are noted.CHEST WALL: No suspicious osseous lesions. No significant axillary, retrocrural, or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hyperattenuating lesion in the right kidney may represent hemorrhagic or hyperdense cyst. | 1.Diffuse moderate to severe Interlobular and intralobular septal thickening with background groundglass opacities and lung base bronchiectasis. Differential diagnosis includes acute CHF superimposed upon a chronic background of deposition disease such as pulmonary hemosiderosis, amyloid or drug toxicity. CT ILD protocol with expiration and prone sequences is recommended for further characterization when feasible.2.Nonspecific 8mm nodule or subpleural lymph node along the right minor fissure and mildly enlarged lymph nodes, possibly reactive, however a follow up scan in 3-4 months is recommended to exclude non-benign lesion.3. Severe coronary artery calcifications. |
Generate impression based on findings. | Reason: left nasal polyp History: history of left inverted papilloma removed by left medial maxillectomy Postsurgical changes of the left medial maxillectomy. There is a thick rind of soft tissue along the residual sinus walls. There is bony deficiency at the anterior inferior sinus wall, which is bridged by nonspecific soft tissue. The remaining sinus wall and the floor of the orbit are intact. Sinus wall is sclerotic. The nasal cavity, left middle and lower turbinates are resected. There is polypoid mucosal thickening posteriorly along the left aspect of the nasal septum. There is also small polypoid components along the residual ethmoid.There are several mucous retention cysts or polyps in the right maxillary sinus. Right ostiomeatal complex is patent.Frontal sinuses are clear. There is mucosal thickening at the bilateral frontoethmoidal recesses. There is mucosal thickening of the bilateral ethmoids. There is also mild mucosal thickening of the sphenoid sinuses, which appears to sphenoethmoid recess.Nasal septum is intact. Mild rightward deviation of the nasal septum. The cribriform plate, fovea ethmoidalis and lamina papyracea appear normal. The orbits are unremarkable. The mastoids are clear. Limited view of the intracranial structure is unremarkable. | 1.Sequelae of sinonasal surgery.2.Thick rind of non-specific soft tissue along the remaining left maxillary sinus with anterior inferior bony deficiency. Comparison with prior exams would be helpful.3.Polypoid mucosal thickening along the left nasal septum and left ethmoid region.4.Polyps or mucous retention cysts in the right maxillary sinus. |
Generate impression based on findings. | Pain. Evaluate right wrist. Three views of the right wrist show two plate and screw devices affixing a comminuted intra-articular fracture of the distal radius. There is dorsal displacement of the distal fracture fragment. We see no evidence of hardware complication. There is a mildly displaced ulnar styloid fracture. Widening of the scapholunate interval is suggestive of ligamentous laxity or disruption. A well corticated ossicle dorsal to the carpometacarpal joint is of doubtful clinical significance. There is soft tissue swelling. | Orthopedic fixation of a distal radius fracture and other findings as above. |
Generate impression based on findings. | Female, 13 years old. Followup fractureVIEWS: Left hand PA, lateral, oblique (3 views) 3/16/2015, 0928 Redemonstration of a fracture through the proximal phalanx of the middle finger, extending from the metaphysis to the physis. The fracture fragment is not displaced. No periosteal reaction.Decreased soft tissue swelling.No new fracture or dislocation. | Nondisplaced Salter-Harris II fracture of the proximal phalanx of the middle finger is again seen. |
Generate impression based on findings. | Reason: e/o bleed History: new dysarthria There is redemonstration of a couple burr holes one in the left frontal bone and one left parietal bone. There is redemonstration of a thin left-sided subdural collection measuring approximately 2 mm in thickness.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Status post left-sided burr holes. A thin left-sided subdural collection is stable and may represent chronic change.3.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | There is diffuse, bilateral abnormality of the white matter involving the cerebrum and cerebellum as well as midbrain and pons without associated mass effect or susceptibility abnormality. There is associated restricted diffusion involving significant portions of the white matter in symmetric fashion bilaterally suggestive of active demyelination.There are two small paired cystic structures adjacent to the frontal horns of CSF intensity consistent with incidental, congenital, connatal cysts.Prominence of the CSF spaces is noted anteriorly and along the anterior proximal.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 acute intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | 1.MRI evidence of duffuse hypomyelination/dysmyelination/demyelination with symmetric bilateral restricted diffusion suggesting components of active demyelination. Given the diffuse, symmetric, bilateral involvement of all supratentorial white matter there is no predominant pattern. Thus, the differential diagnosis would include primary hypomyelination syndromes, mucopolysaccharidoses, mitochondrial encephalopathies, leukodystrophies, and trichothiodystrophy.2.There are two small paired cystic structures adjacent to the frontal horns of CSF intensity consistent with incidental, congenital, connatal cysts.3.Benign enlargement of the subarachnoid spaces which usually resolves by two years of age. |
Generate impression based on findings. | Right knee pain. Four views of the right knee show moderate to severe osteoarthritis, particularly affecting the lateral and patellofemoral compartments. Ossicles projecting lateral to the distal femur likely represent loose bodies in the lateral synovial recess. There is a mild valgus deformity of the right knee. There are extensive vascular calcifications. Moderate osteoarthritis affects the left knee on the frontal view. | Osteoarthritis. |
Generate impression based on findings. | 66 year old female status post left lumpectomy in 2004 for IDC and DCIS, presents today for routine follow up. Patient received radiation and chemotherapy. No current breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker has been placed on a scar overlying the central slightly lower left periareolar region, with expected underlying postsurgical changes. Scattered benign calcifications are present. A stable, benign asymmetry is again present in the superior medial left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. A linear marker has also been placed a scar overlying the left axillary region. Surgical clips are present in the left axilla. | Stable postsurgical changes of the left breast. 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. | Female, 2 years old. History of fractureVIEWS: Right foot, AP, lateral (2 views) 3/16/2015, 0920 Overlying casting material limits evaluation.Cortical disruption at the lateral aspects of the distal second and third metatarsals. Soft tissue swelling at the dorsal aspect of the foot. | Fractures of the second and third metatarsals, status post casting. |
Generate impression based on findings. | Pain. Evaluate wrist out of the splint. Three views of the right wrist again show a screw traversing the fracture near the proximal pole of the scaphoid. There now appears to be bony bridging which is suggestive of healing. The proximal pole appears slightly sclerotic and we cannot exclude avascular necrosis. | Orthopedic fixation of healing scaphoid fracture but with mild proximal pole sclerosis; avascular necrosis cannot be excluded. |
Generate impression based on findings. | Reason: change in mediastinal mass? History: 15 year old with t-lymphoblastic lymphoma s/p induction chemotherapy RADIOPHARMACEUTICAL: 5.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 72 mg/dL. Today's CT portion demonstrates marked interval decrease in the patient's anterior mediastinal mass since the prior study. Additionally, there has been interval resolution of the previously seen pulmonary opacities. There are no pleural effusions. A right PICC line terminates at the cavoatrial junction. There is hepatomegaly with marked hepatic hypoattenuation which is new since the prior PET CT from 2/11/2015. There has been interval resolution of the abdominal ascites seen previously. There is mild fluid reticulation in the subcutaneous fat of the abdominal wall and along the intermuscular fascial planes of the thighs. Today's PET examination demonstrates mild activity in the patient's residual anterior mediastinal soft tissue compared to blood pool, with an SUV of 1.7 (previously 5.7). There are no suspicious pulmonary or pleural areas of uptake on this examination. No new focal areas of abnormal radiotracer uptake are identified. However, there is diffuse radiotracer uptake in the subcutaneous fat of the abdominal wall which is new. Additionally, there is also new uptake along the intramuscular fascial planes of both thighs. | 1. Significant interval decrease in size of the patient's anterior mediastinal mass. The residual anterior mediastinal tissue demonstrates mild radiotracer uptake which is also decreased. This tissue may represent residual tumor, thymic tissue, or some combination thereof. 2. Interval resolution of pleural effusions and pulmonary opacities since the prior PET examination. 3. Hepatomegaly with marked diffuse fatty infiltration which is new since the prior PET examination. This may be therapy related given its acute onset. 4. Diffuse radiotracer uptake throughout the subcutaneous fat of the abdominal wall and within the intermuscular fat planes of both thighs. This is of uncertain etiology and clinical significance, but does not have an appearance that would suggest tumor. |
Generate impression based on findings. | Status post total knee. Three views of the left knee again show postoperative changes of a medial unicompartmental arthroplasty removal and cement spacer placement. A small amount of cement now overlies Hoffa's fat pad which was not present on the prior study and is of uncertain clinical significance. A small joint effusion is noted. Interval removal of the surgical skin staples and the surgical drain. Moderate osteoarthritis affects the remainder of the knee. There is mild osteoarthritis and chondromalacia of the menisci of the right knee on the frontal view. | Postoperative and osteoarthritic changes as described above. |
Generate impression based on findings. | Reason: lung cancer s/p chemorads ck response History: Headache The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is no evidence for brain metastases. Please note that MRI is more sensitive in detecting brain metastases relative to CT.2.No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Reason: 72 yo F smoker with hx of LLL wedge resection for granuloma with mild SOB. Eval for nodules, emphysema progression History: smoker, mild sob LUNGS AND PLEURA: Moderate centrilobular emphysema in the upper lung zones.Scattered micronodules, unchanged, compatible with previous infection.Sharply defined left lower lobe nodule (series 7/56) 21 x 24 mm in diameter, not significantly changed from the previous exam of 2011. A small fleck of calcification is present at the margin of the nodule. There is no evidence of internal fat. Opacity that was present contiguous with the nodule and distally was apparently resected.MEDIASTINUM AND HILA: Mildly enlarged nonspecific lymph nodes, unchanged or decreased.Moderate coronary artery calcification.No pericardial effusion.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable smoothly marginated left lower lobe nodule with minimal calcification compatible with a benign etiology.No new findings. |
Generate impression based on findings. | 60-year-old male status post fall 9 days ago, continued pain of both wrists, right knee, lower back. Three views of the left wrist reveal soft tissue swelling. There is widening of the scapholunate interval suggestive of ligamentous laxity or disruption which may be chronic in etiology. There is narrowing of the radiolunate articulation. Small ossicles are noted along the dorsal and radial aspect of the carpus which appear chronic. There is mild basilar joint osteoarthritis.Three views of the right wrist reveal soft tissue swelling. There is widening of the scapholunate interval suggestive of ligamentous laxity or disruption which may be chronic in etiology. There is narrowing of the radiolunate articulation. A small ossicle is noted along the dorsal aspect of the carpus. There is mild basilar joint osteoarthritis.Four views of the left knee show no acute fracture. Moderate osteoarthritis affects the knee. There is no joint effusion.Four views of the right knee show no acute fracture. Moderate osteoarthritis affects the knee. There is no joint effusion. Irregularity of the distal quadriceps tendon may represent a chronic tear, but the patella is positioned within normal limits.Five views of the lumbar spine show no acute fracture or malalignment. Mild degenerative disk disease and facet joint osteoarthritis affects the spine. | Degenerative arthritic changes as above, we see no acute fracture. |
Generate impression based on findings. | 69 year old female status post right lumpectomy in 2012 for DCIS at outside institution, presents today for routine follow up. Patient received radiation, and Arimidex therapy. History benign bilateral breast biopsies. No current breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker has been placed on scar overlying the upper central right breast with expected underlying postsurgical changes including clips. A biopsy marking clip is noted within the central outer right breast. A dumbbell shaped biopsy marking clip is present within the central slightly outer left breast, mid depth, with a coil-shaped biopsy clip noted within the anterior upper slightly outer left breast. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. Surgical clips are present in the right axilla. | Stable postsurgical changes of the right breast. 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. | A patient submitted outside study for review. Submitted for review are digital mammographic images (9/18/14, 11/18/14), ultrasound images of right breast (11/18/14), images from ultrasound guided biopsy of right breast and post procedural right mammographic images (12/5/14), images from ultrasound guided wire localization of right breast and post procedural right mammographic images (1/14/15) performed at Mercy Hospital. DIGITAL MAMMOGRAPHIC IMAGES (9/18/14, 11/18/14):The breast parenchyma is mostly fatty replaced. High density oval shaped mass with spiculations is present in the right upper outer quadrant.A few benign appearing masses, likely intramammary lymph nodes, are present in both breasts.Multiple benign calcifications are noted in both breasts.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. ULTRASOUND IMAGES OF RIGHT BREAST (11/18/14):A lobulated hypoechoic mass with echogenic rim, measuring 15 x 14 mm, at 10:30 position, 12 cm from nipple, is visualized in the right breast, corresponding to the mass on the mammogram. This is suspicious for malignancy. A benign appearing lymph node is seen in the right axilla. A normal intramammary lymph node is detected in the left 3 o'clock position.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (12/5/14):Ultrasound guided needle biopsy was performed for the mass at 10:30 position with appropriate needle placement. A marker clip was placed within the mass. Post procedural right mammographic images show the marker clip within the mass at anterior aspect.Per outside pathology report, the biopsy result was malignant; invasive ductal carcinoma.IMAGES FROM ULTRASOUND GUIDED WIRE LOCALIZATION OF RIGHT BREAST AND POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (1/14/15):Ultrasound-guided wire localization for the right breast mass was performed. Post procedural right mammographic images show the wire placed by superior-inferior direction. A reinforced portion of the wire is located deeper to the mass. No specimen radiograph is not submitted. | Right breast cancer, status post wire localization.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male 48 years old Reason: Cholangiocarcinoma please assess and provide index lesion measurements for RECIST prior to start of chemo History: As above CHEST:LUNGS AND PLEURA: 5-mm left lower lobe nodule (series 5 image 63). This lesion is too small to characterize and was not included on the previous exam field-of-view.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Poorly defined, infiltrating hypoattenuating lesion within the liver compatible with cholangiocarcinoma. The primary lesion is within the caudate lobe and extending into segments 5 and 6 of the liver measures 12.9 x 6.9 cm in axial dimension (series 3 image 108), previously 10.8 x 5.0 cm. This is associated with distal hypodense branching linearity which may represent upstream biliary dilatation versus thrombosed portal vein branches. There are small adjacent satellite lesions appearing similar to prior. Additional subcentimeter partially cystic focus in the left lobe is mildly increased in size measuring 9 x 6 mm (series 3 image 29), previously 6 x 4 mm. Small volume of ascites within the upper abdomen. The portal vein is thrombosed with cavernous transformation of the collateral vessels. SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple enlarged lymph nodes in the upper abdomen and retroperitoneum. For reference a gastrohepatic lymph node measures 2.3 x 1.2 cm (series 3 image 110), previously 2.2 x 1.4 cm. An enlarged porta hepatis lymph node measures 4.0 x 3.2 cm (series 3 image 114), previously 4.0 x 3.2 cm. While not changed in overall dimension, these lymph nodes are now more convex suggesting interval increase in volume. A para-aortic lymph node measures 2.2 x 1.5 cm (series 3 image 37), previously 1.8 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multiple subcutaneous nodules in the low anterior abdominal wall likely represent injection granulomas.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: Bilateral fat-containing inguinal hernias.OTHER: No significant abnormality noted | 1.Slight interval increase in size of right hepatic lobe mass and satellite nodule compatible with worsening tumor burden.2.Upper abdominal and retroperitoneal lymphadenopathy is not significantly changed by measurement but now has more convex borders suggesting interval increase in volume.3.Subcentimeter pulmonary nodule in the left lower lobe was not included on prior exams for comparison and is nonspecific, but continued follow-up is recommended. |
Generate impression based on findings. | Male 59 years old Reason: Abnormal Liver function Test. Evaluate for Disease. History: Abnormal Liver function Test. Evaluate for Disease. LIVER: The liver measures 18.3 cm in length. The parenchyma is diffusely hyperechoic suggestive of fatty infiltration. There is poor penetration of the liver secondary to diffuse hyperechoic parenchyma which limits evaluation for underlying lesion. If there is high clinical suspicion for focal liver lesion further evaluation with cross-sectional imaging should be considered. The portal vein is patent and demonstrates normal directional flow with peak velocity of 0.2 m/sec. GALLBLADDER, BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall pericholecystic fluid. There is no biliary dilatation.PANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney measures 12.0 cm. The left kidney measures 10.8 cm. There are no shadowing stones or hydronephrosis.OTHER: The spleen measures 8.3 cm. | Diffusely hyperechoic hepatic parenchyma suggestive of diffuse fatty infiltration. Due to resulting poor penetration of the liver evaluation for underlying liver lesion is limited. If there is high clinical concern consideration should be given to cross-sectional imaging. |
Generate impression based on findings. | 65 year old female status post last mastectomy in 2002 for IDC with DCIS, presents today for routine follow up. Patient received chemotherapy. History of right reduction mammoplasty in 2002. No current breast complaints. Family history of ovarian carcinoma in her mother and two maternal aunts. Three standard views, and one spot compression view, of the right 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. Postsurgical changes are present in the right breast, compatible patients history of reduction mammoplasty. An asymmetry is present in the central right breast on MLO view only, and disperses to normal parenchyma on spot compression view. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of non-surgical architectural distortion in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Additionally, given the patient's history and breast density, annual MRI screening might be useful. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 41 years old Reason: asses hiatal hernia and lap band position s/p rygb (02) and lap band (06) History: post prandial abd pain, n Given the reported history Roux-en-Y gastric bypass and subsequent Lap band, we suspect that the gastric remnant has dilated. The portion of the gastric remnant proximal to the gastric has herniated above the diaphragm and measures 2.7 x 3.2 cm. The portion of the gastric remnant distal to the gastric band measures approximately 2.9 x 2.6 cm. Contrast progressed from the esophagus to the gastric remnant without delay. The channel at the level of the gastric band measures approximately 8 mm, and there was no evidence of obstruction at this level.TOTAL FLUOROSCOPY TIME: 1:46 minutes | Post surgical changes related to Roux-en-Y gastric bypass and subsequent gastric banding, with dilatation of the gastric remnant, and herniation of a portion of the gastric remnant above the diaphragm. |
Generate impression based on findings. | Alignment is anatomic. There are no fractures or subluxations. There are no osseous dysplasias. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable. Upon prone maneuvering, the conus and cauda equina translate anteriorly. There is a tiny right paramedian disc protrusion at T12/L1 without significant associated mass-effect and no resulting stenosis. There are no significant other disc pathologies or stenoses. | There is a tiny right paramedian disc protrusion at T12/L1 without significant associated mass-effect and no resulting stenosis. |
Generate impression based on findings. | 2-year-old male history of hydronephrosis and reflux. BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 1 Length*** Right: 6.8 cm Left: 6.7 cm Mean for age: 7.0 cm Range for age: 5.8 - 7.8 cmADDITIONAL OBSERVATIONS: A junctional parenchymal defect is present on the right, a normal variant. | Left grade 1 renal pelvis dilatation. Normal appearance of the kidneys.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Reason: 51y/o female with neck mass; possible neck lipoma vs excess fat History: 51y/o female with neck mass; possible neck lipoma vs excess fat LUNGS AND PLEURA: Dense left perihilar groundglass opacity involving the left upper and left lower lobes, of uncertain chronicity. This appearance is most commonly associated with an acute process such as aspiration, but if the patient is asymptomatic could be related to a resolving inflammatory process.Mild linear scarring along the minor fissure in the right upper lobe.No suspicious nodules.MEDIASTINUM AND HILA: Moderately enlarged AP window lymph nodes measuring up to 10 mm in short axis diameter.Right hilar and paratracheal lymph nodes, some of which are calcified, are also moderately enlarged.Mild coronary artery calcification.Mild pericardial thickening.CHEST WALL: Moderately large left axillary lymph nodes measuring up to 10 mm in short axis diameter.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Patchy left perihilar groundglass opacity involving the upper and lower lobes, suggestive of aspiration and/or infection, but of uncertain chronicity. 2. Moderately enlarged nonspecific mediastinal and left axillary lymph nodes.3. No evidence of a mass in the visualized portion of the neck or mediastinum. |
Generate impression based on findings. | Reason: HNSCC. restaging, Compare to previous History: as above CHEST:LUNGS AND PLEURA: Stable calcified and noncalcified benign-appearing micronodules.No suspicious nodules or masses.Mild centrilobular and paraseptal emphysema is unchanged. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion.Severe coronary artery calcification.No significant hilar or mediastinal lymphadenopathy.CHEST WALL: No suspicious osseous lesions are identified. Mild degenerative disease affects the thoracolumbar spine. No axillary, retrocrural, or cardiophrenic lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Diffuse hypoattenuation of the liver parenchyma is suggestive of fatty infiltration.SPLEEN: Scattered granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypodense lesions in the kidneys bilaterally are too small to further characterize but presumably represent and are unchanged. No hydronephrosis or perinephric inflammation.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the aorta and its branches. Stable unchanged aneurysmal dilatation and thrombosis of the proximal left iliac artery.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. No significant interval change.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female; 51 years old. Reason: 51 y/o met colon ca on chemo. compare to prior. History: see above CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Right-sided chest port with catheter tip at the superior cavoatrial junction. New left internal mammary lymphadenopathy. For future reference, this enlarged left internal mammary lymph node measures 1.4 x 1.3 cm (series 3/26).No enlarged axillary lymph nodes now by CT size criteria. Referenced right axillary lymph node measures 1.7 x 0.9 cm (3/17), previously 2.2 x 1.1 cm.ABDOMEN:LIVER, BILIARY TRACT: Diffuse hepatic metastases have significantly increased in size. Referenced right lobe lesion measures 4.5 x 4 cm (series 3/60), previously 4.1 x 2.8 cm. Portal veins and hepatic veins appear patent. No biliary ductal dilation.SPLEEN: New small peripheral wedge-shaped area of hypoattenuation in the posterior aspect of the spleen, most likely due to infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable reference left para-aortic lymph node measures 1.2 x 0.8 cm (series 3/116), previously 1.2 x 0.8 cm.BOWEL, MESENTERY: There is now continued marked increased in omental and peritoneal mass numbers and volume, compatible with worsening carcinomatosis. Prior referenced nodule measures 2.3 x 3.4 cm (3/111), previously 1.0 x 2.3 cm. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New moderate abdominopelvic ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Again there is significantly increased omental and peritoneal nodularity, compatible with carcinomatosis. Previously described nodule measuring 2 x 4.6 cm on prior study is not discretely measurable due to confluent, masslike peritoneal caking.BONES, SOFT TISSUES: Degenerative changes with sclerosis throughout the lumbar spine in pelvis unchanged.OTHER: New moderate abdominopelvic ascites. | 1. New left internal mammary lymphadenopathy.2. Significantly increased hepatic metastases.3. Significantly increased carcinomatosis with new moderate ascites.4. Small splenic infarct. |
Generate impression based on findings. | 62 year-old female with history of adenoid cystic carcinoma left submandibular gland. CHEST:LUNGS AND PLEURA: Nonspecific 2-mm right upper lobe micronodule. No suspicious pulmonary nodules or pleural effusions.MEDIASTINUM AND HILA: The heart size is normal with no significant pericardial effusion. Mild coronary artery calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Nonspecific 2-mm right upper lobe nodule, likely infectious, otherwise no evidence of metastatic disease. |
Generate impression based on findings. | Female 83 years old Reason: eval for cause of anorexia, weight loss, malnutrition, ? malignancy History: anorexia, weight loss, malnutrition, ? malignancy CHEST:LUNGS AND PLEURA: Scattered reticular and groundglass opacities in the right upper lobe with more focal semi-solid nodule that measures 11 x 5 mm (series 4 image 20), previously 9 x 6 mm.MEDIASTINUM AND HILA: Multiple hypodense thyroid nodules. Multifocal mediastinal and hilar lymphadenopathy much of which is calcified and hypoattenuating compatible with sarcoidosis. However there is new enhancing left superior paratracheal, prevascular, and AP window lymphadenopathy. The left paratracheal lymph node measures 13 x 10 mm (series 3 image 19), previously 6 x 6 mm.Severe coronary artery calcification. The main pulmonary artery is borderline enlarged measuring 3.0 cm in diameter compatible with pulmonary hypertension.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Innumerable poorly defined hypodense lesions in both lobes of the liver compatible with malignancy. There is associated capsular retraction raising the possibility of cholangiocarcinoma. The lesions in the right lobe are confluent limiting measurement. For reference a lesion in the inferior left lobe measures 2.6 x 2.4 cm (series 36 image 96). A lesion in the inferior right lobe measures 2.7 x 2.6 cm (series 3 image 105).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple non-obstructing calculi in the right lower lobe. RETROPERITONEUM, LYMPH NODES: Numerous enlarged porta hepatis lymph nodes many of which are confluent limiting measurement. For reference, a para-caval node measures 2.2 x 1.3 cm (series 3 image 100).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the thoracolumbar spine without focal lytic or blastic lesions. OTHER: Small volume perihepatic ascites. PELVIS:UTERUS, ADNEXA: The uterus is atrophic or surgically absent. Right adnexal cyst versus loculated ascites measures 4.3 x 3.2 cm (series 3 image 163). Bilateral adnexal soft tissue densities measuring 2.1 x 1.6 cm on the left and 2.6 cm on the right (series 3 image 153). It is unclear if these represent the patient's intact ovaries versus enlarged lymph nodes.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the thoracolumbar spine without focal lytic or blastic lesions.OTHER: No significant abnormality noted. | 1. Numerous hypodense lesions within the liver compatible with malignancy. While no definite primary lesion is identified, the associated capsular retraction raises the possibility of cholangiocarcinoma. 2. Multifocal mediastinal and hilar lymphadenopathy. The majority of this is likely related to the patient's sarcoidosis and has not significantly changed from prior, but there are newly enlarged and hypre-enhancing left upper paratracheal, prevascular and AP window lymph nodes suspicious for metastases.3. Right adnexal cyst versus loculated fluid collection and bilateral adnexal soft tissue masses which may represent lymphadenopathy versus intact ovaries. Correlate for history of oophorectomy. Consider pelvic ultrasound to further evaluate the pelvic cyst if the patient has intact ovaries. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules have increased in size.A right middle lobe nodule (series 4/52) measures 10 mm in long axis, increased from 8 mm previously.A left lower lobe nodule measures 17 mm in long axis (series 4/70) increased from 11 mm previously.Multiple additional nodules have also increased in size.MEDIASTINUM AND HILA: Subcarinal lymphadenopathy now measures 37 mm in short axis diameter, markedly increased from 14 mm previously. Other mildly enlarged mediastinal nodes have not significantly changed.No visible coronary artery calcification.Venous catheter extending to the upper right atrium.No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic steatosis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Surgical fixation devices in the lumbar spine.OTHER: No significant abnormality noted. | Progression of pulmonary and mediastinal metastatic disease. |
Generate impression based on findings. | Intracranial hemorrhage The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 50 x 66 mm axial dimension hyperdense lesion centered in the left basal ganglia which is associated with a significant mass effect. There is approximately 14 mm shift of the third ventricle towards the right. There is associated uncal herniation and effacement of the suprasellar cistern. There is additional sub-false and herniation and transtentorial herniation. The right lateral ventricle is enlarged. Blood products fill of the right lateral ventricle and the left lateral ventricle as was the third ventricle.Small hemorrhagic foci are present along the pons and midbrain.There is an extra-axial collection present adjacent to the left cerebellar hemisphere measuring 10 mm in thickness.Some subarachnoid blood is present in the posterior fossa, left more than right, surrounding the cerebellar hemispheres.There is diffuse sulcal effacement present.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Incidental note is made of left medial orbital blowout fracture. Punctate metallic foreign bodies are scattered in the left orbit and periorbital region in stable position.Atherosclerotic calcifications are present along the distal internal carotid arteries.The patient is status post posterior fossa craniotomy. | 1.Since the prior exam the patient has developed a very large hemorrhage centered in the left basal ganglia associated with smaller hemorrhagic foci in in the upper brainstem as well as bilateral intraventricular blood and posterior fossa subarachnoid blood. There is associated mass-effect with subfalcine, transtentorial and uncal herniation. There is significant midline shift present, diffuse sulcal effacement and associated enlargement of the right lateral ventricle.2.There is a left-sided subdural hematoma present within the posterior fossa.3.Findings were discussed with Dr Jason Turner at noon on 3/16/15. |
Generate impression based on findings. | Male 68 years old Reason: new diagnosis CML, epigastric fullness, please eval for liver size, spleen size, or other abnormality Please eval all liver vessels and aorta ivc as well for clot History: epigastric fullness, lower limb swelling DVT negative. LIMITED ABDOMENLIVER: The liver measures 17.8 cm in length and demonstrates normal echogenicity. No focal liver lesion. BILIARY TRACT: Unremarkable appearance of the gallbladder without gallstones, gallbladder wall thickening or pericholecystic fluid. There is no biliary dilatation.PANCREAS: Unremarkable appearance of the pancreatic head and proximal body. The distal body and pancreatic tail are poorly visualized. SPLEEN: The spleen measures 10.7 cm. KIDNEYS: The right kidney measures 11.1 cm. The left kidney measures 11.0 cm. There are no shadowing stones. There is no hydronephrosis.AORTA: Patent with peak systolic flow of 1.1 m/sec.OTHER: Trace ascites. Bilateral pleural effusions. | 1. No evidence of hepatosplenomegaly.2. Patent hepatic vasculature.3. Bilateral pleural effusions and trace ascites. |
Generate impression based on findings. | 52 year old female who has a complaint of left breast abscess for 6 months. No family history of breast cancer. MAMMOGRAM: Three standard views of both breasts, with additional bilateral MLO and cleavage views, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density.Asymmetry is noted within the left retroareolar region. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the left axilla.ULTRASOUND: On physical examination, no palpable abnormality is identified. A draining wound was noted at the 7 o'clock position of the left areolar border. A targeted left ultrasound was performed for the mammographic area of concern. At the 7 o'clock retroareolar region of the left breast, there is a hypoechoic sinus tract extending from the nipple to the cutaneous opening measuring 3.6 x 1.0 x 1.3 cm. No focal fluid collection amenable to drainage is appreciated. Increased vascularity is noted along the tract, suggesting inflammatory change. | Sinus tract extending from the left nipple to the cutaneous opening at the 7 o'clock periareolar region. This may represent healing abscess, or persistent fistulous tract. Surgical consultation and continued surgical management is advised. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | 67-year-old female with intracranial hemorrhage experiencing altered mental status. Redemonstrated is a large intraparenchymal hematoma in the left insula and frontal parietal operculum, without significant interval change when allowing for differences in slice selection and angulation. As before, there is mild surrounding hypodense vasogenic edema and mass effect with partial effacement of the left lateral ventricle, similar to prior. There is minimal rightward midline shift.There are a few small lucencies within the left frontal and parietal bones, some of which represent arachnoid granulations. In addition, there is a small partially lytic lesion in the right paramedian parietal calvarium with an extra-axial calcified component. The ventricles and sulci are stable. There is no new intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No significant interval change in large left frontal parenchymal hematoma with localized mass effect and minimal midline shift. |
Generate impression based on findings. | Male 32 years old Reason: 32 year old patient with pain to palmar of the right finger sp laceration to finger with glass evaluate for foreign body. History: pain and erythema Focused US performed over the right middle finger. No evidence of echogenic foreign body. No fluid collection or edema within the subcutaneous tissues. Unremarkable appearance of the visualized flexor tendon which is intact. | No evidence of echogenic foreign body or collection within the soft tissues of the right middle finger. |
Generate impression based on findings. | Reason: h/o larynx ca and CRT, compare to previous, measurements pls History: none There is redemonstration of a thickening of the laryngeal mucosal tissues which appear stable when compared with previous exam.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a 5-mm by 5-mm lymph node present at the left submandibular space which previously measured 4 mm x 4 mm there is a 2-mm lymph node present at the right submandibular space which previously measured 2 mm.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are endplate and uncovertebral osteophytes present at C6-7. There is redemonstration of a superior endplate compression of T3 which is stable since the prior exam but new since the April 2014 exam. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy.2.There is redemonstration of a superior endplate compression of T3 which is stable since the prior exam but new since the April 2014 exam. |
Generate impression based on findings. | 5 year old male with left orbit rhabdomyosarcoma treated at outside hospital partial resection in March 2014 followed by proton therapy and chemotherapy. HEAD: There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift, herniation, or abnormal enhancement. The imaged mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There is mucosal thickening and secretions within the paranasal sinuses. ORBITS: The extraocular muscles and optic nerves are normal in size and attenuation. There is thinning of the left medial orbital wall. There is mild stranding of the left extra-conal fat without evidence of focal enhancing mass. There is decreased enhancement of the left lacrimal gland that is likely treatment related. | 1.Mild non-specific stranding of the left extraconal fat and mild thinning of the left medial orbital wall of uncertain significance. Comparison with outside prior imaging is recommended. 2.No evidence of intracranial metastasis. |
Generate impression based on findings. | Reason: 45M with history of nasopharyngeal CA s/p XRT. Routine surveillance evaluation. History: history of nasopharyngeal CA s/p XRT Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.A right submandibular space lymph node measuring 6 mm short axis dimension is stable compared to the right jugulodigastric node measures 6 mm short axis dimension and is stable.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses demonstrate mucosal thickening which was also present on the prior exam.. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are degenerative changes in the cervical spine worse at C5-6 where there are endplate and uncovertebral osteophytes associated with narrowing of the neural foramina. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy |
Generate impression based on findings. | Reason: AMS History: AMS The patient is status-post left-sided craniectomy. There is redemonstration of a hematoma centered in the left sylvian fissure associated with small foci of intraparenchymal hemorrhage in the adjacent left insular cortex and the left parietal lobe. There is associated bulging of the left hemisphere through the craniectomy site . There is associated hypodensity in the brains surrounding hematoma. Compared to the previous exam there is no substantial change in the size of the hematoma. There is no substantial midline shift appreciated.There is a redemonstration of encephalomalacia along the inferomedial aspect of the right cerebellar hemisphere as well as multiple hypodensities in the basal ganglia bilaterally. There is redemonstration of uncal herniation and midline shift.There is partial opacification of the paranasal sinuses status post intubation. | 1.Status-post left-sided craniectomy. There is continued evolution of blood products in the left sylvian fissure and adjacent brain parenchyma.2.Foci of hypoattenuation in the bilateral basal ganglia are suspicious for chronic lacunar infarcts.3.Encephalomalacia in the right cerebellar hemisphere is likely related to chronic cerebellar infarct. |
Generate impression based on findings. | 81 years old Female. Reason: History: breast cancer with liver metastasis. Please evaluate response to therapy. RADIOPHARMACEUTICAL: 13.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 118 mg/dL. Today's CT portion grossly demonstrates decreased size of the right breast mass and right axillary lymph nodes. The interval increased size of the hepatic dome lesion. Dependent changes are seen in the lung bases.Today's PET examination demonstrates interval decreased metabolic activity and size of the right breast lesions and right axillary lymph nodes. For reference the SUV Max in the right breast mass is 1.9 (it was 9.1 on prior study). However, there is interval increase in size and metabolic activity of the hepatic dome mass with SUV Max of 10.2 (it was 7.3 on prior study). A foci of increased activity seen on prior study in the right 6th and 10th ribs and L1 vertebral body have resolved. A nonspecific focus of increased activity is seen in a small bowel loop in the right side the pelvis. Mild increased activity is seen in the patchy opacities in the right upper lobe of the lung. Mild FDG uptake is seen in the degenerative changes in the lower lumbar spine. Mild FDG uptake is seen in the skin folds in the inguinal regions. Mild FDG uptake is also seen in the bilateral small inguinal lymph nodes. Mildly increased FDG uptake is seen in the subcutaneous soft tissue density in the hips, which is most likely due to injection. | 1.Interval significant improvement of FDG avid tumor in the right breast and right axilla lymph nodes.2.Interval progression of hepatic metastasis.3.Resolution of right 6th and 10th ribs and L1 vertebral body lesions.4.Inflammatory changes in the right upper lung, inguinal lymph nodes and a subcutaneous soft tissue densities in the hips.5.Nonspecific focal uptake in the small bowel loop in the pelvis. |
Generate impression based on findings. | VESSELS:SINUS OF VALSALVA: 4.0 X 4.0 x 3.5 cmSINOTUBULAR JUNCTION: 3.5 3.7 cmASCENDING THORACIC AORTA AT LEVEL OF MAIN PULMONARY ARTERY: 3.5 X 3.6 cmASCENDING THORACIC AORTA IMMEDIATELY PROXIMAL TO THE INNOMINATE ARTERY: 3.4 X 3.3 cmPROXIMAL DESCENDING THORACIC AORTA IMMEDIATELY DISTAL TO THE LEFT SUBCLAVIAN ARTERY: 2.8 X 2.9 cmDistal transverse thoracic aorta: 2.9 X 3.0 cmCHEST:LUNGS AND PLEURA: Respiratory motion artifact with subsegmental atelectasis involving the left lower lobe.MEDIASTINUM AND HILA: Cardiomegaly with left ventricular and biatrial enlargement. Dense coronary artery and aortic valvular calcifications. No pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Multiple left-sided rib deformities compatible with callus of prior fractures. Deformity of the distal left clavicle appears posttraumatic.ABDOMEN:BONES, SOFT TISSUES: Lumbar immobilization hardware is partially visualized. Extensive degenerative changes of the thoracic spine.OTHER: No significant abnormality noted. | 1.Left lower lobe subsegmental atelectasis.2.Dense aortic valvular and coronary artery calcifications with cardiomegaly.3.Vascular measurements of the thoracic aorta as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Benign coarse calcification in the left breast 6 o'clock position is unchanged.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. The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, additional right CC 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. Scattered benign calcifications bilaterally 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. | Injury Three views of the right foot show no acute fracture or dislocation. There is perhaps mild soft tissue swelling along the dorsum of the foot, but otherwise the foot appears normal for age. | No fracture is evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral benign breast biopsies. Two standard digital views of both breasts and additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Linear scar markers were placed over both upper outer quadrants. Scattered benign calcifications 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of vulvar cancer diagnosed at age 53, status post surgery and radiation. 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 almost entirely fatty, 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. Normal sized 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: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed and paternal grandmother, aunts, great-aunt, and two cousins. 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. The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right benign breast biopsy. Family history of breast cancer diagnosed in 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear scar marker was placed over the right upper outer breast. Underlying postbiopsy architectural distortion in the right breast, mid depth, is unchanged. Scattered bilateral benign calcifications, greater in the right breast, are also unchanged.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: NSC - Screening Mammogram. |
Generate impression based on findings. | Patient fell to the ground today after hearing a pop in his right knee. Patient unable to ambulate. Pain to the anterior-proximal knee. Four nonweightbearing views of the right knee show no acute fracture, malalignment, or joint effusion. | No specific radiographic findings to account for the patient's pain. If further imaging is clinically warranted, MRI may be considered. |
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 almost entirely fatty, unchanged in pattern and distribution. Benign ductal and arterial 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: 2 - Benign finding.RECOMMENDATION: NSA - 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, unchanged in pattern and distribution. Stable benign intramammary lymph node in the right upper outer breast.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: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Mitral stenosis and recent shortness of breath, left upper lobe opacity. LUNGS AND PLEURA: Large loculated left pleural fluid collection with associated compressive atelectasis. The pleural fluid is partially loculated within the major fissure, the majority of the fluid is loculated medially and near the lung base. Small pleural fluid collection on the right. Subsegmental atelectasis left lower lobe. No signs of pneumonia.MEDIASTINUM AND HILA: Moderate circumferential pericardial fluid collection, similar to previous. Severe coronary artery calcifications. Calcification of the mitral valve. Mildly prominent mediastinal and hilar lymph nodes.CHEST WALL: Left rib chronic fracture deformities. Median sternotomy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Exophytic cystic lesions arising from the kidney incompletely included scanning range. Gallbladder is collapsed, but mild wall thickening may be present unchanged. | Large loculated left pleural fluid collection with associated compressive atelectasis, but no signs of pneumonia or other new finding. Moderate pericardial fluid collection. Please refer to separately reported abdominal ultrasound. |
Generate impression based on findings. | 17 years old Male. Reason: disease status evaluation. History of recurrent Hodgkin's lymphoma s/p 2 cycles chemotherapy. RADIOPHARMACEUTICAL: 10.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates interval decrease in size, and number of the multiple lymph nodes in the neck, bilateral axillary regions, left pelvis and inguinal regions. Stable soft tissue density in the bilateral maxillary sinuses.Today's PET examination demonstrates interval significant improvement of hypermetabolic lymph nodes in the bilateral axillary regions, bilateral inguinal regions and pelvis. For reference, the SUV Max in the left axillary lymph nodes is 3.9 (it was 8.4 on prior study). The SUV Max in the left obturator lymph nodes in the pelvis is 1.5 (it was 7.7 on prior study). The right common iliac lymph node with increased activity seen on prior study has resolved. There is interval decreased size of the post procedural change in the left inguinal region.No evidence of FDG avid new lesions is identified. Physiologic activity is seen in the liver, spleen, kidneys, intestines and bladder. Extensive brown fat activity are seen in the neck and upper chest wall, which may limit evaluation of the small lymph node disease. | 1.Significant interval improvement of the hypermetabolic lymphadenopathy in the bilateral axillary regions, bilateral inguinal regions and pelvis.2.Interval decreased size of the post procedural changes in the left inguinal region. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of ovarian cancer diagnosed in maternal grandmother. Two standard digital views of both breasts and additional MLO views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | 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. | Male 74 years old; Reason: eval for progression History: prostate cancer on therapy CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Calcific coronary artery disease.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities are too small to characterize. The hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cysts. The largest cyst has a thin septation.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: Urinary bladder is distended likely due to outlet obstruction. There are small multiple calculi within the urinary bladder on the right and within a left posterior lateral diverticulum.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes in the right hip. There is a sclerotic lesion involving the right L3 vertebral body.OTHER: No significant abnormality noted | 1.Stable exam with a right L3 vertebral body sclerotic lesion. |
Generate impression based on findings. | Malignant neoplasm thyroid gland restaging exam on oral investigational therapy. CHEST:LUNGS AND PLEURA: Left lower lobe module measures 16 x 27 mm (6/71), previously 15 x 20 mm, not significantly changed. Overall size and number of pulmonary nodules not significantly changed.MEDIASTINUM AND HILA: Right paratracheal lymph node measures 12 x 14 mm, previously 13 x 16 mm (4/20). Partially calcified right hilar lymph nodes, mildly prominent, unchanged. Right cardiophrenic nodule/lymph node measures 30 x 25 mm (4/52), previously 24 x 28 mm.CHEST WALL: Postsurgical changes of thyroidectomy and neck dissection. Low-density paratracheal thickening on the right at the level of the thoracic inlet and a centrally hypoattenuating nodule posterior to the right clavicular head are unchanged, please refer to separately reported neck CT.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Left hepatic lobe hypoattenuating lesion (77/148) unchanged, possibly a cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No significant change in pulmonary or nodal metastases. |
Generate impression based on findings. | 67 year old with history of right mastectomy in 2011 for invasive ductal carcinoma and DCIS. Patient received chemotherapy and radiation. History of 3 benign left breast biopsies in the 1960s. Three standard 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 elements, unchanged in pattern and distribution. There are stable benign hyalinized fibroadenomas and stable benign calcifications. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral 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. | 70 year-old female with known right breast carcinoma since 2013, on an aromatase inhibitor. Assess response to therapy. On physical examination, marked skin dimpling and retraction is noted at the one o'clock position, 6 cm from the nipple. A targeted right ultrasound was performed for the patient’s area of concern. At the one o'clock position, 6 cm from the nipple, there is a vague hypoechoic lesion now measuring 0.3 cm (previously 1.0 cm). | Vague hypoechoic lesion remains at the site of index malignancy. Today this measures 0.3 cm (previously 1.0 cm). Patient should continue no follow up with oncologists and surgeon as clinically indicated.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 65-year-old asymptomatic female presents for diagnostic mammography. History of a benign left breast biopsy in 1995. History of large right breast fibroadenoma. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of 4.5 cm oval, lobulated mass in the upper outer quadrant of the right breast. Per the patient, pathology from biopsy showed benign fibroadenoma. A linear marker has been placed on a scar overlying the upper outer left breast. There is redemonstration of a cluster of calcifications in the upper outer left breast, unchanged from prior examination. A biopsy clip is present in the upper inner left breast. Elsewhere, scattered benign calcifications. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | Stable large right breast fibroadenoma. Stable left breast calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Focal left-sided chest pain under nipple, evaluate for pulmonary, bony or soft tissue abnormality. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No visible coronary artery calcifications on this non-cardiac-gated study.CHEST WALL: Very subtle focal area of sclerosis in the anterolateral left third rib without evidence of cortical destruction or cortical displacement, but along its caudal margin there is subtle lucency with a rim of sclerosis. More anteriorly in the same rib there is a focal lucency. No axillary or subpectoral lymphadenopathy is appreciated. The soft tissues overlying this area are unremarkable in appearance.Minimal degenerative changes of the spine with osteophyte formation.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Postsurgical changes left upper quadrant bowel, incompletely included in the scanning range. | Two very subtle lesions in the anterior/anterolateral left third rib; anterior lesion is lucent while the anterolateral lesion is sclerotic. Given the presence of pain, correlation with bone scan and PSA levels are recommended although statistically these are most likely benign. |
Generate impression based on findings. | 56 year old with history of right lumpectomy in 2007 at an outside institution. Patient received radiation and chemotherapy. 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 composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable postsurgical seroma with dystrophic calcifications is again noted in the right breast, without significant changes. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Rule-out fracture. Pain in foot and ankle.VIEWS: Left foot AP/lateral/oblique (3 views) 03/16/15 No significant soft tissue swelling is present. The bones are normal an apparent. A fracture is not seen. | Normal examination. |
Generate impression based on findings. | Female, 5 months old. Evaluate Hickman placement History: line pulled previously, replacedVIEWS: Chest AP/lateral (two views) 3/16/2015, 1249 Left IJ venous catheter tip at the cavoatrial junction.The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax. | Catheter tip at the cavoatrial junction. |
Generate impression based on findings. | Metastatic lung cancer. Compare with prior to evaluate progression. ABDOMEN: LUNG BASES: Please see separate chest CT report 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: Stable bilateral renal cysts RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification affects the abdominal aorta. BOWEL, MESENTERY: No significant abnormality noted. BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality noted BLADDER: No significant abnormality noted LYMPH NODES: No significant abnormality noted BOWEL, MESENTERY: Uncomplicated diverticulosis of the sigmoid colon. BONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted | Stable examination. No acute, inflammatory, or metastaticintra-abdominal process. Please see separately dictated CT chest. |
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