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Generate impression based on findings. | 36 year old female status post right lumpectomy in September 2014 for invasive ductal carcinoma, presents today for 6 month follow up. Patient received radiation, chemotherapy, and hormonal therapy. History of additional benign bilateral breast biopsies. No current breast complaints. No family history of breast cancer. Three standard views of both breasts, with additional left MLO and cleavage views, and magnification views of the right lumpectomy bed, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker has been placed on the scar overlying the lower central right breast with underlying postsurgical changes including mild architectural distortion and surgical clips. Mild skin thickening is present involving the right breast. There is redemonstration of multiple circumscribed masses in both breasts. A winged shaped biopsy clip is present within a mass within the outer slightly upper right breast, posterior depth, and a ribbon shaped clip is present within a mass in the central upper right breast, from prior benign biopsy. A coil-shaped biopsy marking clip is present within a mass within the inner slightly upper left breast. Scattered benign calcifications are present. No new dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Surgical clips are present in the right axilla. | 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. | Renal cell carcinoma CHEST:LUNGS AND PLEURA: No change in reference right upper lobe cavitary nodule best seen on image 29 of series 5 measuring 1.3 x 1.4 cm. The previously noted subcentimeter left lower lobe nodules are no longer identified.Stable right pleural based mass best seen on image 26 of series 3 measuring 4 x 3.2 cm.; adjacent destructive rib lesions unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Stable right lateral destructive rib lesions.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left nephrectomy bed soft tissue focus best seen on image 95 of series 3 measuring 3.3 x 1.3 cm.RETROPERITONEUM, LYMPH NODES: Stable abdominal aortic aneurysm with maximal AP diameter of 3.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable reference lesions; however, previously noted multiple subcentimeter left lower lobe lung nodules are no longer identifiable. No new metastatic disease. |
Generate impression based on findings. | 11-year-old male with history of desaturation and tachycardiaVIEW: Chest AP (one view) 3/16/15 Tracheostomy tube, gastrostomy tube, and musculoskeletal changes of spinal muscular atrophy are not significantly changed. Cardiac silhouette size is not enlarged. Increased lucency of the right upper lobe with new right lower lobe opacity which likely represents atelectasis. Chronic left lung hazy opacity. | New right lower lobe opacity likely representing atelectasis. |
Generate impression based on findings. | Left ankle pain. Question fracture/dislocation. Three views of the left ankle show soft tissue swelling about the lateral malleolus. No acute fracture or malalignment is evident. No ankle joint effusion is seen. | Soft tissue swelling without acute fracture evident. |
Generate impression based on findings. | Fell playing basketball, pain and swelling to hand (especially thumb area). Question of fracture. Three views of the left wrist reveal no acute fracture. There is mild narrowing of the triscaphe joint.Three views of the left hand reveal no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | Male 77 years old; Reason: hx of pseudocyst, pancreatitis History: epigastric pain ABDOMEN:LUNG BASES: Rounded atelectasis in the right lung base, unchanged compared to prior study. 5mm right middle lobe pulmonary nodule. This should be followed as per Fleischner guidelines.LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation, somewhat increased from prior study. Patient is status post cholecystectomy. Air within the distal common duct, presumably iatrogenic. Patent hepatic vasculature.SPLEEN: No significant abnormality noted.PANCREAS: Amplatzer cystogastrostomy tube in situ. Trace peripancreatic fluid remains, further reduced compared to prior study. Focal area of pancreatic hypo enhancement in the body consistent with edema/necrosis (series 2, image 42). Dilatation of the pancreatic duct upstream to this area measuring up to 3 mm in maximum dimension. Persistent peripancreatic mesenteric and retroperitoneal haziness, decreased compared to prior study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific retrocrural lymph nodes are similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Caval filter in situ. Mild calcific arteriosclerosis of the abdominal aorta and branch vessels. 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.Cystogastrostomy tube in situ with near complete resolution of peri-pancreatic pseudocyst/fluid.2.New focal area of hypoenhancement within the pancreatic body consistent with edema/necrosis.3.Mild persistent intrahepatic biliary duct dilatation, somewhat increased compared to prior study.4.5mm right middle lobe pulmonary nodule requires follow-up as per Fleischner guidelines. |
Generate impression based on findings. | 2 months old. Former 30 weeks gestational age patient, distention. Evaluate for obstruction.VIEW: Abdomen AP (one view) 3/17/2015, 0854 Enteric tube terminates in the stomach.Hazy lung base opacities.Generalized bowel distention. Barium has passed to the rectum from the prior exam.No pneumatosis, portal venous gas, or free intraperitoneal air. | No evidence of obstruction. |
Generate impression based on findings. | Male, 13 years old. Status post osteotomy, follow-up. Leg length discrepancyVIEWS: Right femur, AP, lateral (two views) 3/17/2015, 0913 External fixation device, with screws affixing the proximal and distal femoral diaphysis, without evidence of hardware complication.The osteotomy gap measures approximately 7.2 cm with slightly increased intervening callus formation and osseous bridging.Additional fixation plate and screws affix the medial aspect of the distal femoral physis, without evidence of hardware complication. | Continued mild increase in bone formation within the osteotomy gap, without evidence of hardware complication. |
Generate impression based on findings. | Clinical question: Rule out CVA in patient with status post TAVR. Signs and symptoms: Right hand weakness Unenhanced head CT:There is no detectable acute intracranial process however CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Mild periventricular and subcortical low attenuation white matter which considering patient's stated age of 86 likely representing microvascular age indeterminate ischemic strokes. Slight prominence of cortical sulci and ventricular system is within normal range for his stated age.Mild large vessel vascular calcification is noted.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic stroke is suspected |
Generate impression based on findings. | 54 year old female status post right mastectomy for invasive ductal carcinoma, presents today for routine follow up. Patient received radiation and chemotherapy. No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. Scattered periventricular and subcortical foci of flair signal abnormality likely represent chronic nonhemorrhagic small vessel ischemic disease. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear. | 1. No evidence of acute ischemia or other specific findings to account for the patient's symptoms.2. Mild chronic nonhemorrhagic small vessel ischemic disease involving only in the periventricular and subcortical white matter. |
Generate impression based on findings. | 47 year old female status post right lumpectomy in 2007 for invasive ductal carcinoma, presents today for routine follow up. Patient received radiation, chemotherapy, and hormonal 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. A linear marker has been placed on a scar overlying the upper outer right breast. Stable asymmetry is present in the inferior left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Surgical clips are present in the low right axilla. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, 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. | 55 year old female status post left mastectomy for IDC, May of 2014, presents today for routine follow up. History of right breast reconstruction since her last mammogram. Patient received hormonal therapy (tamoxifen). No current breast complaints. Family history of breast carcinoma in her mother. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. New asymmetry is present within the lower central right breast, compatible with surgical scar formation from her recent right breast reconstruction. Stable asymmetry is present in the far posterior central right breast on MLO view. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male; 33 years old. Reason: 33 m p/w abdominal pain History: abd pain, n/v ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mixed lucent and sclerotic lesion in the subcortical right sacrum has appearance typical for nonossifying fibroma (series 3/93).OTHER: No significant abnormality noted | No appendicitis or other acute abnormality. |
Generate impression based on findings. | 62-year-old female with h/o HNC and CRT, compare to previous measurements. CHEST:LUNGS AND PLEURA: Stable scattered micronodules, some calcified. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Normal heart size with no pericardial effusion. No coronary calcifications are seen within the limitations of a non-gated study. Calcified left hilar lymph nodes. No significant mediastinal or hilar lymphadenopathy. Tracheostomy again noted.CHEST WALL: Scoliosis and mild degenerative changes effect visualized the visualized spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic cysts and other subcentimeter hypodensities too small to further characterize. Status post cholecystectomy.SPLEEN: Spleen is unremarkable.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically without focal lesion. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube again noted.BONES, SOFT TISSUES: Scoliosis and mild degenerative changes effect the visualized spine. No suspicious focal osseous lesion. Grade I anterolisthesis of L3 on L4.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 10-year-old male with patella pain and concern for fractureVIEWS: Right knee AP, oblique and lateral (3 views) 3/17/15 A small joint effusion is present. No fracture or malalignment. No patella alta. The extensor mechanism appears intact. | Small joint effusion without fracture or malalignment. |
Generate impression based on findings. | 71 year old female presents for diagnostic mammogram. History of bilateral breast cysts. 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. Stable bilateral circumscribed masses and asymmetries are present. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | 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. | 6-month-old female with fever and cough, concern for pneumoniaVIEWS: Chest AP/lateral (two views) 3/17/15 The aortic arch, cardiac apex comment stomach a left-sided. The cardiothymic silhouette is normal. A double manubrial ossification center is present, a normal variant. Bronchial wall thickening and increased lung volumes consistent with bronchiolitis/reactive airway disease. No pneumonia. | Bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | Reason: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease. History: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response and extent of disease.. CHEST:LUNGS AND PLEURA: Right paramediastinal fibrosis from radiation is unchanged. Right perihilar tumor and associated right lower lobe atelectasis are not changed. Tumor continues to exert mass effect on the right inferior pulmonary vasculature, with particular marked attenuation of the right inferior pulmonary vein. Left pleural effusion and left upper lobe ground glass opacity are nearly resolved. Pulmonary nodules/masses are stable in size and number. Reference measurements are as follows (series 5):Right middle lobe nodule measures 31 x 11 mm (image 45), from previously 33 x 11 mm.Left lower lobe nodule measures 30 x 22 mm (image 47), from previously 32 x 24 mm.MEDIASTINUM AND HILA: Mediastinal adenopathy is not significant changed. Left paratracheal lymph node measures 17 mm in short axis (3/27), from previously 17 mm. Prevascular lymph node conglomerate measures 30 mm in short axis (series 3, image 37), from previously 28 mm. There is mild cardiomegaly with no pleural effusion. Right IJ port catheter tip at the RA/SVC junction.CHEST WALL: Bilateral mastectomies and saline implants again noted. No suspicious focal osseous lesion is identified. Right 5th and 6th posterior rib deformities compatible with healed fractures.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypoattenuating right hepatic lobe lesions are redemonstrated now difficult to accurately compare to prior exams given differences in contrast bolus timing (a right inferior lobe lesion measures 12 mm and a lesion next to the gallbladder measures 10 mm, previously 16 and 13 mm, respectively). No new hepatic lesions identified.SPLEEN: Small subcentimeter hypoattenuating lesion unchanged, likely a cyst.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Bilateral renal cysts again 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.The bowel is normal in caliber without evidence of obstruction or ileus. The colon is stool-filled.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Multiple enlarged gastrohepatic lymph nodes are not significantly changed. | No significant change in pulmonary nodules/masses and mediastinal adenopathy. Hypoattenuating right liver lesions are redemonstrated and are not accurately compared to prior exams. No new hepatic lesions identified. |
Generate impression based on findings. | Left forearm injuryVIEWS: Left wrist AP and lateral 3/17/15 (two views) There is a greenstick fracture of the distal diaphyses of the left radius and a buckle fracture of the distal metadiaphyses of the left ulna. Alignment is anatomic. | Both left forearm fracture, as described. Alignment is anatomic. |
Generate impression based on findings. | 61 year old female status post right mastectomy in 2008 for invasive ductal carcinoma, presents today for routine follow up. Patient received chemotherapy, radiation, and is on Arimidex. History of benign left breast biopsy and left reduction mammoplasty. No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable post-surgical changes of the left breast, compatible with the patients history of reduction mammoplasty. 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. Given the patient's history mammographically occult malignancy, annual screening MRI should be considered. Results and recommendation were discussed with the patient, and all of her questions were answered.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Pain with weight-bearing. Worsening of left knee DJD? Four views of the left knee are provided. Severe osteoarthritis affects the left knee, particularly the medial compartment where there is near bone-on-bone apposition. Ossification within the soft tissues along the medial condyle of the distal femur probably reflects old injury to the medial supporting structures of the knee. There is a small joint effusion. Overall the findings are similar to those seen on the prior study.Mild to moderate osteoarthritis affects the right knee as seen on the frontal view. | Osteoarthritis appearing similar to that seen on the prior study. |
Generate impression based on findings. | Status post L5 -- S1 PSF. Fusion status? Again seen are posterior rods with screws entering the L5 and S1 vertebrae. Intervertebral spacer devices are again noted at L4/5 and L5/S1. There appears to be some bony bridging along the posterior aspect of the L5/S1 intervertebral disk space, appearing similar to the prior study. Faint mineralization is noted within the L4/5 intervertebral disk space, although I not convinced of any frank bony bridging. There is a minimal anterolisthesis of L4 relative to L5. The remaining intervertebral disk spaces are within normal limits. The bones appear demineralized suggesting osteopenia/osteoporosis. There is hypertrophy of the remaining spinous processes with associated degenerative arthritic changes. Mild osteoarthritis affects the sacroiliac joints and right hip. | Postoperative and degenerative changes appearing similar to those seen on the prior study. |
Generate impression based on findings. | Male 73 years old; Reason: prostate cancer on therapy with rising PSA. disease reeval History: prostate cancer ABDOMEN:LUNG BASES: Coronary artery calcifications.LIVER, BILIARY TRACT: Stable scattered subcentimeter hypodensities, too small to accurately characterize.SPLEEN: No significant abnormality noted.PANCREAS: Stable mild dilatation of pancreatic duct near the head, seen as far back as 6/25/2010.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst. Circumaortic renal vein.RETROPERITONEUM, LYMPH NODES: Moderate calcification of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy. Asymmetric enhancement of the right seminal vesicle compared to the left was seen on most recent study from 11/2014 but not in 2010.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No obvious suspicious lytic or blastic osseous lesion.OTHER: Bilateral penile prosthesis. | 1.Asymmetric density of the right seminal vesicle compared to the left as described above is nonspecific. Given history of rising PSA, further evaluation with MRI could be useful if indicated to better evaluate the bed and seminal vesicles. |
Generate impression based on findings. | Male, 8 years old. Follow-up injuryVIEWS: Left elbow AP and lateral (two views) 3/17/2015, 1015 Alignment is anatomic, with residual mild modeling abnormality of the distal humerus.Periosteal reaction along the posterior aspect of the distal humerus appears similar to the prior exam, without discrete fracture line is identified. | Continued healing of supracondylar fracture. |
Generate impression based on findings. | Female; 40 years old. Reason: eval for ovarian pathology History: llq pain, neg preg ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly. No focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypoattenuating lesion of the left kidney superior pole is too small to characterize but likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate circumferential bowel wall thickening of a short segment of the proximal sigmoid colon with moderate surrounding pericolonic fatty stranding. The affected segment contains a few diverticula, and the findings are most compatible with acute diverticulitis. Small focus of intraluminal gas and air is suspicious for intramural abscess, measuring up to 1.8-cm (coronal series 80220/53). Moderate focal induration overlying this area with a tiny focus of probable extraluminal air, most suggestive of microperforation with adjacent phlegmon. No well-formed, drainable pericolonic abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid, likely physiologic. Bilateral tubal ligation clips.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Acute diverticulitis of the proximal sigmoid colon with finding suspicious for small intramural abscess, microperforation, and adjacent phlegmon. No well-formed, drainable pericolonic abscess. |
Generate impression based on findings. | Right hip pain status post mechanical fall. Evaluate for arthritis versus malalignment or bursitis. I see no fracture or malalignment. Mild osteoarthritis affects the hip. | Mild osteoarthritis without fracture or malalignment evident. Please note that I cannot confirm nor exclude bursitis on the basis of conventional radiography. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Reason: s/p EVD placement History: s/p EVD placement Since the prior exam a ventriculostomy has been placed. It enters the right frontal lobe and courses into the right lateral ventricle with tip in the region of foramen of Monro air AP and lateral ventricles have not changed in size.There is redemonstration of a hyperdense focus in the right basal gangliaPeriventricular and subcortical white matter hypodensities of a moderate degree are present.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 cysts along the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Redemonstration and no change of a right midbrain hematoma associated with intraventricular blood.2.Sasses ventriculostomy tube placement3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Hypodensity in the right basal ganglia likely represents with or infarct age indeterminant. |
Generate impression based on findings. | Left TKA Four views of the left knee reveal components of a total knee arthroplasty device situated in near-anatomic alignment without radiographic evidence of hardware complication. Anterior soft tissue swelling and a joint effusion limit evaluation of the extensor mechanism. The previously seen skin staples and drain have been removed.Severe osteoarthritis affects the right knee as seen on the frontal views. | Total knee arthroplasty as above. |
Generate impression based on findings. | Male; 79 years old. Reason: 79M with ESRD on HD and recent episodes of cholecystitis s/p open cholecystectomy with biliary drain placement, now with asymptomatic hypotension not responsive to IVF boluses, ?abscess? ABDOMEN:LUNG BASES: Moderate bilateral pleural effusions with underlying basilar compressive atelectasis, left greater than right, partially visualized. Central venous catheter tip at the IVC-right atrial junction.. Partially visualized heart is normal in size without pericardial effusion. Severe coronary artery calcifications.LIVER, BILIARY TRACT: Cirrhotic liver morphology suggested by nodular surface contour and hypertrophy of the caudate lobe. Scattered small calcifications, mostly likely due to prior granulomatous process. No suspicious liver lesions. No intrahepatic biliary ductal dilation. Main portal vein and its branches are patent.Status post cholecystectomy. Percutaneous biliary T-tube within the prominent common bile duct.SPLEEN: Scattered small calcifications, most likely due to prior granulomatous process.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric decreased enhancement of both kidneys with somewhat striated nephrograms, which is nonspecific and may be related to poor arterial inflow though correlation with UA is recommended to exclude pyelonephritis. Small hypoattenuating lesion in the lower pole of the right kidney, most likely a benign cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branch vessels. Replaced right hepatic artery arising from the SMA noted.BOWEL, MESENTERY: G-tube in place. Prominent appendix measuring up to 8 mm with minimal periappendiceal fatty stranding, with the stranding likely related to the generalized abdominal ascites though appendicitis cannot be entirely excluded. Moderate bowel wall thickening of the ascending colon, most suggestive of portal colopathy.BONES, SOFT TISSUES: Small ventral abdominal wall hernia containing fat, fluid, and air, with the air most likely due to recent surgery.OTHER: Mild upper abdominal ascites. Mesenteric fatty haziness elsewhere, likely related to anasarca/generalized ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Moderate pleural effusions with underlying compressive atelectasis.2. Cirrhotic liver morphology and ascites/anasarca. Ascending colonic wall thickening is likely related to portal colopathy.3. Appendiceal changes likely related to fluid state, but if there is clinical concern for acute appendicitis, short interval follow-up can be obtained.4. Symmetric decreased enhancement of both kidneys with somewhat striated nephrograms, which should be clinically correlated with urinalysis to exclude pyelonephritis.5. Small amount of air within a small fat-containing ventral hernia is most likely due to recent surgery. Clinical correlation is recommended. |
Generate impression based on findings. | 64 year old male. Recurrent colon cancer. Assess for distant metastatic disease. CHEST:LUNGS AND PLEURA: Calcified nodules consistent with prior infection. No suspicious pulmonary nodules. Basilar scarring and/or atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Severe coronary artery calcification. No pericardial effusion. Ectatic ascending aorta measuring 4 cm, unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Calcified splenic granulomata. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole renal cyst. Stable subcentimeter renal hypodensities, too small to characterize.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Calcified atherosclerotic disease of the aorta and branch vessels without aneurysm.BOWEL, MESENTERY: Anastomotic changes at the rectosigmoid. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Anastomotic changes at the rectosigmoid. No discrete colonic mass is identified. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality noted | No evidence of metastatic disease. |
Generate impression based on findings. | History metastatic thyroid cancer, status post right distal femur replacement for deep infection. Complains of right medial proximal leg pain. Please assess for tumor versus infection. There has been interval resection of the distal femur and reconstruction with a total knee arthroplasty with a long stem distal femoral endoprosthesis. There is no evidence of hardware loosening. There is redemonstration of heterogeneous soft tissue within the medial aspect of the thigh near the knee with increased dystrophic calcification on this study. This region is largely obscured by streak artifact from the metal endoprosthesis. However, there is no specific evidence of a discrete fluid collection to suggest an abscess. There is no evidence of underlying cortical erosion. | 1. No specific evidence of a discrete fluid collection or tumor.2. Persistent heterogeneous soft tissues of the right medial thigh with increased dystrophic calcification. |
Generate impression based on findings. | Left shoulder injury. History of left hip fracture, preop planning. Left humeral shaft pain and ecchymosis. Three views of the left shoulder and two views of the left humerus show a comminuted surgical neck fracture of the proximal humerus with slight impaction. AP view of the pelvis shows shortening of the left femoral neck compatible with prior fracture. There is mild osteoarthritis of both hips. Surgical clips are noted within the left lower extremity soft tissues.Two views of the left hip and two views of the left femur again show shortening of the left femoral neck compatible with prior fracture. There is a lucent lesion within the medial femoral condyle of unknown etiology, but given history of malignancy, this is highly suspicious for metastases. Surgical clips are noted in the soft tissues of the left lower extremity. | 1. Comminuted, slightly impacted left humeral surgical neck fracture.2. Shortened left femoral neck compatible with prior fracture.3. Lucent lesion within the medial femoral condyle of unknown etiology; given the patient's age and history of malignancy, this is highly suspicious for a metastatic lesion. Findings communicated to Dr Bielecki via telephone at 1424 hrs on 3/17/2015. |
Generate impression based on findings. | Male 68 years old; Reason: prostate cancer evaluation of disease History: prostate cancer ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Mild fatty infiltration of the liver.SPLEEN: No significant abnormality noted.PANCREAS: 6-mm hypodensity in the pancreatic head felt to represent a fatty cleft.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenal diverticulum. Just posterior to the greater curvature of the stomach, there is a 2.4 x 1.4 cm soft tissue lesion near an area of multiple postsurgical sutures/clips. This is felt to be separate from the adjacent right adrenal gland, and is indeterminate.BONES, SOFT TISSUES: Likely chronic injury of the posterior right 11th rib.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: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Multilevel degenerative changes. No suspicious lytic or blastic osseous lesions.OTHER: No significant abnormality noted. | 1. Indeterminate 2.4-cm mass near an area of surgical clips/sutures in the left upper quadrant, further described above. Please correlate with surgical history in that area, or with prior imaging.2. No definite evidence of metastatic disease. Please correlate with same day bone scan. |
Generate impression based on findings. | 55-year-old male. Melanoma. Compare previous. CHEST:LUNGS AND PLEURA: Scattered micronodules, largest in the right lower lobe is 5 mm (series 5, image 51), unchanged and likely post inflammatory.No new nodules. Mild dependent atelectasis.Mild emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcification. Normal heart size without pericardial effusion. Nonspecific thyroid nodules, unchanged.CHEST WALL: Postsurgical findings of left axillary dissection. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst, unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta. Scattered small retroperitoneal lymph nodes. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small lipoma in the right psoas muscle.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Unchanged scattered small pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease. Stable scattered pulmonary micronodules, likely postinflammatory. |
Generate impression based on findings. | Mass right chest. History of breast cancer Three views of the ribs reveal clips in the right axilla secondary to a mastectomy. I do not see any rib lesions. | Negative rib examination |
Generate impression based on findings. | Retroperitoneal malignancy/history of neuroblastoma, elevated LFTs and right upper quadrant tenderness, uptrending creatinine Suboptimal exam due to large amount of overlying bowel gas.LIVER: Left liver poorly assessed due to overlying bowel gas. Visualized liver parenchyma increased in echogenicity. No biliary duct dilatation delineated. GALLBLADDER, BILIARY TRACT: Visualized gallbladder unremarkable. No shadowing mobile echogenic intraluminal foci seen to suggest underlying cholelithiasis. No secondary signs of acute cholecystitis. No significant gallbladder distention or wall thickening.PANCREAS: Nonvisualization of pancreas, secondary to overlying bowel gas.SPLEEN: Not well seen due to overlying bowel gas.KIDNEYS: Increased renal cortical echogenicity. No hydronephrosis. Right kidney measures 12.1 cm, left kidney measures approximately 13.3 cm.VASCULAR: Main portal vein patent with normal directional flow, velocity measures 32 cm/sec. Patent right portal vein with normal directional flow, velocity measures 35 cm/sec. Left portal vein patent with normal directional flow, velocity measures 22 cm/sec.Common hepatic artery patent, peak systolic velocity measures 88 to 100 cm/sec. Resistive index measured 0.57 to 0.58.Right and left hepatic arteries patent, peak systolic velocities measure 71 cm/sec and 67 cm/sec, respectively, and resistive indices measure 0.60 and 0.59, respectively.Visualized IVC patent. Patent right, middle and left hepatic veins.Abdominal aorta not well assessed secondary to overlying bowel gas.OTHER: Incompletely imaged lobulated structure in anterior abdomen containing fluid and layering debris, presumably distended stomach.Urinary bladder not well delineated. Small to moderate pelvic ascites. | Limited exam, large amount of overlying bowel gas, pancreas, left liver and spleen not able to be evaluated as a result.Increased renal cortical echogenicity, compatible with medical renal disease.Echogenic liver, suggestive of underlying hepatic steatosis/parenchymal dysfunction. Patent hepatic vasculature.Distended stomach. Pelvic ascites. Incompletely imaged right pleural effusion. |
Generate impression based on findings. | 44-year-old female with history of ALL. Pre-allogenic stem cell transplant evaluation. LUNGS AND PLEURA: Few bilateral pulmonary micronodules measuring up to 4 mm, some calcified. No suspicious pulmonary nodules. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No coronary calcifications detected within the limitations of a non-gated study. Increased number of mediastinal lymph nodes, none larger size criteria.CHEST WALL: Right upper extremity PICC tip in the subclavian vein. Left axillary clips.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No suspicious lymphadenopathy or pulmonary nodules. |
Generate impression based on findings. | Male 16 years old Reason: Evaluate intracardiac mass seen on CT at 3/9/15. Status post resection air History: 16 y/o M recently diagnosed with spinal mass, multiple DVTs in LUE. The previously described hypodense, nonenhancing occupying mass of the SVC, right atrium, and the right ventricle has been resected. The right ventricle outflow tract is free of occlusions. The occupying mass of the in the left axillary vein, left internal jugular and left innominate vein as well the azygos is still present. The SVC flow is now unobstructed with no mural masses.No pericardial or left pleural effusion. Right atrial line is noted. A left upper mediastinal surgical clip is noted as well. The left atrium, left ventricle and aorta are patent.Sternal wires are present. | 1. Status post resection of massive thrombus/mass of SVC, right atrium and right ventricle. There was no vitalization likely due to persistent thrombus/mass or ligation of the left innominate , subclavian, left I. J. and axillary vein.2.Interval resolution of left-sided pleural effusion and pericardial effusion.Dr. Peter Varga was present during the elaboration of this report and agrees with the findings. |
Generate impression based on findings. | Limited imaging was obtained for stereotactic localization purposes. There is redemonstration of a large heterogeneous left posterior lateral cerebellar intraaxial mass. The multilobulated T1 hypointense and mildly T2 hyperintense to cortex mass appears to measure 2.2 x 2.8 cm in greatest axial dimensions onto a 201/52, with a more solid appearing dominant component and a smaller T2 hyperintense component which may be cystic. There is also T1 hypointensity corresponding to this portion of the mass, with central T1/T2 isointensity. There is extensive surrounding T2 hyperintensity in a vasogenic pattern, extending up to surrounding the left dentate nucleus, with its margins accentuated by the abnormal signal. There is mild mass effect upon the fourth ventricle, and narrowing of the left foramen of Luschka. Abnormal signal extends cranially into the left mid vermis, with cerebellar sulcal effacement. Extent of abnormal signal appears greater on the outside images, where it was noted to extend just across midline posteriorly, although this is not definitely appreciated on the current images.The ventricles and sulci are within normal limits for age. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal patchy ethmoid air cell fluid opacification. | Redemonstration of likely solid and cystic left cerebellar mass with associated vasogenic edema and mild mass effect upon the fourth ventricle, incompletely characterized without contrast. Slight apparent decreased extent of vasogenic edema which previously crossed midline posteriorly. There is narrowing of the left foramen of Luschka. Differential diagnosis includes primarily metastatic lesion, with primary glial tumor and hemangioblastoma less likely. |
Generate impression based on findings. | Left kidney autotransplantation. Two separate arterial anastomoses. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No fluid collection is identified.KIDNEY: Normal echogenicity. No pelvicaliceal dilation. Kidney measures 9.8 cm in length. Nephroureteral stent is in place extending to urinary bladder.COLLECTING SYSTEM/URETER: No dilation.URINARY BLADDER: Almost completely empty.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. Renal arterial waveforms are of low resistance with resistive indices varying from 0.5 to 0.8. Venous waveforms are normal.OTHER: No free fluid is seen. | Normal examination of transplant kidney. |
Generate impression based on findings. | 56 year old female with right breast 24 x 6 x 6 mm intraductal lesion, likely papilloma. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass measuring 22 x 3 mm at the 6 o’clock position with increased vascularity, 1 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged good. No specimens sank to the bottom of the prefilled container of 10% formalin. All specimens floated bu whitish tissue is present in all of the specimens. Specimen quality was judged good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central inferior aspect of the lesion/dilated duct. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Drs. Abe and Lai. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 51-year-old male. Patient with colon cancer stage IV with no evidence of disease. CHEST:LUNGS AND PLEURA: Stable left upper lobe micronodule. No suspicious pulmonary nodule.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. No visible coronary artery calcification. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Post-surgical findings of a right hepatectomy with no suspicious hepatic mass.SPLEEN: Mild splenomegaly, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Small mesenteric lymph nodes, unchanged. No lymphadenopathy.BOWEL, MESENTERY: Interval takedown of right lower quadrant ileostomy and anastomosis. Moderate stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval takedown of right lower quadrant ileostomy and anastomosis. Moderate stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease. |
Generate impression based on findings. | Male, 56 years old. RFO trigger: Renal transplant surgery. No unexpected radiopaque foreign body. Nonobstructive bowel gas pattern. Nephroureteral stent in the right pelvis. Left sided pelvic drain. | No unexpected radiopaque foreign body. Findings were discussed with the attending physician, Dr. Becker, via telephone on 3/17/2015 at 10:40. |
Generate impression based on findings. | No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or hydrocephalus. No intra- or extra-axial fluid collections. Gray-white matter differentiation is preserved. Scattered opacification of the ethmoid air cells, sphenoid sinuses, and sphenoethmoidal recesses. Left sphenoid sinus with aerated secretions, possible active sinusitis. Partially imaged left nasal cavity opacity. Mastoid air cells and middle ear cavities are clear. Small defect in the left lamina papyracea and rounding of the medial rectus muscle, likely sequela of chronic trauma. | 1.No evidence for acute intracranial abnormality. 2.Possible active left sphenoid sinusitis. Please correlate clinically. |
Generate impression based on findings. | GIST CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter low attenuation left lobe fociSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal sinus cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: 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. | Stable examination without evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Male, 15 months old. S/p VSD repair. Evaluate for interval change.VIEWS: Chest AP/lateral (two views) 3/17/2015 Multiple mediastinal clips are again seen.Cardiothymic silhouette is upper normal in size.Mild scattered atelectasis is unchanged. No new focal air space opacity. No pleural effusions or pneumothorax. | Postsurgical changes and atelectasis, without significant interval change. |
Generate impression based on findings. | Male; 42 years old. Reason: eval for renal stone History: flank pain ABDOMEN:LUNG BASES: Mild left lower lobe bronchial wall thickening with patchy groundglass opacities, most suggestive of aspiration pneumonitis. Mild cardiomegaly. Trace pericardial effusion.LIVER, BILIARY TRACT: Mild hepatic steatosis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydroureteronephrosis. No GU calculi.RETROPERITONEUM, LYMPH NODES: Mild atherosclerosis of the abdominal aorta. Scattered subcentimeter retroperitoneal lymph nodes are nonspecific but not pathologically enlarged by CT size criteria.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Prominent bilateral inguinal lymph nodes are nonspecific but not pathologically enlarged by CT size criteria.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No GU calculi.2. Probable left basilar aspiration pneumonitis.3. Mild cardiomegaly.4. Mild hepatic steatosis.5. Nonspecific retroperitoneal and inguinal lymph nodes as described above. |
Generate impression based on findings. | 65-year-old male with head and neck cancer and CRT. Compared to previous measurements. CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules, some of which are new. These are nonspecific and may represent sequelae of inflammation. Scattered granular opacities, most prominent in the left lower lobe, remain compatible with aspiration bronchiolitis. Right lower lobectomy.MEDIASTINUM AND HILA: Aspirated secretions in the trachea. Heart size is normal no pericardial effusion. Right hilar suture material is compatible with prior resection. Mild coronary and aortic calcifications noted. Small mediastinal lymph nodes, similar to prior studies.CHEST WALL: Moderate degenerative changes affect the visualized spine. No suspicious focal osseous lesion is identified.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesion. Gallbladder is unremarkable.SPLEEN: No focal splenic lesion.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Multiple bilateral renal cysts and other subcentimeter hypodensities, too small to further characterize.PANCREAS: Pancreas is moderately atrophic.RETROPERITONEUM, LYMPH NODES: Small nonenlarged retroperitoneal lymph nodes appear stable in number.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative changes affect the visualized spine.OTHER: No significant abnormality noted. | 1.No specific evidence of metastatic disease.2.Aspiration bronchiolitis. |
Generate impression based on findings. | Left hip pain. Two views of the left hip reveal a bony prominence at the left femoral head/neck junction, best seen on the modified Dunn view, which is suspicious for FAI. There is sclerosis of the acetabulum and osteophyte formation.Additional view of the pelvis shows right acetabular sclerosis and osteophyte formation. | 1. Moderate osteoarthritis of the bilateral hips.2. Bony prominence of left femoral head/neck junction is suspicious for FAI. |
Generate impression based on findings. | Male, 58 years old, with history of cT3 N2 Mx base of tongue squamous cell carcinoma. Irregular thickened and mildly enhancing tissue is evident centered on the right glossotonsillar sulcus. This lesion extends anteriorly into the floor of mouth, posteriorly into the pharyngeal mucosa, and inferiorly into the vallecula with possible involvement of the epiglottis and preepiglottic space. The longest single dimension of this lesion appears to be in the sagittal plane where it measures up to 35 mm (image 47 series 80357). The surface of this lesion appears roughened which could represent ulceration or adherent secretions.The mucosa of the supraglottic larynx is diffusely and symmetrically edematous. The remainder of the aerodigestive mucosa is unremarkable.Treatment related findings are demonstrated in the neck including thickening of the platysma and infiltration of the fat planes. No pathologic adenopathy is detected by size criteria.The salivary glands and thyroid are free of focal lesions. The cervical vessels enhance normally with evidence of atherosclerotic calcification at the carotid bifurcations. Ill-defined patchy opacities are evident in the right upper lobe. No concerning osseous lesions are demonstrated. | 1.Irregularly marginated tumor centered in the right glossotonsillar sulcus with extension into the floor of mouth, pharyngeal mucosa, and vallecula with possible involvement of the epiglottis and pre-epiglottic space.2.Diffuse edema of the supraglottic larynx is likely related to treatment, but direct visual inspection is suggested to exclude disease extension.3.No pathologic adenopathy is detected in the neck.4.Ill-defined patchy opacities in the right upper lobe are likely inflammatory in nature. Dedicated chest imaging can be considered if clinically warranted. |
Generate impression based on findings. | Three weeks of increasing midline tenderness at C7 and upper T-spine with increased pain with C-spine flexion. Five views of the cervical spine reveal no acute fracture. Alignment is anatomic. The neuroforamina are grossly patent. Vertebral body heights are maintained.Two views of the thoracic spine show no acute fracture or malalignment. Vertebral body heights are maintained. | No acute fracture is evident. |
Generate impression based on findings. | Female; 27 years old. Reason: r/o acute intraabdominal process History: severe abdominal pain, intractable nausea/vomiting ABDOMEN:LUNG BASES: Mild left basilar streaky subsegmental atelectasis and/or scarring. Mild clustered nodular opacities with tree-in-bud in the right lower lobe, most likely related to infectious or aspiration-related bronchiolitis (e.g. series 4/5).LIVER, BILIARY TRACT: Mild dilation of the common bile duct measuring up to 8 mm with distal smooth tapering, likely normal in this patient status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are nonspecific but not pathologically enlarged by CT size criteria.BOWEL, MESENTERY: Though the appendix is not well visualized, no inflammatory change in the right lower quadrant to suggest acute appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterine fibroids.BLADDER: Distended bladder with mild bilateral hydroureter, most likely related to fluid status though correlation for outlet obstruction is recommended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of pelvic free fluid, likely physiologic. | 1. Right lower lobe nodular opacities are most likely related to infection as described above. If there is clinical concern for neoplasm, a follow-up dedicated CT chest with contrast can be obtained.2. Distended bladder with mild bilateral hydroureter, most likely related to fluid status but correlation for outlet obstruction is recommended.3. Otherwise, no acute abnormality. |
Generate impression based on findings. | Fourth/fifth toe swelling and erythema after trauma. Evaluate for fourth and fifth toe fracture. Two views of the fourth and fifth toes reveal no acute fracture or malalignment. There is mild soft tissue swelling. | No acute fracture is evident. |
Generate impression based on findings. | Symmetric enlargement of the thyroid gland, compatible with history of Graves' disease. Right thyroid lobe measures 4.8 x 4.8 x 9.1 cm. Left thyroid lobe measures 4.9 x 5.2 x 9.3 cm. No discrete thyroid lesion on this noncontrast CT. No significant substernal component. There is no direct compression of the airway by the thyroid gland. The airway is patent.Right maxillary mucous retention cyst. The parotid glands and submandibular glands are symmetric bilaterally. There is no pathological lymph node enlargement or lymphadenopathy identified. There are no nasopharyngeal, oropharyngeal, hypopharyngeal or laryngeal masses identified. Limited view of the intracranial contents is unremarkable. The imaged orbits are unremarkable. The imaged mastoid air cells and middle ear cavities are patent.Mild leftward convexity of the cervical spine. There is minimal lateral displacement of right lateral mass of C2 with respect to C1, as well as slight asymmetric narrowing of the right para-odontoid space, likely positional. Mild degenerative changes of the cervical spine. | Symmetric diffusely enlarged thyroid gland without airway compression. |
Generate impression based on findings. | Male 58 years old; Reason: h/o RCC History: none ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing punctate stone in the upper left kidney. Numerous parapelvic cysts in the right kidney. Right kidney is not seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of recurrence. |
Generate impression based on findings. | 53 year old male. Fibromatosis. Evaluate for progression. 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: Mild calcified atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: Small mesenteric lesions, not significantly changed. Reference lesion anterior to the third part of the duodenum is 1.1 x 0.8 cm, previously 1.3 x 0.6 cm (series 3, image 75). Other reference mesenteric lesion is 1.8 x 0.7 cm, previously 1.7 x 0.5 cm (series 3, image 91).Post-surgical findings in the right colon and surgical sutures along the greater curvature of the stomach, unchanged.BONES, SOFT TISSUES: Small sclerotic foci in the T11 vertebral body and left ilium, unchanged and likely benign.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable small mesenteric lesions with no new sites of disease. |
Generate impression based on findings. | 70 year old female status post right lumpectomy in 2006 for infiltrating ductal carcinoma, presents today for routine follow up. Patient received radiation therapy. No current breast complaints. Family history of breast carcinoma in her maternal grandmother and maternal aunt. Three standard views of both breasts, and three spot magnification views of the right breast, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Post-surgical changes are present in the lower inner right breast, with stable seroma. Skin thickening is noted of the right breast, unchanged. A cluster of calcifications is present within the outer, slightly superior right breast, which are further evaluated on magnification views, likely representing fat necrosis. No new dominant mass or areas of nonsurgical architectural distortion in either breast. Surgical clips are present in the right axilla. Benign appearing lymph nodes are projected over the left axilla. | High probability benign calcifications in the right breast. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Pain. Left lower extremity weakness. Evaluate for osteoarthritis, degenerative disk disease, compression fracture, rotator cuff tear. Three views of the left shoulder are provided. The bones appear demineralized suggesting osteopenia/osteoporosis. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. The acromiohumeral interval is preserved, although please note that I cannot exclude the possibility of a rotator cuff tear on the basis of conventional radiography.Three views of the thoracic spine are provided. The bones appear demineralized, suggesting osteopenia/osteoporosis. I see no frank compression fracture. There is mild to moderate multilevel degenerative disk disease.Five views of the lumbar spine are provided. The bones appear demineralized suggesting osteopenia/osteoporosis. I see no frank compression fracture. There is mild multilevel degenerative disk disease that has perhaps progressed slightly when compared with the prior study. | Degenerative arthritic changes as described above without fracture evident. |
Generate impression based on findings. | Female 63 years old; Reason: rapid weight loss of 30 pounds in 3-4 months, smoking history, early satiety, concerned for pancreatic cancer, lung cancer History: as above CHEST:LUNGS AND PLEURA: There is a 5-mm nodule in the right upper lobe (series 5, image 54). This was present on prior study where it is remeasured at 5 mm and it is unchanged. MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Small hepatic calcification consistent with prior granulomatous process. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic mass or pancreatic duct dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter right common iliac chain lymph node is nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific right external iliac chain lymph nodes. Evaluation is difficult given the adjacent streak artifact. The largest measures 1.8 x 1.1 cm (series 3, image 176).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right total hip prosthesis with resulting streak artifact which limits evaluation of the pelvis.OTHER: No significant abnormality noted. | 1. Stable 5-mm right pulmonary nodule.2. Nonspecific right external iliac chain lymph nodes. Evaluation of the pelvis is limited due to adjacent streak artifact. |
Generate impression based on findings. | There is an hypodense, nonenhancing occupying mass in the left axillary vein, left internal jugular and left innominate vein as well SVC and azygos vein, which is getting into the right atrium, crossing the tricuspid valve and ending in the right ventricle. The right ventricle outflow tract appears to be free of occlusions. The occupying mass is continuous and smooth, with mild lobulations at the level of the right atrium. Although the SVC appears to be almost completely occupied , since the exam was performed by injecting the contrast from the right antecubital vein, some patency persist.Pericardial and left pleural effusion, with dependent atelectasis of the left lung base is noted as well. The left atrium, left ventricle and aorta are patent. | 1.Likely massive thrombus of the left axillary, subclavian, IJ and innominate vein, as well azygos and SVC, which is continuous and getting into the right atrium and ventricle. The very unlikely possibility of intramural mass due to invasion or metastases may be contemplated.2.Pericardial effusion.3.Left pleural effusion. |
Generate impression based on findings. | Male 54 years old; Reason: metastatic prostate cancer, evaluation of disease after 6 cycles of investigational therapy. History: metastatic prostate cancer CHEST:LUNGS AND PLEURA: Apical cystic disease. Small dependent bibasilar atelectasis. No definite suspicious lung nodule seen.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Small gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again visualized are small paraaortic and aortocaval lymph nodes. Reference aortocaval lymph node without significant change, measuring 1.3 x 0.9 cm on image 128 series 3.BOWEL, MESENTERY: Left-sided colon diverticulosis without evidence of acute diverticulitis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Scattered iliac lymph nodes seen. Reference left external iliac lymph node, measuring 2.9 x 0.8 cm, image 186 series 3, previously measured 2.8 x 1.1 cm.BONES, SOFT TISSUES: Extensive osseous metastatic disease, similar in appearance and distribution to prior study. Please refer to concomitant recent bone scan from same day for additional findings. | 1. No significant change in reference lymph nodes as described.2. Size and extent of metastatic osseous disease subjectively similar to prior study. Please note that bone scintigraphy is a more sensitive indicator of activity of skeletal metastatic disease, see concomitant recent bone scan from same day for additional findings. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. No abnormal flow voids are identified within the region of the basal ganglia. The midline structures and craniocervical junction are within normal limits. There is homogeneously decreased fat signal throughout the visualized marrow with slightly thickened appearance of the calvarium, consistent with history of sickle cell disease. There is moderate mucosal thickening within the right greater than left maxillary sinus, with moderate opacification of right mastoid air cells. There is minimal patchy opacification of the ethmoid sinus with mild mucosal thickening in the left frontal sinus There is prominence of soft tissue along the posterior nasopharynx, slightly greater on the left side, likely representing reactive lymphoid tissue within the adenoids in a patient of this age.The intracranial internal carotid arteries are normal in course and caliber. There is likely artifactual slight attenuation of the mid to distal left M1 segment with heterogeneous appearance of the flow related enhancement. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.Perfusion imaging does not demonstrate any significant abnormality. There is probable artifactual decreased in MTT along the left MCA region without abnormality of TTP. | 1. Unremarkable MRI brain and MRA head. No MR evidence of moyamoya disease at this time. No significant perfusion abnormality.2. Moderate fluid opacification of right mastoid air cells with scattered paranasal sinus mucosal disease. |
Generate impression based on findings. | Lumbar pain. Ankle pain. Two views of the lumbar spine are provided. The bones appear slightly demineralized. Mild degenerative disk disease affects L5/S1. I see no spondylolisthesis or frank instability between the flexion and extension views. There is a mild compression deformity of T12 that was present on the prior study. There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries.Three views of the right ankle are provided. There is a small ossicle overlying the distal tip of the fibula which may reflect old trauma, but I see no acute fracture or malalignment. The ankle otherwise appears normal for age. | Mild L5/S1 degenerative disk disease and other findings as above. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Moderate centrilobular emphysema and bronchial thickening compatible with bronchitis.New 3-mm solid micronodule in the right lower lobe (series 5/56), most likely secondary to infection or bronchial mucous plugging, but continued follow-up is recommended to confirm stability or resolution.No other suspicious nodules.MEDIASTINUM AND HILA: Enlarged heterogeneous hypodense nodules within the right lobe and isthmus of the thyroid are not significantly changed over multiple prior exams.No pericardial effusion.No significant abnormality noted.No mediastinal or hilar adenopathy.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple small hypodense lesions consistent with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged L4 vertebral body superior endplate depression.OTHER: No significant abnormality noted. | New micronodule in the right lower lobe, most likely benign, but follow-up is recommended to confirm stability or resolution. No other evidence of metastatic disease. |
Generate impression based on findings. | 80 year-old male with history of NSCLC lung cancer CHEST:LUNGS AND PLEURA: Right upper lobe mass with surrounding radiation reaction, infiltrative tumor and consolidation, measuring approximately 6.6 x 6.3 cm at the reference level (series 5, image 79), not significantly changed since prior exam provided differences in slice selection, previously 6.6 x 5.6 cm at this level. . Areas of hypoattenuation within the mass may reflect areas of necrosis. Worsening consolidation in the posterior segment of the right upper lobe (3/34), likely a combination of solid and necrotic tumor and postobstructive consolidation, correlate for signs of pneumonia. Moderate centrilobular and paraseptal emphysema. Stable right middle lobe and bilateral lower lobe bronchial wall thickening. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Right coronary artery stent. Severe coronary artery calcification. Interposition graft is unchanged.Right hilar lymphadenopathy has increased (3/38) 18-mm, previously 15-mm (non-index measurement 3/38). Numerous small enhancing ipsilateral mediastinal lymph nodes not significantly changed. Tumor infiltration into the right mediastinal fat extending up to the lateral wall of the trachea and surrounding the right upper lobe bronchus has increased.Right brachiocephalic vein, left brachiocephalic vein and superior vena cava are severely compressed by the mass, though the SVC is patent centrally, the degree of compression has increased compared to the previous examinations.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Median sternotomy wires and fixation placed. Invasion of the right second rib as above. Extension of the lung mass into the right chest wall and intercostal muscles with right second rib cortical destruction appears similar to the prior exam. Small left low cervical lymph node (3/4) is unchanged. Enhancing right internal mammary chain lymphadenopathy is present, probably unchanged, though very poorly visualized due to anterior chest wall hardware artifact.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities are unchanged and likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Small hiatal hernia. Wall thickening of the gastric antrum was not previously reported to be FDG avid may be of inflammatory etiology and is unchanged. Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Lytic lesion in the L4 vertebral body is unchanged. Unchanged subtle diffuse sclerosis of the lower lumbar spine and visualized pelvis with scattered small internal lucencies. The sclerosis is new from earlier study such as a PET/CT from 6/11/2014. Given the diffuse nature this is more likely to be metabolic than metastatic.OTHER: No significant abnormality noted. | 1.No significant interval change in size of right apical reference level measurements, though the posterior segment of the right upper lobe is now consolidated and presumably involved by tumor.2.Tumor infiltration into the mediastinum with development of extrinsic compression of the superior vena cava, left brachiocephalic vein and right brachiocephalic veins, correlate for clinical signs of SVC syndrome.3.Mediastinal and chest wall involvement by tumor as detailed in the body of the report. |
Generate impression based on findings. | Prior lumbar surgery. Evaluate for spondylolisthesis. Severe degenerative disk disease affects L5/S1. Relatively mild degenerative disk disease affects L3/4 and L4/5. I see no spondylolisthesis or frank instability between the flexion, neutral, and extension views. Vertebral body heights are preserved.There is a 3-cm rounded metallic density within the lower mid abdomen that has the appearance of the 5 stacked disk-like structures. This was present in the mid to upper abdomen on the prior study, but is now in a different location. This could represent an ingested foreign body/bodies. | 1.Degenerative disk disease without evidence of spinal instability2.Findings suggestive of an ingested foreign body/bodies in the lower midabdomen. This was relayed to Dr. Mok at the time of dictation. |
Generate impression based on findings. | 66 year old female status post left lumpectomy in 2007 for invasive lobular carcinoma, presents today for routine follow up. Patient received radiation and hormonal therapy (tamoxifen). 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker has been placed on a scar overlying the upper central left breast, with expected underlying postsurgical distortion. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 73 years old Reason: prostate cancer with rising PSA on therapy. History: prostate cancer Scattered foci of increased radiotracer uptake in the spine, right ribs and right SI joint are again unchanged. No abnormal osseous foci are identified to indicate metastatic disease. | No evidence of bone metastases, with no significant interval change. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements CHEST:LUNGS AND PLEURA: Apical pleuroparenchymal scarring unchanged.Minimal centrilobular emphysema. No interval suspicious pulmonary nodules or pleural effusion.MEDIASTINUM AND HILA: Heart size is unchanged. Moderate coronary artery calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There has been prior cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes of the glenohumeral joints. The appearance of the T8 precaval body is unchanged, likely intra-osseus hemangioma.OTHER: Right Bochdalek hernia. Extensive atherosclerotic disease involving the splenic artery. | No evidence of metastatic disease. |
Generate impression based on findings. | There are postoperative changes of bilateral antrostomy, partial ethmoidectomy, and sphenoidotomy. Right antrostomy is patent. Additionally, there are questionable findings of partial bilateral middle turbinectomy. There is near complete opacification of bilateral maxillary and frontal sinuses with moderate-to-severe, diffuse mucosal thickening of the ethmoid air cells. There is chronic thickening of the sinus walls. The nasal septum is deviated rightward.The mastoid air cells and middle ears are clear. There appears to be an empty sella, otherwise the partially visualized skull base and brain appear normal. | 1.Moderate to severe scattered opacification and mucosal thickening of the paranasal sinuses, similar to the prior examination.2.Extensive postoperative changes. |
Generate impression based on findings. | Pain Mild osteoarthritis affects the ankle. Additionally, there is irregularity of the medial articular surface of the talar dome with small foci of depression of the subchondral bone plate and underlying sclerosis that I suspect represents an old osteochondral injury. A tiny density overlying the posterior recess of the ankle joint on the lateral view could conceivably represent a small loose body, but this is equivocal. Mild degenerative changes also affect the midfoot. There is diffuse soft tissue swelling. | Osteoarthritis and findings compatible with an old talar dome osteochondral injury as described above. |
Generate impression based on findings. | Female 48 years old; Reason: rule out renal recurrence History: hx or renal cell carcinoma, sp partial nephrectomy ABDOMEN:LUNG BASES: Granulomatous changes of the right lung including calcified hilar lymph nodes and scattered granulomas.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post partial right nephrectomy. Previously seen 2 cm simple cyst in the upper right kidney is not seen on today's CT, and this is likely post surgical. Redemonstrated simple left renal cysts. Nonobstructing stone in the inferior right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post partial nephrectomy and likely cystectomy of the right kidney as described above. No definite evidence of recurrence. |
Generate impression based on findings. | 69 year old female with left breast mass 9:00. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a mixed echogenicity mass measuring 25 x 14 mm at the 9 o’clock position with increased vascularity, 12 cm from the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged very good. One specimen sank to the bottom of the prefilled container of 10% formalin. Two specimens partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central posterior aspect of the lesion. No evidence of large hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Lai. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. This is most likely a malignancy. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Reason: enlarged goiter. need to rule out narrowing of trachea History: none Respiratory motion degrades exam quality.LUNGS AND PLEURA: Persistent lingular linear atelectasis. No pleural effusion or pneumothorax. Scattered nonspecific micronodules. No suspicious nodules or masses.MEDIASTINUM AND HILA: No significant interval change in size of large thyroid goiter with unchanged tracheal narrowing. The trachea measures 11 mm in diameter at its narrowest, previously 10 mm (series 3, image 20). Anterior displacement of the trachea is unchanged.Bioprosthetic aortic valve is present. Unchanged left ventricular aneurysm with epicardial patch graft or mesh material.No pericardial effusion. Moderate coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary, subpectoral, retrocrural or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant change in size of goiter with stable narrowing and anterior displacement of the trachea. |
Generate impression based on findings. | Renal cell carcinoma CHEST:LUNGS AND PLEURA: Mild cardiomegaly.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: AbsentPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy site clear.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Large left inguinal hernia again noted with multiple loops of bowel within the hernia sac without evidence for obstruction or bowel wall edema.OTHER: No significant abnormality noted | Stable examination without evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Reason: Cerebral AVM surgery. It is not known if there is residual AVM present. The patient being anticoagulated Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is a reverse filling of the posterior communicating arteries - left is larger than the right. There is no angiographic evidence for vasculitis or residual AVM.Right common carotid artery: There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no angiographic evidence for vasculitis.Right external carotid artery: There is no evidence for arteriovenous fistula. There is no angiographic evidence for vasculitis.Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissectionLeft internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no evidence for aneurysm, AVM or AV fistula. There is no angiographic evidence for vasculitis. The left A1 is larger than the right A1 segment. There is partial opacification of the right ACA and the left PCA on this injection.Left external carotid artery: There is no evidence for arteriovenous fistula. There is no evidence for AVM. There is no angiographic evidence for vasculitis.Right common iliac artery: There is no contraindications for the deployment of a closure device. | 1.No evidence for residual AVM. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: There has been interval resolution of the previous right middle lobe pneumonia. Several nodules were previously obscured by the pneumonia and are slightly more prominent compared to 8/1/14. One measures 5 mm (1/23), as compared to 2 mm on 8/2014. The second, more anterior and inferior nodule, measures 6 mm (4/210), as compared to 4 mm on 8/2014. These are suspicious for metastases and warrant attention on subsequent imaging.There is a focus of scarring within the anterior right upper lobe which appears linearon the coronal view. There are associated centrilobular nodules suggestive of a mild bronchiolitis in this location (5/36).No pleural effusions.MEDIASTINUM AND HILA: A right hilar lymph node has increased in size from 17mm to 20mm (3/48). Paratracheal lymph nodes have mildly increased in size. No left hilar lymphadenopathy.The heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Interval placement of a filter within the infrarenal IVC, superior to the location of the previous IVC thrombus which is no longer present. | Interval resolution of right middle lobe pneumonia. Residual scarring in this location is noted, along with centrilobular nodules of likely mild bronchiolitis.Two peripheral right middle lobe micronodules have increased in size when compared to 8/2014. These are suspicious for metastases. Attention to these on subsequent imaging recommended.Increased size of right hilar lymph node, now 20 mm as compared to 17 mm. Mildly increased size of paratracheal lymph nodes. |
Generate impression based on findings. | Spinal stenosis, lumbar region, with neurogenic claudication. There is severe degenerative disk disease as well as facet joint osteoarthritis throughout the lumbar spine. There is a slight leftward curvature of the lumbar spine. There is a grade 1 retrolisthesis of T12 and L1 and a grade 1 anterolisthesis of L4. Moderate osteoarthritis also affects the sacroiliac joints. Lumbar vertebral body heights are preserved. There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries. | Severe degenerative arthritic changes as described above. |
Generate impression based on findings. | Female, 76 years old, history of tonsil cancer status post CRT. Post treatment changes are again seen including volume loss along the left tongue base as well as infiltration of the fat planes of the neck. No mucosal lesions are seen.No pathologic adenopathy is detected by size criteria. A left level 2 reference lymph node measures 9 x 4 mm (image 38 series 8), previously 8 x 4 mm.Salivary glands and thyroid are unremarkable. The cervical vessels opacify normally with evidence of atherosclerosis at the carotid bifurcations. No destructive osseous lesions are seen. A large cystic structure is present along the left coracoid process and a smaller cystic structure is seen adjacent to the right. Findings are likely related to glenohumeral joint degeneration. | Redemonstration of treatment related findings with no evidence to suggest local disease recurrence or pathologic adenopathy. |
Generate impression based on findings. | Male; 49 years old. Reason: Pancreas cancer currently on vaccine study please assess and compare to previous scan and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Stable calcified and noncalcified pulmonary micronodules stable. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Small residual soft tissue attenuation in anterior mediastinal area similar to earlier study, may reflect small residual thymic tissue. Calcified left hilar lymph nodes, likely reflecting sequela of prior granulomatous disease.CHEST WALL: No suspicious osseous lesions.ABDOMEN:LIVER, BILIARY TRACT: Reference left liver lesion measuring 1.1 x 0.9 cm, unchanged (series 3/85). No new suspicious hepatic lesions. Calcified hepatic granulomata. Common bile duct stent present with associated pneumobilia. Unchanged mild intrahepatic biliary duct prominence. SPLEEN: Multiple splenic calcified granulomata.PANCREAS: Stable prominence of the pancreatic duct at level of head, measuring 8 mm. Accounting for differences in technique, no significant change with respect to ill-defined hypoattenuating pancreatic head mass, which measures approximately 2.9 x 2.1 cm (series 3/11, previously 3 x 2.4 cm. Remainder of pancreas atrophic. Stable associated hepatic arterial encasement and pancreatic mass abutment of the portal vein near confluence. Grossly stable enlarged peripancreatic and portacaval lymph nodes. Reference portacaval lymph node measures 3 x 2.1 cm (series 3/94), not significantly changed from prior study when it measured previously 2.8 x 2.1 cm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small left extrarenal pelvis. Hypoattenuating subcentimeter renal lesions, too small to characterize (including exophytic posteriorly located left renal hypoattenuating focus that does not measure simple fluid), are stable.RETROPERITONEUM, LYMPH NODES: Reference left paraaortic lymph node measures 0.8 x 0.8 cm, unchanged (series 3/129). Reference peri-celiac lymph node measures 1.1 x 0.5 cm (series 3/91), not significantly changed since prior study when it measured 1 x 0.5 cm.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Small prostatic calcification.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious osseous lesions. | No significant interval change in index lesions. No new sites of disease. |
Generate impression based on findings. | Legs giving way. Assess implants. Again seen are posterior rods with screws entering the L1, L2, L4, and L5 vertebrae. There is straightening of the lumbar spine. The posterior components of the left L1 and L2 pedicle screws, as well as one of the L5 pedicle screws, have dislodged, but this appears similar to that seen on the prior study. There is bony bridging along the posterolateral aspect of the lumbar spine extending from L2 through L5. Endplate irregularity and sclerosis at L2/3 suggests prior diskitis/osteomyelitis. Moderate degenerative disk disease affects L5/S1. | Postoperative and arthritic changes of the spine as described above. |
Generate impression based on findings. | History bladder carcinoma status post radical cystectomy with Indiana pouch ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter low attenuation left lobe hepatic focusSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Percutaneous left nephroureteral catheter with distal end within the Indiana pouch; no hydronephrosis. Right renal atrophy with mild hydronephrosis and hydroureter. Incompletely characterized low-attenuation focus within the right kidney best seen on image 31 of series 3 measuring 1.6 x 0.9 cm.RETROPERITONEUM, LYMPH NODES: Abdominoaortic aneurysm with maximal AP diameter 4.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophic.BLADDER: Status post cystectomy with unremarkable appearing Indiana pouch.LYMPH NODES: Large confluent left pelvic mass encasing the left iliac vessels best seen on image 88 of series 3 measuring 5.1 x 4.5 cm. Right internal iliac mass best seen on image 96 of series 3 measuring 3.7 x 3 cmBOWEL, MESENTERY: Trace ascitesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral pelvic masses worrisome for metastatic adenopathy.Incompletely characterized low-attenuation focus within the right kidney; would recommend correlation with ultrasound.Abdominal aortic aneurysm with maximal AP diameter 4.6 cm. |
Generate impression based on findings. | Evaluate for renal artery stenosis, history of hypertension RIGHT KIDNEY: Measures 10.8 cm. Increased renal cortical echogenicity. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis. No hydronephrosis. No perinephric free fluid. Upper pole cystic focus, measuring 1.4 x 1.2 x 0.9 cm.LEFT KIDNEY: Measures 12.2 cm. Increased renal cortical echogenicity. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis. No hydronephrosis. No perinephric free fluid. DOPPLER: Abdominal aorta peak systolic velocity is 60 cm/sec.Right kidney: Patent right renal vein.Peak systolic velocity of right renal artery is 60 cm/sec origin. Peak systolic velocities of right renal artery are40 cm/sec distally, 60 cm/sec at mid portion and 100 cm/sec proximally.Resistive indices of segmental arteries range from 0.54 to 0.67. Arcuate arteries in right kidney not well seen but resistive indices range approximately from 0.55 to 0.60. Left kidney:Patent left renal vein.Peak systolic velocity of left renal artery is 40 cm/sec in origin. Peak systolic velocities of left renal artery area 30 cm/sec distally, 50 cm/sec at midportion and 30 cm/sec proximally.Resistive indices of segmental arteries range from 0.59 to 0.66. Resistive indices of arcuate arteries range from 0.63 to 0.70.BLADDER: Visualized bladder unremarkable. | No sonographic evidence of renal artery stenosis. Echogenic kidneys, compatible with medical renal disease. |
Generate impression based on findings. | Bilateral hip pain. Three views of the right hip, three views of the left hip, and AP view of the pelvis reveal no acute fracture or dislocation. The bilateral hip joints and sacroiliac joints appear normal. | No acute fracture is evident. |
Generate impression based on findings. | Female 14 years old Reason: location of sitz marks (day 5) History: pica; feculent emesisVIEW: Abdomen AP (one view) 3/17/15 Eight Sitz markers are located in the right hemiabdomen and a right one in the left. No evidence of obstruction or free air. | Sitzmarks location as described. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: 55 year old female with headache, known brain metastases, recent start on anti-coagulation. Unenhanced head CT:There is no detectable acute intracranial findings. CT however is insensitive for the early detection of an acute nonhemorrhagic ischemic stroke.Previously known tint metastatic lesion seen on MRI cannot be detected on this study.Cerebral cortex, cortical sulci, ventricular system, CSF spaces and the gary - white matter differentiation is unremarkable.Unremarkable calvarium, scalp, orbits, paranasal sinuses and mastoid air cells and middle ear cavity pneumatization. | Unremarkable exam. |
Generate impression based on findings. | 18 years, Female. Reason: stent placement History: L ureteral stent placed at OSH Nonobstructive bowel gas pattern. Average stool burden. Left nephroureteral stent in expected position. | Left nephroureteral stent in expected position. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 52 year old male hx of abdominal surgery with 4 weeks of abdominal pain, nausea, vomiting. Please evaluate for obstruction. History: Intractable nausea and vomiting. Nonobstructive bowel gas pattern. No free air on upright view. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 64 yo F s/p AAA repair History: abd pain Interval placement of lower abdominal aortic stent graft, in expected position. Multiple additional surgical clips unchanged. Nonobstructive bowel gas pattern. Right nephroureteral stent and peritoneal shunt tubing unchanged. | Interval placement of lower abdominal aortic stent graft without complication. |
Generate impression based on findings. | Pain. Injury. Two views of the left hip and an AP view of the pelvis are provided. The bones appear demineralized. There is mild irregularity of the margin of the greater trochanter superiorly which could conceivably represent an acute fracture, although this is also the site of a previous fracture sustained in April 2014 and therefore it may simply represent sequela of prior injury. Mild osteoarthritic changes affect both hips. Degenerative arthritic changes also affect the sacroiliac joints and lower lumbar spine. Surgical clips are noted in the pelvis. | Slight irregularity of the superior aspect of the greater trochanter could conceivably represent an acute fracture, but may reflect old injury (i.e., a healed fracture at this location sustained last year). If further imaging evaluation is clinically warranted CT may be considered. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Clinical question: Evaluate sinuses. Signs and symptoms: Chronic sinusitis and nasal polyposis. Medtronic fusion sinus CT:There is extensive to near complete opacification of all paranasal sinuses consistent with pansinusitis. Uniformly the contents of the sinuses along the inner walls of the sinuses are low in density (mucosal thickening) and higher density otherwise. The higher density content could represent chronic long-standing history cough sinusitis however possibility of fungal sinusitis cannot be entirely excluded. There is complete occlusion of bilateral ostiomeatal units of maxillary sinuses as well as bilateral sphenoethmoidal recesses.Examination also demonstrate extensive opacification of the nasal passage which could represent clinically suspected polyposis. There is no evidence of destructive bony changes however mild bony remodeling and thinning of the sinuses is detected.Bilateral mastoid air cells and middle ear cavities remain well pneumatized and unremarkable.Unremarkable images through the orbits. | 1.Extensive chronic pansinusitis with occluded bilateral ostiomeatal units and sphenoethmoidal recesses.2.Increased soft tissue within the nasal passage likely representing clinically suspected polyposis.3.Slightly higher density of the contents of the sinuses likely indicating long-standing chronic sinus disease. Possibility of underlying fungal sinusitis however cannot be entirely excluded.4.Well pneumatized bilateral mastoid air cells and middle ear cavities. |
Generate impression based on findings. | 61 year old female status post left lumpectomy June 2013 for invasive ductal carcinoma with DCIS, presents today for routine follow up. Patient received radiation and hormonal therapy. No current breast complaints. Family history of breast carcinoma in her maternal cousin. Three standard views of both breasts, and 2 magnification views of the left lumpectomy bed, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density is, unchanged in pattern and distribution. Postsurgical changes are present in the lower inner left breast, including surgical clips. Skin thickening is noted of the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Surgical clips are also present in left axilla. Benign appearing lymph nodes are projected over the right axilla. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male, 56 years old, history of T2N2BM0 left base of tongue p16+ cancer, status post CRT. Post-treatment findings are redemonstrated with reticulation of the subcutaneous fat and supraglottic mucosal thickening, unchanged. No evidence to suggest recurrent tumor is seen.No pathologic adenopathy is detected by size criteria. A reference left level 2 lymph node measures up to 6 mm short axis (image 46 series 6), previously 8 mm.The salivary glands and thyroid are unremarkable. The cervical vessels are patent. No concerning osseous lesions are detected. A mucus retention cyst in the right sphenoid sinus is unchanged. | No evidence of local disease recurrence or pathologic adenopathy. |
Generate impression based on findings. | Female; 51 years old. Reason: Hx of diverticular disease History: hx diverticulitis, pre-op exam. The scout film showed proper positioning of the rectal tube and balloon. Barium flowed freely from the rectum to the cecum. The exam demonstrated moderate diverticulosis of the sigmoid colon as well as scattered diverticula elsewhere. No evidence of diverticulitis, sinus tracts, or fistulae. The colonic mucosa was otherwise normal in appearance without evidence of polyps or mass lesions. Small amounts of barium and air were refluxed into the terminal ileum. Spot films of the terminal ileum were normal. The appendix was visualized and is normal in appearance. No significant tortuosity or redundancy of the colon was noted. | Moderate sigmoid diverticulosis without acute colonic abnormality. FLUORO TIME: 6 minutes 42 seconds. |
Generate impression based on findings. | GIST ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Slight interval decrease in size of mesenteric masses. Left upper quadrant reference mesenteric mass best seen on image 80 of the coronal projection now measures 11.2 x 9.2 cm; this is in comparison to 12 x 9.7 cm on 12/16/2014. Reference right lower quadrant mass best seen on image 74 on the coronal projection now measures 10.7 x 8.6 cm; this is in comparison to 12.9 x 8.2 cm on 12/16/2014.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slight interval decrease in size of mesenteric masses. |
Generate impression based on findings. | Sarcoma/MFH, evaluate for progression. LUNGS AND PLEURA: Postsurgical volume loss on the left from wedge resection. Left upper lobe collapse; previously seen short segment of the aerated bronchus is now unopacified caudal to the level of the suture line towards the hilum. Reference central measurement is 16-mm (4/32), previously 17-mm on the 12/28/2014 scan and approximately 18 mm when remeasured at this level and there 1/14/2014 scan; differences in measurement most likely reflect scan variability. Soft tissue opacity seen about the suture line in the collapsed left upper lobe unchanged. The cranial reference level measurements is unchanged at 33 x 27 mm (4/24). Left lower lobe bronchus is stenotic (5/108). Small volume of pleural fluid on the left, partially anteriorly loculated or pleural thickening is observed, pleural fluid volume slightly increased over the past two exams. In a couple of areas, the pleural thickening appears slightly nodular such as within the left posterior costophrenic angle (4/74) and within the inferolateral aspect of the left major fissure (4/62).A loculated fluid collection in the left cardiophrenic angle (4/64) has slightly increased in size measuring 21 x 20 8 mm, previously 17 x 19 mm. The adjacent pericardial thickening is present.Mild emphysema. No pleural fluid on the right. No suspicious nodules elsewhere.MEDIASTINUM AND HILA: Previously seen soft tissue stranding and fluid in the left cardiophrenic angle within the fat pad has become more solid over the past two scans, for reference the largest lesion measures 14 x 16 mm (4/52) pulse other small lymph nodes unchanged..CHEST WALL: Please note that identification of intramuscular soft tissue metastases is limited by this technique. Numerous punctate (sub-5 mm) lymph nodes in the low neck, axilla and subpectoral regions bilaterally, not significantly changed, abnormal in multiplicity but not in size.Mildly enlarged left intercostal lymph nodes (4/65 for example), not normally visible.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Please note that the presence of intravenous contrast material limits sensitivity for the detection of sarcomatous metastases which may appear isoattenuating to the hepatic parenchyma post contrast infusion. Elevation of the left hemidiaphragm suggestive of phrenic nerve paralysis. | Slight increase in pleural fluid and pleural thickening in the left hemithorax with ipsilateral intercostal lymph node enlargement suspicious for indolent metastatic disease or infection the pleural space, further evaluation recommended. Left cardiophrenic soft tissue nodule likely result of localized extension of pleural process. Obstructing left suprahilar mass with distal atelectasis not conclusively changed allowing for differences in scan variability although a previously aerated left upper lobe segmental bronchus is now obstructed. |
Generate impression based on findings. | Male 74 years old; Reason: history of metastatic prostate cancer, rising PSA, assess for disease extent CHEST:LUNGS AND PLEURA: Biapical pleural nodularity/scarring. Again seen are scattered calcified and noncalcified micronodules. Reference left upper lobe lung nodule stable, measuring 4 mm, image 65 series 4. Increased size of another left upper lobe lung nodule, measuring 5 mm, image 35 series 5, previously measured 3 mm. Reference right upper lobe without significant change accounting for differences in technique, measuring 3 mm, image 94 series 4, previously measured 4 mm. Increased size of nearby right upper lobe lung nodule, measures 3 mm, image 92 series 4, previously measured 1 mm. New nodules present, for example, in right upper lobe anteriorly, 4 mm lung nodule, measuring 128 series 4. Mild upper lobe emphysema. Bibasilar linear atelectasis/scarring. No pleural effusion.MEDIASTINUM AND HILA: Mildly prominent mediastinal and hilar lymph nodes. Reference right hilar lymph node slightly smaller, measuring 1 x 0.9 cm, image 19 series 3, previously measured 1.2 x 1.2 cm. Small anterior mediastinal soft tissue attenuation, stable from prior study, may be residual thymic tissue. Mild calcified coronary artery disease. Atherosclerotic aorta. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypoattenuating right hepatic focus, too small to characterize and indeterminate, measures 0.8 cm, image 99 series 3, previously measured 0.5 cm on January 13, 2010 CT study.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy with multiple surgical clips seen.BLADDER: Improved diffuse bladder wall thickening.BONES, SOFT TISSUES: Enlarging osseous metastatic disease. For example, lesion located in right iliac bone measures 3.2 x 2.1 cm on image 167 series 3, previously measured 2.6 x 1.7 cm. Please note that bone scintigraphy is more sensitive for evaluation, please refer to concomitant nuclear medicine bone scan from same day for additional findings. | 1. New and enlarging lung micronodules as described, nonspecific but suspicious for metastatic disease.2. Enlarging osseous metastatic disease. Please note that bone scintigraphy is more sensitive for evaluation, please refer to concomitant nuclear medicine bone scan from same day for additional findings.3. Indeterminant hepatic focus as above.4. Reference right hilar lymph node slightly smaller. |
Generate impression based on findings. | There is an interspinous fusion device between L4 and L5 spinous processes. Bone graft material is identified just anteriorly without no definite bony bridging identified to the adjacent native bone, although margins are slightly indistinct. There is stable grade 1 anterolisthesis of L4 on L5 measuring 6 mm. The scout lateral view and the sagittal reformatted images demonstrate the remainder of the lumbar spine to be in normal alignment, with a normal lumbar lordosis. There is moderate disk narrowing L4-L5 and L5-S1, with vacuum phenomenon at L5-S1. The vertebral body and disk space heights are otherwise well-maintained.There is no acute fracture.At T12-L1, there is no significant disk pathology or stenosis.At L1-L2, there is a central/right paracentral disk extrusion which migrates cranially by 7 mm. There is indentation of the ventral thecal sac.At L2-L3, there is no significant disk pathology or stenosis.At L3-L4, there is a left distal foraminal/far lateral shallow disk protrusion.At L4-L5, there is uncovering of the disk with significant bilateral facet arthropathy and ligamentum flavum thickening, greater on the left side. There is likely at least moderate central spinal stenosis at this level and moderate bilateral foraminal narrowing.At L5-S1, there is a diffuse disk bulge with slight right-sided prominence. There is bilateral facet arthropathy and ligamentum flavum thickening with moderate-severe right and mild left foraminal narrowing.Limited views through the retroperitoneum demonstrate a punctate calcification within the left kidney in the interpolar region which may represent a nonobstructing renal calculus. There is also a punctate calcification in the lower pole of the right kidney. Colonic diverticulosis is noted. | 1. Degenerative grade 1 anterolisthesis of L4 on L5 with evidence of posterior interspinous fusion device. Associated bone graft maternal is identified with no definite bony bridging at this time, although there is suggestion of ill-defined superior and inferior margins.2. At least moderate central canal stenosis at L4-5 with moderate bilateral foraminal narrowing. Additional moderate-severe right foraminal narrowing at L5-S1.3. Probable punctate nonobstructing renal calculi. |
Generate impression based on findings. | Six-months postop Again seen are postsurgical changes of partial C2 as well as total C3 and C4 laminectomy as well as posterior spinal fusion seen from C2 to C4. Lateral screws and rods are intact and appear well-positioned. There is mild periscrew lucency on the left at C4. Interval decrease in lucency at the left C3-C4 facet joint is noted.Again seen is cervical kyphosis centered at the C4-C5 level, not significantly changed since prior. Again noted is prominent ossification of the posterior longitudinal ligament extending from the C2 to the C6 levels.There is osseous fusion involving the C4 to C6 vertebral bodies. Endplate osteophytes and diminished intervertebral disk is noted at C6-C7 and unchanged. Individual levels as below:At C2-3 there is ossification of the posterior longitudinal ligament with the spinal canal surgically decompressed. No significant neural foraminal narrowing.At C3-4 there is ossification of the posterior longitudinal ligament, eccentric to the right. There is mild to moderate associated right neural foraminal narrowing. Spinal canal is surgically decompressed. No significant left neural foraminal narrowing.At C4-5 there is right paracentral ossification of the posterior longitudinal ligament with the spinal canal surgically decompressed. There may be mild asymmetric right spinal canal stenosis below the level of the laminectomy as seen previously. No significant neural foraminal narrowing.At C5-6 there is no significant spinal canal or neural foramina narrowing. At C6-7 there is a posterior disk osteophyte complex with mild-to-moderate spinal canal stenosis. There is also bilateral uncovertebral hypertrophy resulting in moderate bilateral neural foraminal narrowing. At C7-T1 there is a small disk osteophyte complex without significant spinal canal or neural foraminal stenosis. Paraspinous soft tissues demonstrate expected postoperative changes but are otherwise unremarkable. | 1. Postsurgical changes of C2 to C4 laminectomy and posterior spinal fusion. Hardware is intact and well positioned. There is mild periscrew lucency at C4 on the left. There is interval decrease in lucency at the left C3-C4 facet joint which may suggest mild progression of fusion.2. Degenerative changes as seen previously with mild to moderate right neural foraminal narrowing at C3-C4 and bilaterally at C6-C7, as well as mild-to-moderate spinal canal narrowing at C6-C7 related to disk osteophyte complex.3. Extensive ossification of the posterior longitudinal ligament from C2 to C6 with surgical decompression as above.4. Cervical kyphosis centered at C4-5 not significantly changed since prior. |
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