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Generate impression based on findings. | Clinical question: 46-year-old female with lymphoma status post LP for ITT chemotherapy. Signs and symptoms:anisocoria. Nonenhanced head CT:Detectable intracranial edema, hemorrhage, mass-effect, midline shift or hydrocephalus.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and grade I right sided differentiation.The unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Reason: evaluate for PE History: chest pain, shortness of breat PULMONARY ARTERIES: Evaluation for pulmonary embolism is limited secondary to low bolus volume; 40 cc of contrast extravasated into the right antecubital fossa. The patient was evaluated and returned to the emergency room in good condition. No pulmonary embolus to the segmental level.LUNGS AND PLEURA: Stable centrilobular and paraseptal emphysema. Persistent apical pleural parenchymal scarring. There is aspirated mucus within the central right upper lobe bronchus which abruptly tapers several centimeters beyond the ostium as result of prior right upper lobectomy. No suspicious pulmonary nodules or interval pleural effusion.MEDIASTINUM AND HILA: Patulous esophagus which contains fluid in the distal segment. It circumferentially thickened at the level of the distal transverse arch (8/98). This can be further evaluated with endoscopy.No mediastinal or hilar lymphadenopathy. Heart size is normal. No pericardial effusion. No significant coronary artery calcifications.CHEST WALL: Stable right superior posterior interosseous bridging. T8/9 endplate sclerosis.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Multiple scattered calcifications within the right upper abdomen, possibly calcified lymph nodes, unchanged. Hepatic hypodensities stable. Nodularity left adrenal gland unchanged. | No pulmonary embolism. Postsurgical findings reflect prior right upper lobectomy without suspicious pulmonary nodule.Circumferential thickening in the mid segment of a diffusely patulous esophagus. Further evaluation with endoscopy is recommended.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Clinical question: Status post fall. Signs and symptoms: Status post fall. Nonenhanced head CT:No detectable acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Is there fracture? Signs and symptoms: MVA yesterday. Restrained driver, pain in neck and lower back. Nonenhanced cervical spine CT:Images through the skull base demonstrate mucosal thickening in the right chamber sphenoid sinus. Menisci fracture.Bilateral mastoid air cells and middle ear cavities remain been pneumatized.There is normal anatomical alignment the vertebral column.There is no evidence of fracture.No convincing evidence of perispinal soft tissue abnormalities.Very minimal degenerative changes of cervical spine are noted.Images through the lower cervical spine are degraded due to extensive streak artifact from the shoulders. No gross abnormality is identified. Limited view of the lung apices are unremarkable. | No evidence of fracture or malalignment. |
Generate impression based on findings. | Clinical question: Is there hemorrhage. Signs and symptoms: Syncopal episode. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Slight prominence of cortical sulci for age and unremarkable exam otherwise. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical spine CT:There is normal anatomical alignment the vertebral column. Unremarkable images through the skull base.There is no evidence of fracture all vertebral column. Degenerative changes of cervical spine (primarily of the posterior articulating facets) without convincing evidence of spinal canal compromise at any level. There is also no evidence of neural foraminal compromise at any level.Unremarkable paraspinal soft tissues. | 1.Nonenhanced head CT.2.No evidence of fracture or malalignment of the cervical spine. |
Generate impression based on findings. | Clinical question: Objective tinnitus, rule-out mass. Signs and symptoms: as above. Nonenhanced head CT:There is no detectable acute intracranial process.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal for patient stated age of 8 years.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable. Bilateral internal auditory canals and partially visualized inner ear structures demonstrate no convincing evidence of abnormality. If further evaluation is clinically deemed necessary follow-up with an MRI is recommended.Unremarkable images through the orbits, paranasal sinuses, calvarium and soft tissues of the scalp. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Concussion: 53-year-old female with history of severe aortic stenosis, anemia, renal transplant with current Rhizopus infection. Signs and symptoms: Dyspnea, anemia. Nonenhanced head CT: Examination demonstrate prominence of cerebral cortical sulci as well as the cerebellar -- vermian folia patient's stated age of 53. Findings are concerning for mild underlying parenchymal volume loss. Tiny CSF space calcification in the posterior left sylvian fissure is a nonspecific finding. Possibility of vascular calcification should be considered. There are no additional similar findings.Gray -- white matter differentiation is preserved. Ventricular system remains within normal and with maintained midline. Subarachnoid spaces are unremarkable.Unremarkable calvarium and soft tissues of the skull. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced maxillofacial CT:Paranasal sinuses remain well pneumatized and without evidence of acute or chronic sinus disease. A tiny retention cyst in the left chamber of the sphenoid sinus however is detected. Ostiomeatal units are maxillary sinuses are patent bilaterally.Sphenoethmoidal recesses of the sphenoid sinus remain patent. Images through the nasal passage are unremarkable.Bilateral mastoid air cells and middle ear cavities remain well pneumatized. Unremarkable images through the orbits. | 1.Nonenhanced head CT demonstrate no acute intracranial findings.2.Unremarkable nonenhanced maxillofacial CT. |
Generate impression based on findings. | 64 year old female, history of left nephrectomy now status post complex TEVAR with no urine output. Concern for ischemia. ULTRASOUND KIDNEYSRIGHT KIDNEY: Increased echogenicity of the right kidney measuring 8.8 cm in length. Cyst at the midpole measures 1.0 cm x 0.9 cm x 1.0 cm. No hydronephrosis or shadowing calculi are noted.LEFT KIDNEY: Status post left nephrectomy.OTHER: Foley catheter in a decompressed bladder limits evaluation. | 1. Increased echogenicity of the right kidney suggestive of parenchymal dysfunction. Subcentimeter renal cyst. No hydronephrosis. 2. Patent renal vasculature with no evidence of stenosis. |
Generate impression based on findings. | Clinical question: Assess for intracranial hemorrhage in setting of seizure-like activity this AM. Signs and symptoms: Assess for intracranial hemorrhage in setting of seizure-like activity this AM. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.Extensive periventricular and subcortical low attenuation of white matter grossly similar to prior exam and highly suggestive of age indeterminate small vessel ischemic strokes. Consider follow-up with an MRI exam if acute stroke is suspected.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. CT is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Grossly stable extensive findings suggestive of age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Male, 6 months old. Evaluate for occult fractures History: 6 m/o male with unexplained bruisingEXAMINATION: 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) 3/16/2015, 1726 Bone mineralization and modeling are normal. No acute or healing fracture identified.A small bulge along the medial aspect of the left proximal tibial metaphysis likely represents normal variant anatomy. | Normal examination. |
Generate impression based on findings. | 14-year-old male with gunshot wound to left ankleVIEWS: Left ankle AP, oblique and lateral; left foot: Lateral, oblique, AP (3 views) 3/16/15 Skin markers are placed at the lateral malleolus and over the lateral aspect of the plantar surface of the foot representing entrance and exit wounds of bullet. Comminuted fracture of the lateral aspect of the distal fibula. Several tiny fine, linear and round radiopaque bullet fragments are present within the soft tissues along the tract of the bullet. Swelling and irregularity of the soft tissue along lateral aspect of the ankle. | Distal fibular fracture secondary to gunshot wound with very small residual bullet fragments along the bullet tract. |
Generate impression based on findings. | Reason: h/o TxN2a head and neck ca, s/p CRT, eval response, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Lingular mucoid impaction with atelectasis (5/24). Mixed solid and ground glass nodule medial left lower lobe (4/185) measuring 2.3 x 1.9 cm. This is suspicious for a primary adenocarcinoma. Several additional satellite micronodules are noted superior to this (4/158). Solid nodule lateral left lower lobe (5/64) 3 x 6 mm.Scattered pulmonary micronodules right upper lobe. Scattered areas of ground glass in the right lower and bilateral upper lobes (5/75, 117). No pleural effusion.Mild paraseptal emphysema.MEDIASTINUM AND HILA: Size is normal. No pericardial effusion. Incidental lipomatous hypertrophy of the interatrial septum. Moderate coronary artery calcifications.Small superior anterior mediastinal lymph nodes. No hilar or mediastinal lymphadenopathy.CHEST WALL: Right port with catheter terminating in the central superior vena cava.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: Nonspecific nodularity the left adrenal gland. Attention on subsequent imaging recommended to exclude metastasis.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.Percutaneous gastrostomy tube in place with the balloon in the gastric antrum.BONES, SOFT TISSUES: Anterior osteophytes of the lower thoracic spine.OTHER: Diffuse atherosclerotic disease of the abdominal aorta. | Predominantly solid nodule medial left lower lobe measuring 2.3 x 1.9 cm suspicious for a primary adenocarcinoma. Additional satellite nodules within the left lower lobe suspicious for small metastases. Nonspecific, multifocal ground glass bilaterally.Mucoid impaction within distal bronchioles of the lingula.No mediastinal or hilar lymphadenopathy. |
Generate impression based on findings. | Male, 10 years old. Evaluate for pneumonia. History: cough, feverVIEWS: Chest PA/lateral (two views) 3/16/2015, 1914 Cardiac silhouette size is normal.Redemonstration of a curvilinear opacity at the medial right lung base. Mediastinum is shifted to the right. Right lung is small. Multiple dilated vessels in the expected location of the right lung hilum. Coil embolization material extends inferiorly toward the midline. No new focal pulmonary opacity, pleural effusion, or pneumothorax. | Scimitar syndrome. No evidence of pneumonia. |
Generate impression based on findings. | 12-year-old female with shoulder pain status post traumaVIEWS: Left shoulder: Internal and external rotation (two views) 3/16/15 No fracture or malalignment. The humeral head is normally positioned with the glenoid. No significant soft tissue swelling is noted. | No fracture or malalignment. |
Generate impression based on findings. | Cellulitis and foot, tender shin. Question of free air. Two views of the left tibia/fibula reveal no foci of gas within the subcutaneous tissues. No acute fracture or malalignment is evident. Extensive vascular calcifications are noted.Three views of the left foot show increased loss of soft tissue at the tip of the great toe with underlying cortical erosion of the tuft of the great toe, which is suspicious for osteomyelitis. There is a mid-diaphyseal osteotomy of the fifth metatarsal with unchanged margins. An ossicle at the base of the fifth metatarsal is likely from old trauma, unchanged from the prior study. | Probable osteomyelitis of the great toe tuft. |
Generate impression based on findings. | 49 years, Female. Reason: dobbhoff placement History: dysphagia Limited study, pelvis excluded from field of view. There is a Dobbhoff tube with its tip projecting over the proximal body of the stomach. There are diffuse interstitial and airspace opacities compatible with edema and infection as seen on the prior chest radiograph. | Dobbhoff tube with its tip projecting over the proximal body of the stomach. |
Generate impression based on findings. | 35-year-old male. Extensive ulcers on sacrum. Evaluate for osteomyelitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal lymph nodes. BOWEL, MESENTERY: Left lower quadrant colostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged pelvic lymph nodes along the common iliac, external iliac, and inguinal regions bilaterally, likely reactive.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Large sacral decubitus ulcer extending nearly to the bone, which is surrounded by soft tissue induration extending into the right ischiorectal fossa. Small amount of subcutaneous emphysema at the right aspect of the inferior sacrum (series 4, image 133). Mottled sclerosis and irregularity of the sacrum with a large erosion inferiorly on the right (series 80320, image 12) likely reflects chronic osteomyelitis.The left femur has been surgically removed with extensive heterotopic ossification in the surgical bed. Chronic deformities of the bilateral inferior pubic rami with adjacent heterotopic bone formation. Asymmetric increased sclerosis of the left superior pubic ramus is nonspecific, may be post-surgical or represent chronic osteomyelitis.Deep ulcer in the left upper thigh extending nearly to the left inferior pubic ramus with soft tissue induration at its base.OTHER: No significant abnormality noted | Large sacral decubitus ulcer extending nearly to the bone with subcutaneous emphysema tracking along the right lower sacrum. Sclerosis and irregularity of the sacrum, likely reflects chronic osteomyelitis. Asymmetric increased sclerosis of the left superior pubic ramus is nonspecific, may be post-operative or reflect chronic osteomyelitis. MRI wwo contrast would be useful for further evaluation of these bony abnormalities. |
Generate impression based on findings. | Male, 6 years old. Asthma attack, wheezing, resp distressVIEW: Chest AP (one view) 3/16/2015, 1956 The cardiothymic silhouette is normal.Mild peribronchial thickening. Streaky right lower lobe opacities, compatible with subsegmental atelectasis. No pleural effusions or pneumothorax. | Reactive airway disease/bronchiolitis pattern, with no evidence of pneumonia. |
Generate impression based on findings. | Crohn's disease and long-term Remicade infusions. Persistent abdominal pain. Is terminal ileum narrowed?EXAMINATION: MR enterography without and with IV contrast 03/16/15 ABDOMEN:LIVER, BILIARY TRACT: Normal in appearance. No biliary ductal dilation is present. The gallbladder is normal in appearance.SPLEEN: Normal in size.PANCREAS: Normal in appearance. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No pelvicaliceal dilation is present. The kidneys are symmetric.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal in appearance..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free fluid is seen.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended and normal in appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Terminal ileum is normal in appearance. No narrowing is identified. No abnormal enhancement is present. Peristalsis is normal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. |
Generate impression based on findings. | Male, 4 years old. Evaluate for fracture. Foot pain. Dropped concrete slab on foot.VIEWS: Right foot AP, lateral, oblique (3 views) 3/16/2015, 1957 Minimally displaced transverse fractures through the first and second metatarsal diaphyses.Mild soft tissue swelling of the forefoot.No additional fracture or dislocation identified. | Minimally displaced transverse fractures through the first and second metatarsal diaphyses. |
Generate impression based on findings. | Hit something with right hand today. Pain and swelling to right hand. Three views of the right hand show a middiaphyseal transverse fracture of the fourth metacarpal with slight radial and volar angulation of the distal fracture fragment. No additional fracture is identified. There is soft tissue swelling about the dorsum of the hand. | Transverse fracture of the fourth metacarpal. |
Generate impression based on findings. | 51-year-old female with possible diagnosis of lymphangiomyomatosis LUNGS AND PLEURA: Rapid accumulation of bilateral moderate sized pleural effusions with adjacent compressive atelectasis. Mild intralobular septal thickening. Numerous thin-walled cysts, variable in size, measuring up to 2.2 cm in diameter. Patchy peripheral groundglass opacities predominantly in the upper lobe.MEDIASTINUM AND HILA: ET tube tip is above the carina. Punctate calcification thyroid and hyperdense nodule in the level thyroid. The heart size is normal. No pericardial effusion. No visible coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Sclerotic focus in the T11 vertebral body presumably represents a benign bone island. No axillary, or cardiophrenic, or retrocrural lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Fluid measuring 32 Hounsfield units surrounds the liver and spleen. Abnormal soft tissue density measuring up to 70 Hounsfield units is noted in the abdomen adjacent to the stomach and within the mesentery concerning for hemorrhage, new from comparison CT from outside hospital. Surrounding mesenteric stranding is also present. Amorphous fat density and soft tissue density with small foci of air are present expanding the left renal space concerning with no appreciable normal renal parenchyma. Right adrenal nodule. NG tube tip is in the gastric fundus. Hypoattenuating lesion measuring 1.5 cm in the right lobe of the liver is nonspecific. Additional scattered subcentimeter hypoattenuating lesions. The gallbladder is filled with contrast. | 1.Amorphous mixed fat and soft tissue density lesion expanding the left renal space compatible with ruptured angiomyolipoma. Additional high density fluid with surrounding mesenteric fat stranding is noted throughout the abdomen compatible with more acute hemorrhage that that seen on prior exam.2.Patchy peripheral groundglass opacities may reflect aspiration. Mild pulmonary edema. 3.Findings compatible with lymphangiomyomatosis. Bilateral pleural effusions with adjacent compressive atelectasis.Findings relayed to clinical service at 0915 on 3/17/15. |
Generate impression based on findings. | Male 42 years old; Reason: rule out stone History: Abd pain, hematuria Streak artifact from spinal fixation device as well as motion artifact limits evaluation. The absence of intravenous and oral contrast also limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Right middle lobe opacity is incompletely evaluated but likely represents atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal glands are poorly visualized given the above described limitations.KIDNEYS, URETERS: The kidneys are bilaterally atrophic. Transplant kidney in the left iliac fossa. There is no hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific haziness/fluid throughout the mesentery.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: Multiple nonspecific prominent inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Renal osteodystrophy. Degenerative changes in both hip joints. Spinal fixation device in situ. Scoliosis of the thoracolumbar spine with fusion of multiple thoracic vertebral bodies.OTHER: Right inguinal hernia containing non obstructed loops of bowel and trace fluid. | Very limited study due to motion artifact, streak artifact and absence of intravenous and enteric contrast. Within these limitations there is no evidence of stone within the transplant kidney. Right inguinal hernia containing non obstructed bowel loops and trace fluid. No specific cause for patient's abdominal pain or hematuria is identified. |
Generate impression based on findings. | 10-year-old male with fever and productive cough, history of asthma.VIEWS: Chest PA/lateral (two views) 3/16/15 The cardiothymic silhouette is normal. No focal lung opacities. No pleural effusion or pneumothorax. Mild bronchial wall thickening and hyperinflation of the lungs is consistent with bronchiolitis/reactive airway disease. | Mild bronchiolitis/reactive airway disease. |
Generate impression based on findings. | There is trace hyperdensity within left greater than right occipital sulci, consistent with acute subarachnoid hemorrhage. No evidence of mass effect or hydrocephalus. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. | Occipital subarachnoid hemorrhage, left greater than right, without mass effect or hydrocephalus.Findings discussed with Dr. Kiraly by Dr. Stephanie Jo by telephone on 3/17/2015 at 9:55AM. |
Generate impression based on findings. | Pain swelling status post hit 2 to 3 weeks ago. Question of fracture or foreign body. Three views of the right hand reveal no acute fracture or malalignment. Tiny ossified fragments adjacent to the first metacarpophalangeal joint are likely chronic in etiology. No radiopaque foreign body is identified. Mild osteoarthritis affects the triscaphe joint and DIP joints. There is mild soft tissue swelling about the dorsum of the hand. | No acute fracture or radiopaque foreign body is evident. |
Generate impression based on findings. | 15 year-old female with syncope and shortness of breathVIEWS: Chest AP/lateral; cervical spine: AP and lateral (4 views) 3/17/15 Cervical spine: The vertebral heights and disk spaces are maintained. No fracture or subluxation of the cervical spine. No prevertebral soft tissue swelling. Straightening of the cervical lordosis is likely secondary to c-collar.Chest: The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. No focal air space opacity. No pleural effusion or pneumothorax. | No fracture or subluxation of cervical spine. No acute cardiopulmonary abnormality. |
Generate impression based on findings. | 46 year old female status post right mastectomy in 2008 for mucinous IDC with extensive DCIS, presents today for routine follow up. Patient received chemotherapy and hormonal therapy. History of benign left breast biopsy. No current breast complaints. No family history of breast cancer. Two standard and implant displaced views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A biopsy marking clip is noted within the slightly upper outer left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | 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. | Multiple medical problems with right hand swelling/pain. Three views of the right hand reveal no acute fracture or malalignment. The bones are diffusely demineralized. | No acute fracture is evident. |
Generate impression based on findings. | Clinical question: 44-year-old female with history of ALL; pre-allo SCT evaluation. Signs and symptoms: As above. Unenhanced maxillofacial CT:There are small foci of soft tissue thickening in bilateral inferior aspects of maxillary sinuses consistent the minimal chronic sinus disease and tiny retention cysts. There is a slight progression of this finding since prior exam from 2013.The paranasal sinuses are otherwise well pneumatized and unremarkable. Ostiomeatal units of maxillary sinuses and the sphenoethmoidal recesses of the sphenoid are patent.Images through the nasal passage demonstrate moderate leftward nasal septum deviation and a bony septal spur projecting to the left which is in contact and deform the mucosal of the left inferior turbinate. There is no detectable bony abnormality of the maxillofacial region. Bilateral mastoid air cells and middle ear cavities remain well pneumatized and unremarkable. Images through the orbits are unremarkable.Incidental note is made of a prominent periapical lucency of the right last maxillary molar without significant change since prior exam. | 1.No detectable acute sinusitis.2.Minimal mucosal thickening in the dependent bilateral maxillary sinuses with slight interval worsening since prior study.3.Unremarkable paranasal sinuses otherwise.4.Nasal septum deviation to the left as detailed.5.Incidental note is made of a prominent periapical lucency of the right last maxillary molar without significant change since prior exam. |
Generate impression based on findings. | Female, 17 years old. Swelling. Evaluate for fracture.VIEWS: Right hand, PA, lateral, oblique (3 views) 3/16/2015, 2008 Curvilinear lucency at the base of the second metacarpal raises the question of a nondisplaced fracture.Mild local soft tissue swelling. No significant joint effusion.No additional fractures or dislocation identified. | Questionable nondisplaced fracture at the base of the second metacarpal. Correlation with point tenderness is recommended. Follow-up radiographs in 7 to 10 days may be helpful if clinically indicated. No additional fracture or dislocation. |
Generate impression based on findings. | The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. The distal spinal cord and conus are within normal limits with the conus terminating at the mid L1 level.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine. There is a prominent dorsally projecting synovial cyst at the L5-S1 level on the right which measures 9 x 6 mm on 2701/9. There is associated asymmetric right facet degeneration at this level. Other smaller scattered dorsally projecting synovial cysts are also seen along the thoracolumbar spine, best visualized on the sagittal STIR images.There is usual dependent STIR hyperintense edema within the upper lumbar deep subcutaneous fat. | Minimal scattered dorsally projecting synovial cysts of the lower thoracic and lumbar spine, most prominent at the L5-S1 level on the right with associated facet degeneration. Otherwise, unremarkable noncontrast MRI of the entire spine. |
Generate impression based on findings. | Pain status post fall, left anterior chest wall bruise. Question of fracture. Metallic BBs denote the site of the patient's pain. No acute rib fracture is identified. | No acute rib fracture is identified. |
Generate impression based on findings. | Male 21 days old Reason: Is central line in correct placement? History: 34 weeker requiring central accessVIEW: Chest and abdomen AP (two views) 3/16/15 at 1809 hrs ET tube tip is below the thoracic inlet. Proximal side-port of NG tube is above GE junction. Left upper extremity venous access terminates at the axillary vein. The urinary catheter has been removed. A new right lower extremity PCVC terminates at the infrahepatic IVC.Cardiac silhouette size is normal. Persistent right-sided hydropneumothorax. Normal aeration of the left lung.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Misplaced NG tube, removal of urinary bladder catheter time PCVC placement.Persistent right-sided hydropneumothorax.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | 16-month-old female with fever and coughVIEW: Chest AP (one view) 3/17/15 Aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal. Mild bronchial wall thickening is consistent with bronchiolitis/reactive airway disease. Streaky opacity in the right middle lobe may represent atelectasis. No pleural effusion or pneumothorax. | Bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | Female, 17 years old. Pain, evaluate for fracture.VIEWS: Right shoulder, AP (internal, external) (two views) 3/16/2015, 2006 The osseous structures and joint spaces are normal.The humeral head is normally positioned with respect to the glenoid fossa.No significant joint effusion or soft tissue swelling. | No acute fracture or dislocation. |
Generate impression based on findings. | Male, 5 years old. Reason: Rule out alveolar ridge fracture. Frontal upper gum tenderness s/p fallVIEWS: Mandible, Panorex (one views) 3/16/2015, 2019 The visualized osseous structures and the temporomandibular joints are normal. | No acute fracture or dislocation. |
Generate impression based on findings. | Male 34 years old; Reason: hx renal tx on prograf, ESRD on HD History: RUQ/RLQ abd pain, vomiting, hematuria ABDOMEN:LUNG BASES: Mosaic attenuation pattern within the lung bases which may relate to phase of respiration. Severe pericardial and cardiac valve calcification. Punctate calcification in the left lung consistent with prior granulomatous process.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The native kidneys are severely atrophic bilaterally. Transplant kidney in the right iliac fossa. The transplant kidney appears enlarged and edematous and there is mild perinephric stranding. There is mild prominence of the collecting system.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The appendix is identified in the midline/right lower quadrant and appears unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased density of the imaged bones suggestive of renal osteodystrophy.OTHER: Trace pelvic free fluid. | 1.Abnormal appearance to the transplant kidney on this limited noncontrast exam. This would be better evaluated with dedicated transplant kidney ultrasound as indicated.2.Severe pericardial and cardiac valve calcification. |
Generate impression based on findings. | 70 year old female status post left lumpectomy in 2001 for IDC, presents today for routine follow up. Patient received radiation therapy. 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. Postsurgical changes are present within the left breast including volume loss, skin thickening, and postsurgical architectural distortion. These findings are not significantly changed from prior examination. Scattered benign calcifications are present, including vascular calcifications. No dominant mass, suspicious microcalcifications or areas of 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. | Shoulder pain with popping and instability. Evaluate for bony pathology. There is slight inferior translation of the humeral head with respect to the glenoid on the Grashey view, but the clinical significance of this is uncertain. I see no fracture or frank dislocation. The acromioclavicular joint appears normal. | Slight inferior translation of the humeral head relative to glenoid seen on the Grashey view is of uncertain significance. I see no fracture or frank dislocation. If further imaging evaluation is clinically warranted, MR arthrography may be considered. |
Generate impression based on findings. | Male 11 years old Reason: position of IJ History: s/p nephrectomy and kidney auto transplantVIEW: Chest AP (one view) 3/16/15 at 1904 hrs. Right IJ central line terminates at the RA/SVC junction. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. No focal lung opacities. No effusions or pneumothorax. | Normal examination. |
Generate impression based on findings. | 76-year-old female. Known aortic aneurysm repair. Drop in hemoglobin, tachycardia. Bleeding?. ABDOMEN:LUNG BASES: Bibasilar dependent atelectasis. Calcified granulomas in the lung bases.LIVER, BILIARY TRACT: 9 mm arterially enhancing lesion (series 10, image 48), too small to characterize, may be a flash-filling hemangioma. No biliary duct dilatation. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Chronic contour deformity of the posterior aspect of the left kidney, likely from a prior infarct, unchanged. Symmetric enhancement of the kidneys.RETROPERITONEUM, LYMPH NODES: Type B abdominal aortic dissection extending from above the renal arteries into the left common iliac artery, unchanged. Dissection flap is again seen extending into the left renal artery which is supplied by both the true and false lumens, unchanged.No evidence of aortic rupture.Small dissection flap in the proximal celiac artery with associated aneurysmal dilation measuring up to 10 mm (series 10, image 58), unchanged.Ectatic distal descending thoracic aorta down to the level of the diaphragmatic hiatus measuring up to 3.7 cm in diameter, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Suprapubic catheter in a collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes of the lumbar spine with unchanged severe compression deformity of the L4 vertebral body.OTHER: No significant abnormality noted | Stable type B dissection of the aorta without evidence of rupture. |
Generate impression based on findings. | 51 year-old female with dysphagia, evaluate for extrinsic compression of the esophagus The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are patent and unremarkable. The epiglottis, vallecula, piriform sinuses, and vocal cords appear normal. Small left tonsillar calcification. The parotid and submandibular glands appear unremarkable. There are multiple small hypodense thyroid nodules without associated mass effect which are nonspecific. No lymphadenopathy is noted. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. | 1. No evidence of extrinsic compression of the esophagus or other specific findings to account for the patient's dysphagia.2. Nonspecific small thyroid nodules for which further evaluation with ultrasound may be considered if clinically warranted. |
Generate impression based on findings. | 51 years, Female. Reason: abdominal distension, assess for ileus, obstruction History: abdominal distension, assess for ileus, obstruction Nonobstructive bowel gas pattern with a paucity of bowel gas and gas in the right hemicolon and stomach. There is a nasogastric tube with its tip projecting over the fundus of the stomach. Left upper quadrant embolization coils. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Wrist pain and swelling The bones are slightly demineralized. There is volar rotatory subluxation of the scaphoid. Mild degenerative arthritic changes affect the wrist. I see no fracture. | Volar rotatory subluxation of the scaphoid and mild degenerative arthritic changes. |
Generate impression based on findings. | Female 43 years old evaluate for unexpected radiopaque foreign object. Towel clips project over the right upper and left lower quadrants as well as over the left hip, and were confirmed by O.R. housestaff. No unexpected radiopaque foreign object is identified. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign object.These findings were discussed by telephone with Dr. Marie-Teresa C. Colbert, the surgeon, on 03/16/2015 at 19:00. |
Generate impression based on findings. | Pain in the right knee. Rule-out DJD. Four views of the right knee are provided. Severe osteoarthritis affects the knee, particularly the lateral compartment where there is near bone on bone apposition. The degree of osteoarthritis has perhaps progressed slightly when compared with the prior study. A bony excrescence projecting from the posterior aspect of the proximal fibula may either represent a tug lesion or an exostosis, unchanged.Components of a longstem total left knee arthroplasty device are situated in near-anatomic alignment as seen on the frontal view. | Osteoarthritis and other findings as above. |
Generate impression based on findings. | Female 4 days old Reason: eval lung fields History: term, perinatal depression, seizures. Abdominal distention.VIEW: Chest and abdomen AP (two views) 3/17/15 at 335 hours. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. No focal lung opacities. No effusions or pneumothorax.Normal abdominal gas pattern. No evidence of obstruction or free air. No pneumatosis intestinalis or portal venous gas. | Normal examination. |
Generate impression based on findings. | Male, 81 years old, newly diagnosed high risk prostate cancer with increased activity in the left maxillary/ethmoid sinus region and left calvarium on bone scan. A prominent vascular channel is evident traversing the left parietal bone, which may at least in part correlate with the focus of increased uptake seen within the left calvarium on bone scan. There are, in addition, several scattered small nonspecific calvarial lucencies bilaterally. No sclerotic or frankly destructive bony lesions are seen. The left maxillary region showing increased uptake on bone scan is not adequately included within the field of view of this exam.Mild patchy white matter hypoattenuation is seen, a nonspecific finding. No evidence of parenchymal edema, mass effect or loss of gray-white distinction is seen. No intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are within normal limits for size and morphology. | 1.Focus of increased radiotracer uptake within the left calvarium on bone scan may correlate to a vascular channel which seems to traverse this region. No definite or typical appearing calvarial metastatic lesions are seen.2.The field of view this examination is not adequate to assess the area of increased radiotracer uptake seen within the left maxillary region. If this area still requires assessment, a sinus CT would provide adequate coverage.3.Mild patchy white matter hypoattenuation is nonspecific but may reflect age indeterminate microvascular ischemic disease. No other significant intracranial findings are noted. |
Generate impression based on findings. | 64 years, Female. Reason: OG adjusted History: OG Pelvis is not included in the field of view and motion artifacts limits evaluation. There is an enteric tube with its tip projecting over the distal body of the stomach. Please refer to concomitant chest radiograph for further thoracic findings. | Enteric tube with its tip projecting over the distal body of the stomach. |
Generate impression based on findings. | Male 10 months old Reason: eval lung fields History: former 21 weeks with BPDVIEW: Chest AP (one view) 3/17/15 158 hours. NG and tracheostomy tubes again noted. Persistent soft tissue edema.Cardiac silhouette size is enlarged. Bibasilar opacities, likely atelectasis unchanged. Note is made that there is incomplete visualization of the lung bases and diaphragms. | Within the limitations described above, persistent bibasilar atelectasis. |
Generate impression based on findings. | Female 40 years old; Reason: METASTATIC COLON CANCER ON CHEMOTHERAPY EVALUATE FOR INTERVAL CHANGE History: COLON CANCER CHEST:LUNGS AND PLEURA: 1.4 x 1.3 cm spiculated mass previously measured 2.2 x 2.0 cm in the right lower lobe (3:45). Previously seen 4 cm mass in the right upper lobe has significantly decreased in size, to the point where it is somewhat difficult to measure, but is approximately 2.6 x 1.3 cm (3:33).MEDIASTINUM AND HILA: No significant abnormality noted..CHEST WALL: Right chest wall port tip in the right atrium. A few prominent subcentimeter axillary lymph nodes are not enlarged by size criteria.ABDOMEN:LIVER, BILIARY TRACT: Hepatic hypodensity in the left lobe is stable, with peripheral nodular enhancement, suggestive of a hemangioma.SPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Persistent circumferential abnormal thickening of the hepatic flexure, but with more pericolonic induration, likely post therapeutic. Overall thickening appears somewhat decreased compared to PET/CT (3:163 versus 3:117). Several prominent lymph nodes surrounding the mass are slightly difficult to measure given patient motion, but the largest partially calcified node, previously measured 1.2 cm, and now measures 8 mm (3:180, versus 3:128).BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: Enlarged bulky uterus, and heterogenous cervix could be secondary to fibroids. In conjunction with focal apparent increased endometrial fluid anteriorly, correlation with recent pelvic sonograms is suggested.BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted.. | 1. Significant interval decrease in size of pulmonary masses as above. 2. Redemonstrated right colonic mass, with apparent decrease in circumferential thickening. Associated decrease in size of local regional lymphadenopathy.3. Enlarged bulky uterus and cervix, likely secondary to fibroids, with likely related increased focal endometrial fluid near the fundus. Correlation with prior pelvic sonograms is recommended. |
Generate impression based on findings. | Male 48 years old; Reason: hepatobiliary pathology History: p/w chest pain, elevated WBC and Alk Phos; currently with cholecystostomy tube for acute cholecystitis ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Interval insertion of a cholecystotomy tube which appears coiled within the fundus. The gallbladder is decompressed although not completely collapsed. There are persistent pericholecystic inflammatory changes without located fluid collection or abscess. SPLEEN: Splenomegaly measuring 16.2 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule and left adrenal thickening are unchanged.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple portacaval lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Decompression of the gallbladder secondary to cholecystotomy tube insertion. Persistent pericholecystic inflammatory changes without loculated fluid collection or abscess. |
Generate impression based on findings. | 66-year-old female. Pain, distention. Evaluate for an anastomotic leak. ABDOMEN:LUNG BASES: Small bilateral pleural effusions with adjacent atelectasis.LIVER, BILIARY TRACT: Left hepatic lobe lesion measures 2.3 x 2.8 cm, unchanged (series 3, image 44), previously biopsied to be a hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical findings of low anterior resection with end-to-end rectosigmoid anastomosis and a right lower quadrant diverting ileostomy. 7.3 x 5.4 cm presacral fluid collection, which may be post-operative although an anastomotic leak cannot be excluded. Nonspecific mild wall thickening and hyperenhancement of small bowel and rectum running adjacent to this collection. Dilated mid to distal jejunum measuring up to 3.3 cm with decompressed loops in the pelvis and left lower quadrant, suggestive of a small bowel obstruction. A distinct transition point is difficult to identify, possibly in the region of the left lower quadrant (series 3, image 90). No evidence of bowel ischemia. The colon is distended, containing fluid and scybala, which may be due to post-operative ileus.Focal hyperdensity in the stomach, presumably ingested enteric contents.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace abdominal ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter in a collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Nonspecific presacral fluid collection may be post-operative although an anastomotic leak cannot be excluded. If high clinical suspicion for leak, correlation with a fluoroscopic study would be helpful.2. Findings suggestive of a small bowel obstruction.3. Small bilateral pleural effusions. |
Generate impression based on findings. | Reason: eval for sinusitis in pt with neutropenia History: neutropenic fever, L ear fullness; AML on the ABT-199/decitabine trial There is mucosal thickening of the left maxillary sinus and one of the left Haller cells, stable from prior study. Right Haller cell is clear. Ostiomeatial units are patent. Frontal, ethmoid, and sphenoid paranasal sinuses are clear. The cribriform plate, fovea ethmoidalis and lamina papyracea appear normal. Nasal septum is mildly deviated to the right. There are several missing teeth from the left maxilla. Prominent bilateral TMJ degenerative changes, with mild lateral subluxation of the left TMJ. The orbits are unremarkable. The imaged mastoid air cells and middle ear cavities are clear. Limited view of the intracranial structure is unremarkable. | 1.Bilateral TMJ degenerative changes, with lateral subluxation of the left TMJ. 2.Stable mucosal thickening of the left maxillary sinus and one of the left Haller cells. |
Generate impression based on findings. | Male 12 days old Reason: Is there increased infiltrates History: worsening vent settings /Pulm hemorrhageVIEW: Chest and abdomen AP (two views) 3/17/15 at 314 hours. Right mainstem bronchus intubation. Central line terminates at the SVC. UAC tip is at T10. Misplaced NG tube unchanged. Increasing soft tissue edema.Complete atelectasis of the left lung. Cardiac silhouette is not visualized. Large right lung volume with diffuse, coarse haziness and pattern of PIE. No effusions or pneumothorax.Unchanged complete paucity of abdominal gas. | Misplaced NG and ET tubes.Complete atelectasis of the left lung and diffuse lung haziness with pattern of PIE of the right lung.Persistent complete paucity of abdomen chest. |
Generate impression based on findings. | 59 years, Male. Reason: pre op for peg History: constipation Nonobstructive bowel gas pattern. Moderate stool burden in right and transverse colon. High-density contrast material noted within the rectum from recent swallow study. Pelvic calcifications which appear to be within the vas deferens based on morphology. | Nonobstructive bowel gas pattern. Moderate stool burden in right and transverse colon. |
Generate impression based on findings. | 45-year-old female with numbness/tingling along ulnar aspect of arm/hand. Right shoulder pain. Rule-out C-spine DJD, pinched nerve. Evaluation of the cervicothoracic junction is slightly limited overlying anatomy. There are anterior vertebral body osteophytes at C4/5, but the intervertebral disk spaces are preserved. Vertebral body heights are within normal limits. Alignment is within normal limits. | Small anterior vertebral body osteophytes at C4/5 with no specific findings to account for the patient's symptoms. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 79 years, Male. Reason: 79 yo M with h/o CHF, now with elevated LFT's, AMS, s/p Dobbhoff placement History: AMS Pelvis excluded from field of view. Dobbhoff tip in antropyloric region. Nonobstructive bowel gas pattern. Vascular calcifications. Unchanged mediastinal surgical clips. Cardiomegaly and left basilar opacity, please see same day chest radiograph report for further details. | Dobbhoff tip in antropyloric region. |
Generate impression based on findings. | 64 years, Female. Reason: ETT and OG placement History: just was intubated Pelvis is not included in the field of view. There is an enteric tube with its tip projecting over the distal body of the stomach. Partially imaged pacemaker lead is unchanged in position. Please refer to concomitant chest x-ray for further thoracic findings. | Enteric tube with its tip projecting over the distal body of the stomach. |
Generate impression based on findings. | 12-year-old male with history of fractureVIEWS: Left elbow AP, lateral (two views) 3/17/15 Overlying cast material obscures fine bone detail. Healing fracture fragments are in unchanged position. The fractured medial epicondyle remains displaced medially. A fracture fragment adjacent to the lateral aspect of the humeral metaphysis is unchanged. | Healing fracture fragments in unchanged position. |
Generate impression based on findings. | Pain. Has fracture remains nondisplaced? There is callus formation along the proximal diaphysis of the second metatarsal surrounding what appears to be a nondisplaced transverse fracture, the margins of which are indistinct. There is spur formation along the dorsolateral aspect of the first cuneiform, and there appears to be slight lateral translation of the second metatarsal relative to the middle cuneiform on the oblique view; these findings may indicate an old Lisfranc injury, but this is equivocal. Note is made of an os peritoneum and a small os trigonum. A sclerotic focus in the base of the fifth metatarsal likely represents a bone island. | Healing fracture of the second metatarsal and other findings as above. |
Generate impression based on findings. | Exam is somewhat limited to to lack of contrast and suboptimal larger field of view.The left cervical plexus and brachial plexus are visualized. Slight asymmetric irregular and possible incompletely linear course of the mid left C5 and C6 nerve roots is questioned with slightly thickened and ill-defined appearance of the mid left C6 nerve root on 701/25. There are no surrounding areas of abnormal signal or inflammatory changes within the fat. There are no masses or lymphadenopathy identified. There are no compressive masses demonstrated. There is no axillary lymphadenopathy. There are no focal fluid collections.There is bilateral dependent pulmonary opacity likely representing atelectasis. | Questioned subtle abnormalities involving mid left C5 and C6 nerve roots which may suggest mild inflammatory changes/neuritis. No compressive mass or fluid collection. Follow-up imaging may be obtained as clinically indicated. |
Generate impression based on findings. | Female 34 years old; Reason: Metastatic breast cancer with acute jaundice and hyperbilirubinemia. Evaluate for progression of hepatic disease/hepatic obstruction. History: jaundice, hyperbilirubinemia CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules.The largest in the right lower node measures 6 mm. This is not identified on prior study. Otherwise the appearance is not significantly changed compared to prior study. Postradiation changes are again noted in the left upper lobe.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Bilateral breast prostheses noted. Left axillary clips noted. Hypoattenuating right thyroid nodule is unchanged. Sclerotic osseous foci within the sternum, the right proximal humerus, the bilateral ribs and vertebral bodies consistent with osseous metastatic disease. Left chest wall Port-A-Cath with tip terminating at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Innumerable hypoattenuating lesions throughout the liver consistent with metastatic disease. Overall the lesions appear stable/mildly increased compared to prior study and there is new perihepatic ascitic fluid. Persistent areas of right hepatic lobe ductal dilatation are unchanged.Reference right hepatic lobe lesion measures 3.0 x 3.3 cm (series 3, image 100), previously 3.2 x 3.4 cm.The distal hepatic and portal veins are attenuated but patent.SPLEEN: Hypoattenuating splenic lesions are stable/minimally increased in size and remain suspicious for metastatic disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic foci within the pelvic bones and thoracic and lumbovertebral bodies consistent with metastatic disease and appearing similar to prior.PELVIS:UTERUS, ADNEXA: The uterus is absent or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered sclerotic foci within the pelvic bones and thoracic and lumbovertebral bodies consistent with metastatic disease and appearing similar to prior.BONES, SOFT TISSUES: Scattered sclerotic foci within the pelvic bones and thoracic and lumbovertebral bodies consistent with metastatic disease and appearing similar to prior.OTHER: Increased pelvic free fluid. Trace fluid tracking along the right paracolic gutter. | 1.Extensive hepatic metastatic disease appearing similar/minimally increased compared to prior study.2.New right middle lobe lung nodule warrants close attention on follow-up imaging.3.Diffuse osseous metastatic disease is unchanged.4.New perihepatic fluid and increased pelvic free fluid. |
Generate impression based on findings. | Reason: 64 yo M with HCV/Etoh cirrhosis c/b newly diagnosed HCC, eval for mets History: newly diagnosed hepatocellular carcinoma. LUNGS AND PLEURA: No suspicious nodules. Patchy areas of mild groundglass opacities in the upper lobes. Bronchial wall thickening. Trace left pleural effusion. Minimal scarring/atelectasis at the lung bases. MEDIASTINUM AND HILA: Aspirated tracheal debris. Heart size normal with no pericardial effusion. Low-density cardiac blood pool is typical of anemia. Severe coronary and aortic valve calcifications. No significant mediastinal or hilar adenopathy. Paraesophageal varices noted.CHEST WALL: No axillary adenopathy. Moderate degenerative changes affect the lower thoracic and upper lumbar spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cirrhotic liver morphology and moderate upper abdominal ascites. | 1.No evidence of metastases.2.Minimal left pleural effusion.3.Nonspecific mild upper lobe ground glass opacities may represent early mild smoking-related interstitial lung disease, drug reaction, or hypersensitivity pneumonitis. The appearance is not typical of infection. |
Generate impression based on findings. | Male 44 days old Reason: Is there evidence of atelectasis History: tachypneaVIEWS: Chest AP/lateral (two views) 3/17/15 at 330 hours NG tube terminates at the stomach. Cardiac silhouette size is enlarged but stable. No change in right lung base atelectasis/mass. Bowel loops appears to be getting into the chest cavity anteriorly, although repaired diaphragm may be above them. | No change in right lung base atelectasis/mass.Anterior bowel loops at the level of the chest, location of the diaphragm above or below within cannot be ascertained. |
Generate impression based on findings. | Chronic bilateral lower extremity pain from knees to ankles. No history of trauma. Evaluate for bony pathology. Four views of the right knee and two views of the right tibia/fibula are provided. The knee appears normal, with no specific findings to account for the patient's pain. The tibia and fibula likewise appear normal with no specific findings to account for the patient's pain.Four views of the left knee and two views of the left tibia/fibula are provided. There is a sclerotic focus within the distal femoral metaphysis along the posterior endosteal surface that probably represents a healing/healed non-ossifying fibroma, of doubtful clinical significance. The knee otherwise appears normal. There is mild thickening of the cortex along the distal diaphysis of the left fibula which could conceivably reflect an old healed stress fracture, but this is equivocal, and I see no specific findings to account for the patient's pain. | No specific findings to account for the patient's pain. Other findings as described above. |
Generate impression based on findings. | 43 years, Male. Reason: eval for post-op ileus History: abd pain, bloating Nonobstructive bowel gas pattern. Right upper quadrant surgical clips. Foley catheter in bladder. Multiple chest tubes and mediastinal drains and left lower lobe opacity, please see same day chest radiograph report for further details. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Stable postsurgical changes of right neck dissection, flap reconstruction, and radiation. There is stable loss of fat plane in the right masticator and buccal spaces. There is also persistent effacement of fat in the right mandibular foramen. Stable lucent lesion within the left mandibular angle. Unchanged erosive changes within the right posterior maxilla.There is focal area of enhancement overlying the right mandible, stable from December 2013 study. This area was not enhancing on June 2013 study but is unchanged in configuration and size. This area was not hypermetabolic on PET study from October 2013. Favor post treatment changes of parotid gland; attention on subsequent imaging. Remaining parotid and salivary glands are atrophic.The airway is patent. Stable supraglottic soft tissue edema. Right sternocleidomastoid muscle is atrophic. Thyroid gland is unremarkable. No pathologic cervical lymphadenopathy by CT size criteria. Resection of the right internal jugular vein.Opacification of the visualized bilateral ethmoid sinuses and maxillary sinuses. There is interval progression of sinus disease with mild mucosal thickening of the sphenoids and sphenoethmoidal recesses. Postsurgical changes of the sinus with stable nasal septal defect.Limited view of the intracranial structures are unremarkable. Imaged orbits are unremarkable. Centrilobular emphysema of the lung apices. Right apical scarring. There is multilevel degenerative changes of the cervical spine, most severe at C5/6 and C6/7 levels, with possibly moderate-severe central canal stenosis at C5/6 level. | 1.No evidence of locoregional recurrence.2.Focal area of enhancement overlying the right mandible, stable from December 2013. Favor post treatment changes of parotid gland; attention on subsequent imaging.3.Progression of chronic sinus disease.4.Moderate-severe central canal stenosis at C5/6 level. Correlate with symptoms and obtain MRI if clinically indicated. |
Generate impression based on findings. | Female, 56 years old, history oral tongue cancer, follow-up exam. Redemonstrated is evidence of bilateral neck dissection and partial midline mandibulectomy with bone graft reconstruction. The bone graft seems well incorporated on the left and at least partially incorporated on the right. The residual native right mandible seems to show a more permeative pattern than on the prior examination, particularly in the vicinity of the bone graft.Irregular soft tissue thickening along the mandible, with extension into the left submandibular space, appears similar to the prior examination. No new mass or pathologic enhancement is seen to suggest recurrent disease.Scattered cervical lymph nodes have not significantly changed. None is pathologically enlarged by size criteria.The parotid glands are unremarkable. The submandibular glands do not appear to be present. The right lobe of the thyroid contains a heterogeneous nodule, as does the isthmus, similar to prior.The left IJ vein is of small caliber through portions of the neck, but the remaining cervical vessels enhance normally. Emphysema is evident in the lung apices.Multilevel cervical spondylosis is demonstrated along with prominent left-sided facet hypertrophy, all similar to prior. No new concerning osseous lesions are seen in the cervical region. | 1.Redemonstration of postoperative changes in the neck with no definite findings to suggest recurrent disease.2.The residual native right hemimandible shows a more prominent permeative appearance than on the prior examination. Findings could reflect an inflammatory process or the long-term effects of radiation.3.No pathologic adenopathy is detected by size criteria. |
Generate impression based on findings. | Ankle pain, inferior/posterior to the lateral malleolus. Question of fracture. Three views of the left ankle reveal no acute fracture or malalignment. No ankle joint effusion is seen. Vascular calcifications are noted. | No acute fracture is evident. |
Generate impression based on findings. | Pain, AMS. Fracture after fall? Three views of the left shoulder are provided. The bones appear demineralized, but I see no fracture. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. Note is made of carotid calcifications.Three views of the ribs are provided. The bones appear demineralized. Mild deformity of the lateral aspect of the right ninth rib likely represent an old healed fracture, but I see no acute fracture. Degenerative arthritic changes affect both shoulders as well as the spine. There is atherosclerotic calcification of the aorta.Two views of the right hip show mild osteoarthritis. I see no acute fracture. The bones appear slightly demineralized.Two views of the left hip are provided. The bones appear slightly demineralized. Mild osteoarthritis affects the hip. I see no acute fracture. An AP view of the pelvis is provided. The bones appear slightly demineralized. Mild osteoarthritis affects both hips. Degenerative disk disease affects the visualized lower lumbar spine. Evaluation of the sacrum is limited by overlying bowel contents, but I see no acute fracture. | Degenerative arthritic changes and other findings as above. I see no acute fracture. |
Generate impression based on findings. | Male, 5 days old. Previous 32 weeks gestational age patient. Evaluate UVC positionVIEW: Chest and abdomen AP (two views) 3/16/20 15, 1922 Umbilical venous catheter tip at the level of a hepatic vein.Nasogastric tube with distal side port below the level of the GE junction.Cardiothymic silhouette is normal.Hazy bilateral lung opacities, with normal volumes.Normal bowel gas pattern. | Umbilical venous catheter tip is at the hepatic vein level. |
Generate impression based on findings. | Female, 87 years old.Complex EVAR/TEVAR. Surgical skin staples project over the right hip. No unexpected radiopaque foreign bodies are identified. | No unexpected radiopaque foreign body is identified within the pelvis.These findings were relayed to Dr. Steppacher, the attending surgeon, via telephone at 2315 hrs on 3/16/2015 by the resident on call. |
Generate impression based on findings. | Male; 62 years old. Reason: G tube in place? History: OSH with G tube in place Nonobstructive bowel gas pattern. Left nephroureteral stent in place. G-tube balloon within the gastric body. | G-tube balloon within the gastric body. |
Generate impression based on findings. | Reason: Restaging T3 oral cavity cancer History: none CHEST:LUNGS AND PLEURA: No pleural effusion or pneumothorax. Reference 7-mm nodule adjacent to the left major fissure (series 4, image 203) is unchanged in size. Scattered punctate calcified micronodules. No suspicious nodules or masses.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.Heart size is normal. No pericardial effusion.Mild coronary artery calcification.CHEST WALL: Subchondral cysts and degenerative changes affect bilateral shoulders. No suspicious osseous lesions are identified. Heart generative disease affects the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered subcentimeter hypoattenuating lesions in the liver are too small to further characterize.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.A sclerotic focus in the right iliac wing with represents a benign bone island. Lytic lesions in the L3 and L4 vertebral bodies likely represent Schmorl's nodes although additional attention to these lesions on subsequent studies should be given. Lytic lesion lesion in the left iliac wing may represent an intraosseous lipoma. Additional other lytic appearing lesions throughout the skeletal system are too small to further characterize. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Unchanged 7-mm index nodule in the left lower lobe.2.Scattered subcentimeter lytic lesions throughout the skeletal system are nonspecific and not significantly changed since the prior exam. |
Generate impression based on findings. | 71-year-old female. Buttock hematoma. Tense area with erythema on right buttock. History of breast cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval placement of a left nephroureteral stent which pigtail ends in the left renal pelvis and bladder. No hydronephrosis.Atrophy and cortical thinning of the left kidney. Bilateral subcentimeter renal hypoattenuating foci are too small to characterize, unchanged.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter. Interval resolution of previously seen lymphadenopathy. The reference left para-aortic lymph node is now subcentimeter in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Fibroid uterus. Catheter terminates in the uterine cavity. Cervical mass consistent with known squamous cell carcinoma is 3.1 x 5 cm, previously 4.9 x 5.9 cm (series 3, image 118).BLADDER: Foley catheter terminates in a collapsed bladder.LYMPH NODES: Previously seen left external iliac lymphadenopathy has resolved. Scattered small subcentimeter pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Heterogeneous high density collection in the medial right buttock is 6.3 x 4.2 cm (series 3, image 143) with extension to the right ischiorectal fossa, consistent with hematoma. OTHER: Mild nonspecific presacral fluid/standing and pelvic fat haziness. | 1. 6.3 x 4.2 cm right medial buttock hematoma.2. Cervical mass consistent with known primary squamous cell carcinoma, decreased in size. Interval resolution of retroperitoneal and pelvic lymphadenopathy.3. Interval placement of left nephroureteral stent with resolution of hydronephrosis. |
Generate impression based on findings. | History of diabetes, wound to right second toe. History of amputation of the great toe on the right. Purulent drainage, swelling. Three views of the right foot reveal interval amputation of the first digit at the metatarsophalangeal joint. There is cortical destruction along the head of the first metatarsal laterally with an adjacent soft tissue defect. There is also interval destruction of the remaining second digit distal phalanx and the middle phalanx. There is soft tissue irregularity along the tip of the second toe. | Findings compatible with osteomyelitis of the first metatarsal head and second digit middle and distal phalanx. |
Generate impression based on findings. | Male 12 years old Reason: Interval change History: ETT, intubated, respiratory distress.VIEW: Chest AP (one view) 3/17/15 at 522 hours. Right upper extremity venous access terminates likely at the long thoracic vein. Cholecystectomy clips again noted. ET tube terminates below thoracic inlet. Thoracolumbar dextrorotoscoliosis unchanged.Cardiac silhouette size is normal. Streaky opacities of the left upper and lower lobe are unchanged and likely chronic. No effusions or pneumothorax. | No change in left lung opacities. |
Generate impression based on findings. | 22 years, Female. Reason: Evaluate for obstruction History: New NBNB vomiting without diarrhea Nonobstructive bowel gas pattern. No free air on upright view. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female 14 years old Reason: post-op, status post fracture.VIEWS: Right knee AP and lateral 3/17/15 (two views) Trans-metaphyseal screws of the distal right femur are again noted. Interval increasing in periosteal reaction and callus formation on the medial aspect of the distal metaphyses and over the tip of the most superior screw. Alignment is anatomic. | Healing fracture, in anatomic alignment with no evidence of hardware complications. |
Generate impression based on findings. | Status post fractureVIEWS: Right tibia-fibula AP and lateral 3/17/15 (two views) Healing distal fracture of the right tibia is in anatomic alignment. Fracture line is still visualized on lateral view. | Healing fracture , in anatomic alignment. |
Generate impression based on findings. | Drop in hemoglobin. Large thigh mass. Evaluate hematoma CT examination was performed of the pelvis with coronal and sagittal reconstructions. The visualized osseous structures are unremarkable. A large medial thigh mass is partially visualized.CT examination of the right thigh reveals a large medial mass that measures approximately 6.5 cm by 7 cm x 7 cm.. When compared to surrounding muscle there is some increased attenuation in this mass. It is certainly consistent with a large hematoma. The underlying bones are unremarkable. | Large right medial thigh mass consistent with a hematoma |
Generate impression based on findings. | Follow-up Again seen is an oblique fracture of the distal fibula with fracture fragments in near-anatomic alignment, and there is soft tissue swelling along the lateral aspect of ankle. This appears similar to the prior study accounting for slight positional differences. Chronic enthesopathic changes at the Achilles insertion on the calcaneus also appear similar to those seen on the prior study. | Distal fibular fracture appearing similar to the prior study. |
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. Circular skin marker was placed over the left upper outer breast. a few scattered coarse benign calcifications bilaterally are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign 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. | Patient hit wall with hand. Swelling, deformity. Question of fracture. Three views of the right hand and two views of the right wrist show oblique, comminuted fractures through the base of the fourth and fifth metacarpals. The fracture fragments are in near-anatomic alignment. There is soft tissue swelling about the dorsum of the hand. There is deformity to the fifth metacarpal which is likely related to prior trauma. | Comminuted fractures of the base of the fourth and fifth metacarpals. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral breast reductions. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Swirled parenchymal pattern bilaterally compatible with history of breast reductions. 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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Neck pain, previous fusion. Back pain. Two views of the cervical spine are provided. The patient has undergone multilevel laminectomy. The patient has also undergone anterior fusion at C6/7. The C6 screw is fractured. There is intervertebral device spacer device at C6/7. Amorphous density within the intervertebral disk space may reflect some bony bridging but this is equivocal. There is obliteration of the C4/5 disk space, and severe degenerative disk disease at C5/6. Moderate to severe degenerative disk disease also affects C3/4 and C7/T1, but the cervicothoracic junction is partially obscured by overlying anatomy.Five views of the lumbar spine are provided. The patient has undergone multilevel laminectomy. There is severe multilevel degenerative disease throughout the lumbar spine, particularly affecting the lower lumbar levels. Relatively mild facet joint osteoarthritis affects the lumbar spine. Alignment is within normal limits. Vertebral body heights are preserved. There appears to be partial lumbarization of S1. | Postoperative changes and severe degenerative disk disease as described above. |
Generate impression based on findings. | Female; 45 years old. Reason: Recent sx History: L flank pain ABDOMEN:LUNG BASES: Amplatzer device in the interatrial septum.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval left nephrectomy with mild fluid and fatty stranding seen in the surgical bed. Remnant distal left ureter is mildly dilated with punctate density seen near the left UVJ, suggestive of a tiny calculus (series 3/131).Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: At least partially loculated fluid collection tracking along the anterolateral aspect of the left psoas muscle near suture material and measuring up to 5.6 x 3.2 cm in greatest axial dimension (series 3/82), which is nonspecific and may be due to evolving hematoma or early abscess in the appropriate clinical context.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Small hypoattenuating left ovarian lesion, likely a physiologic cyst. Small amount of fluid in the endometrial canal, likely physiologic.BLADDER: Left bladder ureterocele seen on prior study is not well visualized.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of hemorrhage seen layering dependently, likely postoperative in etiology. Right pelvic surgical clips. | Interval postoperative changes of left nephrectomy. Left retroperitoneal at least partially loculated nonspecific fluid collection may be due to an evolving hematoma or early abscess in the appropriate clinical context. Small amount of hemorrhage in the pelvis, likely postoperative in etiology. Remnant distal left ureter is mildly dilated and likely contains a punctate calculus near the left UVJ. |
Generate impression based on findings. | Reason: rule out posterior circulation deficit History: dizziness Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:There is a redemonstration of a large CSF signal attenuation fluid collection within the posterior fossa posterior that displaces the cerebellum anteriorly, left hemisphere greater than right. The vermis is also mildly hypoplastic.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for cervicocerebral occlusive disease.3.No evidence for acute internal hemorrhage mass effect or edema4.Posterior fossa arachnoid cyst vs. mega cisterna magna vs. less likely Dandy-Walker spectrum lesion, almost certainly congenital and incidental. It is unchanged from the prior exam. |
Generate impression based on findings. | Reason: evaluate for bleed expansion or hydrocephalus History: worsening mental status, unable to follow commands There is a 12-mm hematoma present in the right midbrain associated with intraventricular blood involving the third ventricle and to a lesser degree lateral ventricles. The temporal horns of the lateral ventricles are dilated.There is a hypodense focus in the right basal ganglia.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses demonstrate a mucous retention cysts along the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Right midbrain hematoma associated with intraventricular blood.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Hypodensity in the right basal ganglia likely represents lacunar infarct - age indeterminant. |
Generate impression based on findings. | Reason: ICH - r/o vascular cause History: as above Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries.There is a 6x5 mm aneurysm along the lateral division of the right superior cerebellar artery approximately 4mm from its origin. A second SCA aneurysm is present whose opacification measures 3x2mm but is associated with an adjacent right midbrain hypodensity and hyperdensity further into the midbrain. There is early opacification of the Great Vein of Galen and proximal straight sinus. Additionally there are prominent pial vessels along the quadrigeminal cisternThe anterior communicating artery and the posterior communicating arteries are identified and are intact. There is fetal origin of the right PCA with small right p1 segment. The left p1 is slightly larger than the left PCOMA.The right vertebral artery is larger than the left vertebral artery. There is extracranial origin of the right PICA.CT head:There is a 12-mm hematoma present in the right midbrain associated with intraventricular blood involving the third ventricle and to a lesser degree lateral ventricles. The temporal horns of the lateral ventricles are dilated.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst along the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There are two right superior cerebellar artery aneurysms present associate with a suspected quadrigeminal plate cistern arteriovenous malformation. The aneurysm that is adjacent to the midbrain hematoma may be partially thrombosed and is thus suspected to have been the one that ruptured. Alternatively the hematoma may be more directly related to the AVM. Because the source of the bleeding is not definitively delineated on this exam, conventional arteriography will help further evaluate these aneurysms, AVM and the source of the bleeding.2.There is a right midbrain hematoma present which is stable compared to the prior exam.3.There is mild ventriculomegaly present associated with intraventricular blood. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Severe centrilobular and paraseptal emphysema. Apical fibrosis and pleural thickening likely related to radiation changes. Scattered nonspecific calcified and noncalcified micronodules. No suspicious nodules or masses.Interval aeration of left apical bulla with small amount of fluid within. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Reference precarinal lymph node measures 8 mm (series 3, image 37), previously 7 mm. Additional scattered mediastinal and hilar lymph nodes not significantly changed since prior exam. Foci of air within the RVOT may have been introduced via contrast injection.The heart size is normal. No pericardial effusion. Moderate coronary artery calcification.Esophagus is unchanged in appearance.CHEST WALL: Moderate disease affects the thoracolumbar spine. Healed left seventh rib fracture.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged gallbladder distention, cystic duct stones, and mild intrahepatic biliary ductal dilatation. 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: Mild atherosclerotic disease of the aorta and its branch vessels. Complete thrombosis of the infrarenal aorta and visualized iliac arteries bilaterally. Aneurysmal dilation of the right 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. | 1.No evidence of metastatic disease. 2.Interval aeration of previously seen fluid filled left apical bulla suspicious for persistent/active infection.3.Unchanged gallbladder distention, cystic duct stones, and mild intrahepatic biliary ductal dilatation. |
Generate impression based on findings. | 50 year-old female. Upper abdominal pain, elevated amylase and lipase. Ovarian cancer status post 9 cycles of MEK-162. Compare to 1/14/15 scan. CHEST:LUNGS AND PLEURA: Scattered stable micronodules, likely postinflammatory.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. No visible coronary artery calcification.Left chest wall port tip terminates in the SVC.CHEST WALL: Nonspecific thyroid nodules, unchanged.ABDOMEN:LIVER, BILIARY TRACT: Calcified lesion adjacent to the left hepatic lobe is 1.5 x 1.4 cm (series 3, image 102), unchanged. No biliary ductal dilatation.SPLEEN: Nonspecific hypodense splenic lesion, unchanged.PANCREAS: New soft tissue lesions adjacent to the pancreatic tail and along the left anterior renal fascia suspicious for peritoneal disease. For reference, one of these lesions measures 1.9 x 2.1 cm (series 3, image 121).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: New mild right hydronephrosis and ureteral dilatation with transition point at ill-defined soft tissue surrounding a surgical staple (series 3, image 144), suspicious for a peritoneal deposit. This soft tissue was present on prior exam but increased in prominence. Small bilateral renal cysts. Angiomyolipoma in the lower pole of the right kidney, unchanged. RETROPERITONEUM, LYMPH NODES: Surgical clips in the retroperitoneum.BOWEL, MESENTERY: Postsurgical findings of a right lower quadrant ileostomy. Post-surgical findings of omentectomy. Scattered calcifications in the upper abdomen and peritoneum. Clustered soft tissue nodularity in the right iliac fossa consistent with peritoneal disease, not significantly changed. Reference nodule is 1.6 x 1.7 cm (series 3, image 148), previously 1.5 x 1.7 cm.New peritoneal studding of the gastric antrum measuring 2 x 3.4 cm (series 3, image 112).BONES, SOFT TISSUES: Soft tissue nodularity in the bilateral thighs, unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Post-surgical findings of hysterectomy. Calcified soft tissue mass at the apex of the vaginal cuff, mildly increased in size.BLADDER: No significant abnormality noted.LYMPH NODES: Calcified right pelvic lymph node is 1.5 x 1.7 cm (series 3, image 166), previously 1.5 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. New peritoneal deposit on the gastric antrum and additional suspicious peritoneal lesions adjacent to the pancreatic tail and studding the left anterior renal fascia. This may account for elevated pancreatic enzymes in given history - although an underlying component of pancreatitis cannot be entirely excluded, but felt to be less likely.2. New mild right hydroureteronephrosis terminating at an ill-defined soft tissue surrounding a surgical staple, likely a peritoneal deposit. |
Generate impression based on findings. | Anterior left knee pain after fall. Four views of the left knee reveal soft tissue swelling anterior to the patella. No acute fracture or malalignment is evident. No joint effusion is identified. | Soft tissue swelling without acute fracture evident. |
Generate impression based on findings. | Fall on left patella. Question of fracture. Five views of the left knee reveal no acute fracture or malalignment. There is mild osteophyte formation in the medial and patellofemoral compartments. Enthesopathic changes are noted at the quadriceps insertion. A small joint effusion is seen. | No acute fracture is evident. |
Generate impression based on findings. | Refractory acute leukemia. Complaining of dental pain. Question of source of neutropenic fever. Panorex radiographic mandible reveals poor dentition with loss of multiple teeth. There is no gross bone destruction to suggest osteomyelitis. No significant interval change. | Poor dentition appearing similar to the prior study. |
Generate impression based on findings. | Pain. Hammertoes. The bones appear slightly demineralized. There is a moderate hallux valgus deformity and moderate osteoarthritic changes at the first metatarsophalangeal joint. There appears to be a hammertoe deformity of second toe. Relatively mild osteoarthritic changes affect the midfoot and ankle. | Hallux valgus deformity and other findings as above. |
Generate impression based on findings. | 7-year-old female with history of wheezing.VIEW: Chest AP (one view) 3/16/15 Cardiothymic silhouette is normal. Right middle lobe opacity and streaky left lower lobe opacity may represent infection or atelectasis. No pleural effusion or pneumothorax. | Right middle lobe and streaky left lower lobe opacity may represent atelectasis or infection. |
Generate impression based on findings. | Increasing back pain, history of subacute compression fracture of L1 and status post kyphoplasty. Evaluate for changes. Five views of the lumbar spine show postsurgical changes of a kyphoplasty at L1. The remaining vertebral body heights are preserved. There is mild degenerative disk disease at L5/S1 with mild anterior osteophytes in the lower lumbar spine. No acute fracture is evident. | Postsurgical changes at L1 without significant interval change. |
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