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Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are screening mammogram dated February 17, 2015, and right diagnostic mammogram and right breast ultrasound dated February 24, 2015 performed at High Tech Medical Park. For comparison, screening mammograms dated February 11, 2014 and February 5, 2013 are available. SCREENING MAMMOGRAM (2/17/2015):Three standard views of both breasts, were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. An asymmetry is present within the lower, far posterior right breast on MLO views only. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the left breast. RIGHT DIAGNOSTIC MAMMOGRAM AND ULTRASOUND (2/24/2015):MAMMOGRAM: An ML view and two spot compression views of the right breast were obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is redemonstration of an asymmetry within the lower, far posterior right breast, which persist on spot compression imaging.ULTRASOUND: Sonographic images from targeted ultrasound in the lower outer right breast were submitted. At the 6 o'clock position of the right breast, 6 to 7 cm from the nipple, there is an oval, circumscribed, hypoechoic lesion measuring 0.5 x 0.2 x 0 .7 cm, likely representing a cyst. At the 7 o'clock position of the right breast, two to 3 cm from the nipple, there is a 0.5 x 0.3 x 0.5 cm circumscribed, anechoic cyst. | Mildly complicated cyst at the 6 o'clock position of the right breast. Suggest repeat ultrasound for more complete characterization of the cyst. BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Left lower lobe subsegmental atelectasis.No suspicious pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: There is a bioprosthetic valve in the aortic position. Heart size is normal. No pericardial effusion. Incidental lipomas hypertrophy of the interatrial septum. Retained epicardial electrode is notedCHEST WALL: Sternum is well approximated by hardware.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: Stable size of exophytic left inferior pole cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | GIST CHEST:LUNGS AND PLEURA: Stable biapical scarring.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter transiently enhancing focus within segment 6 of the right lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: 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 examination without acute, inflammatory, or metastatic process. |
Generate impression based on findings. | 74 years old Male. Reason: lung cancer workup. History: lung cancer workup. RADIOPHARMACEUTICAL: 10.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates a new mass in the superior segment of the right lower lobe. Multiple enlarged lymph nodes are seen in the mediastinal paratracheal regions. The bilateral pleural effusions with associated dependent changes are again noted. Streaky and patchy opacities are seen in the lower lungs.Today's PET examination demonstrates intense FDG uptake in the new mass in the superior segment of the right lower lobe with SUV Max of 14.1. A small focus of increased activity was present on the prior study at this mass location. Also intense FDG uptake in the multiple conglomerate mediastinal lymph nodes at right paratracheal and precarinal regions. Intense FDG uptake is also seen in the right hilar lymph nodes.A focus of increased activity is seen in the pleural thickening in the right lateral chest wall pleura with SUV Max of 1.9 (series 4/145), which is nonspecific. A focus increased activity is seen in the left proximal femur, which is nonspecific.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder.No other evidence of FDG avid tumor. | New hypermetabolic mass in the superior segment of the right lower lobe, consistent with the cancer. Retrospective, hypermetabolic focus was seen on prior study in the segmentHypermetabolic lymph nodes in the right hilum and mediastinum at the right paratracheal and precarinal regions.Small focus of increased activity in the right lateral chest wall pleura, which is nonspecific.Small bilateral pleural effusions. |
Generate impression based on findings. | Dizziness and giddiness. Evaluate for lesion/aneurysm. There is no evidence of intracranial hemorrhage or mass effect. There are extensive areas of periventricular and subcortical white matter hypoattenuation, which are unusual in this age group. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is partial opacification of the frontal sinuses and bilateral ethmoid sinuses. There is near complete opacification of the right maxillary sinus. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of intracranial hemorrhage or mass effect.2. Extensive areas of periventricular and subcortical white matter attenuation, which are unusual in this age group. Possibilities include vasculopathy, demyelination, and old toxic-metabolic injury, for example. Suggest MRI for further evaluation as clinically indicated.3. Moderate paranasal sinus opacification is partially evaluated.Findings discussed with Dr. Ahn on 3/17/2015 at the time of dictation. |
Generate impression based on findings. | Male 55 years old; Reason: 55 yo M hx of wilson's disease and cirrhosis with increasing transaminitis and AFP. Eval for HCC. History: cirrhosis ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Diffuse hypoattenuation of the cirrhotic liver. TIPS shunt in place. 3.6 x 3.8 cm (12:42 and 11:42) vague hyperdense lesion adjacent to the gallbladder fossa, likely correlating to recently seen sonographic lesion is not well characterized on the CT, as there is no definite enhancement, or washout of this lesion. Other similar appearing lesions are seen around the gallbladder fossa, and this may represent focal fat sparing.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left and right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Stable right subcentimeter pericardial/diaphragmatic lymph node.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small esophageal varices. | 1.Incompletely characterized previously seen sonographic lesion adjacent to the gallbladder. A subtle area of hyperdensity, further described above, may conceivably correlate with the sonographic lesion, but demonstrates no definitive features of HCC. However, further, more definite characterization with MRI is recommended. |
Generate impression based on findings. | Back pain. Degenerative disk disease affecting the spine appears similar to that seen on the prior study. Levoscoliosis of the thoracolumbar spine, as measured from the superior endplate of T12 to the inferior endplate of L3, increases slightly to 25 degrees with bending to the right (compared to 20 degrees on the routine frontal view from the prior study). The levoscoliosis decreases to approximately 10 degrees upon bending to the left. There is slight leftward translation of the L2 and L3 vertebral bodies, particularly with bending to the right. | Scoliosis as described above. |
Generate impression based on findings. | Pain. Preop. Three views of the right knee are provided. Severe osteoarthritis affects the knee, particularly the lateral compartment where there is near bone on bone apposition. Components of a left total knee arthroplasty device are situated in near anatomic alignment as seen on the frontal view.A mechanical axis radiograph of the right lower extremity is provided. Again seen is severe osteoarthritis of the right knee. There is approximately 19 degrees of valgus alignment of the knee with respect to the neutral mechanical axis, although this may be slightly influenced by patient rotation. | Osteoarthritis and valgus deformity of the knee as above. |
Generate impression based on findings. | Patient had surgery on infected left knee approximately 1 year ago and is having similar pain for the past 2 to 3 days. Increased pain in the left knee. Assess for effusion versus osteomyelitis. Four views of the left knee reveal no acute fracture or malalignment. There is chronic deformity of the patella. No cortical destruction is identified to suggest osteomyelitis. No joint effusion is seen. | No joint effusion or specific radiographic evidence of osteomyelitis. |
Generate impression based on findings. | Spindle cell neoplasm and obstruction of right ureter.EXAMINATION: Right retrograde pyelogram 03/17/15 41.8 seconds of fluoroscopy time was used.Multiple surgical clips are seen in the right pelvis.Contrast was injected into the right distal ureter. Only a small piece of ureter is visualized. | Obstruction of right ureter to retrograde injection. |
Generate impression based on findings. | Evaluation of the craniocervical junction demonstrates no evidence of tonsillar ectopia or Chiari 1. There is preserved biphasic flow ventrally and dorsally at this foramen magnum. Abnormal T2 signal involving the bilateral cerebellar hemispheres is partially visualized and was present on priorThere is no evidence of segmentation abnormality involving the vertebral column. There is no evidence of central spinal stenosis at any level. The signal intensity and caliber of the cord is within normal limits. No evidence of syrinx. There is no detectable paraspinal mass on these non-contrast images or appreciable neurofibromas at the level of neural foramina.THORACIC SPINE | 1. Upper thoracic dextroscoliosis, mid-thoracic levoscoliosis, and thoracolumbar dextroscoliosis better assessed on radiographs from 8/21/2014 and progressed since prior MRI from 2011.2. No evidence of Chiari 1, syrinx, tethered cord, or large neurofibromas on this noncontrast study, as clinically questioned. |
Generate impression based on findings. | 68 years old Female. Reason: initial staging, non-small cell lung cancer. History: newly diagnosed adenocarcinoma of lung. For initial staging. RADIOPHARMACEUTICAL: 13.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion grossly demonstrates large right pleural effusion with compression atelectasis of the right lung. Cystic lesion with calcification is seen in the gallbladder fossa, which can be further evaluate with ultrasonography.Today's PET examination demonstrates a hypermetabolic mass in the compressed right lower lobe with SUV Max of 10.4. In addition, several foci of increased activity are seen in the compressed right lung. The numerous foci of increased activity are noted in the right chest pleura. Increased metabolic activity is seen in the mediastinal right paratracheal and subcarinal lymph nodes.A focus increased activity is seen in the right suprarenal region adjacent to the diaphragmatic crus.Physiologic activity is seen in the liver, spleen, kidneys, intestines, ureters and bladder. | 1.Hypermetabolic tumor in the right lower lobe with large right effusion and extensive right pleura metastasis.2.Lymph node metastases in the right lung hilum and mediastinal right paratracheal and subcarinal regions.3.Nonspecific focus of increased activity is seen in the right supra-renal region. |
Generate impression based on findings. | Rib pain after fall. Question of rib fracture. Three views of the ribs show a minimally displaced fracture of the anterior left 4th rib. Median sternotomy hardware is noted. Abdominal surgical clips and vascular calcifications are seen. | Anterior left 4th rib fracture. |
Generate impression based on findings. | 72-year-old male with pleural mesothelioma. CHEST:LUNGS AND PLEURA: Small left pleural effusion, significantly decreased from previous exam; may be partially loculated medially at the level of the pulmonary trunk. Pleurex catheter at the left lung base has been repositioned with tip now in the posterior costophrenic angle. Diffuse pleural thickening is again noted in the left hemithorax and may be mildly decreased in extent, with reference measurements as follows (series 3):At the level of the aortic arch at the 10 o'clock position, pleural thickening measures up to 4 mm (image 29), from previously 13 mm.At the level of the right main pulmonary artery at the 12 o'clock position, pleural thickening measures up to 19 mm (image 44), from previously remeasured at 21 mm.At the level of the right main pulmonary artery at the 5 o'clock position, pleural thickening measures up to 6 mm (image 44), from previously 6 mm.Two left upper lobe subpleural nodules measuring 16 and 13 mm (image 30, series 4) are new from the previous exam. 19-mm left lower lobe nodule is also newly evident (series 4, image 70), though may have been previously obscured by atelectasis/large left pleural effusion.Previously seen right upper lobe nodule measures 10 mm (series 4, image 24), unchanged from previously 10 mm. Right lower lobe partially calcified nodule is also unchanged at 13 mm (series 4, image 54), from previously 13 mm. MEDIASTINUM AND HILA: Again seen is mediastinal invasion of tumor into the pericardial space, not significantly changed. Trace pericardial effusion is also decreased. Small mediastinal lymph nodes are stable and remain not enlarged by CT size criteria.CHEST WALL: Stable invasion of the chest wall by pleural tumor, anteriorly abutting the left pectoralis major with stable destruction of the adjacent ribs. Soft tissue nodules along the pleurex catheter tract are smaller, measuring 49 x 22 mm (series 3, image 67), from previously 60 x 42 mm. Anasarca has resolved. Stable T11 sclerotic focus, likely a bone island. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Right hepatic lobe hypodense lesion likely representing metastasis has increased in size, measuring 40 x 40 mm (series 2, image 81), from previously 24 x 19 mm. No new hepatic lesions are identified.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically without focal lesion.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderate calcifications affect the abdominal aorta and its branches. No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Normal in caliber without evidence of obstruction or ileus. Colon is stool filled.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Left pleural thickening has decreased mildly in extent.2.Tumor seeding along the pleurex catheter tract appears mildly decreased in size.3.Stable mediastinal and anterior chest wall tumoral invasion.4.Increased hepatic and left lung metastases, as above.5.Significantly improved left pleural effusion and anasarca. |
Generate impression based on findings. | Female; 72 years old. Reason: 72F s/p cystectomy on 2/5/15 complicated by intra-abdominal abscess, now readmitted with concern for wound infection; please assess for intraabdominal process History: as above ABDOMEN:LUNG BASES: Calcified lung nodules from prior granulomatous disease. Mitral valve annular calcification. No other significant abnormalities seen.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cyst. Stable prominence of the renal pelvises. Interval removal of bilateral ureteral stents. Postsurgical changes from right lower quadrant urinary diversion conduit with ileal conduit exiting the slight right abdomen centrally.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy seen. Stable appearance of extensive aortic atherosclerotic calcifications with internal stent in the distal aorta. Extensive atherosclerotic calcifications are seen in the proximal common iliac arteries bilaterally.BOWEL, MESENTERY: Small hiatal hernia with small residual gastric pouch from prior gastric bypass surgery. No bowel obstruction. Apparent colonic wall thickening due to under distention.BONES, SOFT TISSUES: Open anterior abdominal wound with increased subcutaneous stranding and soft tissue density, which may be due to cellulitis. No drainable abscess is evident.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Prior hysterectomy.BLADDER: Status post cystectomy.LYMPH NODES: No lymphadenopathy. Interval resolution of pelvic fluid collections. Stable left approach pelvic drain. BOWEL, MESENTERY: No bowel obstruction. Apparent colonic wall thickening due to under distention.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post cystectomy/hysterectomy with ileal conduit urinary diversion with expected appearance. 2. Interval resolution of pelvic fluid collections. No intra-abdominal or intrapelvic abscess is evident.3. Findings suggestive of cellulitis involving the open anterior abdominal wound, but no evidence of drainable abscess. |
Generate impression based on findings. | Male 54 years old Reason: metastatic prostate cancer, evaluation of disease after 6 cycles of investigational therapy. Please complete PCWG2 form History: prostate cancer Numerous foci of increased or decreased uptake consistent with osseous metastases involving the axial and appendicular skeleton, no significant change since prior examination. No evidence of new osseous lesions are identified. | Diffuse osseous metastatic disease, with no significant interval change. |
Generate impression based on findings. | Clinical question: Status post removal of right maxillary sinus fungal ball. Signs and symptoms: Nasal congestion and discharge. Medtronic fusion sinus CT:The examination demonstrates interval extensive postoperative changes are endoscopic functional sinus surgery with resultant removal of the right ostiomeatal unit and right ethmoidectomy.Right maxillary sinus demonstrate extensive opacification however with mild interval improvement since preoperative exam. The content of right maxillary sinus demonstrate no increased density to suggest fungus ball. A bony defect along the alveolar ridge of the right maxillary sinus measuring approximately 13 mm in size which remains similar to prior study and representing patient's known oroantral fistula. Bony thickening of the right maxillary sinus wall as result of chronic long-standing sinusitis demonstrate no significant change since prior exam.Postoperative changes results in improvement of opacification at the ethmoidectomy site.The floor of right orbit and the right retro-septal space remains intact.The left maxillary sinus demonstrate interval improvement and without evidence of residual sinus disease.Frontal and sphenoid sinuses remain well pneumatized and unremarkable.Bilateral mastoid air cells and middle ear cavities remain well pneumatized and unremarkable. | 1.Interval postoperative changes on the right as detailed.2.Extensive residual soft tissue density within the right maxillary sinus without high density content to suggest fungus ball.3.Stable right-sided oroantral fistula since prior exam.4.Essentially unremarkable other paranasal sinuses and improvement since prior exam.5.Unremarkable mastoid air cells and the cavities an intact bilateral orbits. |
Generate impression based on findings. | Male 68 years old Reason: metastatic prostate cancer History: metastatic prostate cancer Degenerative changes are noted in the shoulders, and knees. Large increased area of radiotracer uptake in the thoracic and lumbar spine, with no focal area of increased uptake, likely due to degenerative changes. No convincing evidence of osseous metastatic disease. | No evidence of bone metastases. |
Generate impression based on findings. | Right wrist bone protrusion. Concern for fracture. Three views of the right wrist reveal no acute fracture or malalignment. There is a small calcification adjacent to the ulnar styloid which is likely chronic in etiology and may represent a small accessory ossicle. There is mild osteoarthritis of the distal radioulnar joint with osteophyte formation. | Degenerative changes without acute fracture. |
Generate impression based on findings. | 39-year-old female, status post ACDF for congenital spinal stenosis and HNP, with neck pain and left upper extremity radiculopathy There is loss of the normal cervical lordosis. The craniocervical junction appears normal. Postoperative changes of C5 through C7 ACDF. There is moderate diffuse congenital spinal canal narrowing. The cord signal is normal throughout.C2-3: No significant neuroforaminal narrowing. Moderate congenital spinal canal stenosis.C3-4: Right greater than left uncovertebral joint hypertrophy with moderate left neuroforaminal narrowing. Moderate spinal canal stenosis.C4-5: Moderate right paracentral disk protrusion. Moderate indentation of the ventral thecal sac without significant neuroforaminal stenosis. Mild to moderate central canal stenosis.C5-6: Moderate left uncovertebral joint hypertrophy and moderate left neuroforaminal stenosis. Mild to moderate central canal stenosis.C6-7: Moderate bilateral uncovertebral joint hypertrophy and left greater than right neuroforaminal narrowing. There is flattening of the left ventral cord, as well as moderate to marked central canal stenosis. C7-T1: No significant neuroforaminal or spinal canal stenosis. | 1. Moderate diffuse congenital spinal canal stenosis, with superimposed spondylotic changes worst at C6/7. The cord signal is normal throughout.2. Multilevel uncovertebral joint hypertrophy and neuroforaminal narrowing as described above.3. Moderate right paracentral disk protrusion at C4/5. |
Generate impression based on findings. | Male 58 years old Reason: assess for metastatic disease History: intermediate risk prostate cancer Solitary faint focus of increased radiotracer uptake in the left occipital region, which may represent osseous metastatic lesion, recommend follow-up for further evaluation. | Single focus in the left occipital region, which may represent osseous metastasis. Recommend follow-up examination for further evaluation. |
Generate impression based on findings. | Pain. Three views of the left ankle show a side plate and screw device affixing the distal fibula with a syndesmotic screw and two orthopedic screws affixing the medial malleolus. No evidence of hardware complication. Alignment is anatomic. The fracture lines are not visualized. | Healed orthopedic fixation of bimalleolar fractures. |
Generate impression based on findings. | Injury.VIEWS: Right elbow AP/lateral (two views), right forearm PA/lateral (two views) 03/17/15 The distal humerus is broadened and the olecranon fossa appears to be shallow. The posterior aspect of the capitellum is slightly irregular. | Posttraumatic changes with probable shallow olecranon fossa. |
Generate impression based on findings. | Follow-up. Three views of the right ankle show a side plate and screw device affixing the distal fibula. An orthopedic screw affixes the medial malleolus. No evidence of hardware complication. The fracture lines are indistinct consistent with healing. | Orthopedic fixation of bimalleolar fractures. |
Generate impression based on findings. | Female; 81 years old. Reason: assess for progression of OA in shoulder History: pain and decreased ROM. Increased subchondral cysts, joint space narrowing, and glenohumeral osteophytes, compatible with mild interval progression of osteoarthritis. No acute fracture or dislocation. | Mild interval progression of glenohumeral osteoarthritis. |
Generate impression based on findings. | 59-year-old with history of right mastectomy for ILC. On Tamoxifen. 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. Biopsy clip in the left outer breast again noted. Scattered benign calcifications and asymmetries are unchanged.Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female; 66 years old. Reason: knee pain after fall 2 months ago. r/o bony path History: pain in the right knee. No acute fracture or dislocation. Scattered tricompartmental osteophytes and joint space narrowing compatible with mild osteoarthritis, most pronounced in the patellofemoral compartment. | Mild osteoarthritis without fracture. |
Generate impression based on findings. | Male 53 years old; Reason: Pre-kidney transplant evaluation. Assess vasculature to support kidney transplant. History: Pre-transplant evaluation. The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Subcentimeter right lower lobe pulmonary cyst. Mild basal atelectasis.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypoattenuating renal lesions are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Vasculature: Aorta: Mild calcific arteriosclerosis of the abdominal aorta.Right common iliac artery: Approximately 180 decrease circumferential calcification of the wall.Right external iliac artery: No significant calcification.Right internal iliac artery: Close to 360 degrees calcificationLeft common iliac artery: Approximately 200 decrease circumferential calcification of the wall.Left external iliac artery: Approximately 40 degrees calcification.Left internal iliac artery: Approximately 40 degrees calcification.Mild bilateral common femoral calcification (less than 60 degrees).PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Nonspecific mildly prominent subcentimeter inguinal lymph nodes are likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Iliac artery calcification as detailed above. |
Generate impression based on findings. | Female; 47 years old. Reason: eval primary, new brain lesion History: new brain lesion CHEST:LUNGS AND PLEURA: Mixed cavitary and solid, spiculated mass in the left apex measuring up to 3.7 x 2.3 cm in greatest axial dimension (series 4/20), suspicious for lung cancer. Abutment of the mass along the posterior left apical pleural surface, suspicious for pleural involvement. Mild upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size. No pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta extending into the iliacs.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid, likely physiologic. Corpus luteal cyst seen in the left ovary.BLADDER: Prominent urethral insertion at the base of the bladder of uncertain clinical significance.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of pelvic free fluid, likely physiologic. | Left apical mass, suspicious for lung cancer though tuberculosis or atypical mycobacterial infection could have a similar appearance.Results discussed with Dr. Ardelt at 3:08 p.m. on 3/17/15. |
Generate impression based on findings. | Male; 49 years old. Reason: Dysphagia and shortness of breath. Cervical spine is visualized to the top of C6 on the lateral view. No acute fracture or malalignment. Vertebral body heights are preserved. The prevertebral soft tissues and epiglottis are within normal limits. | No acute osseous or soft tissue abnormality identified. |
Generate impression based on findings. | Female 11 years old Reason: assess for constipation, obstruction, ileus History: RLQ pain, no BM x4dVIEWS: Abdomen AP supine and upright 3/17/15 (two views) Mild fecal loading. Normal abdomen gas pattern. No evidence of obstruction or free air. | Normal abdomen. |
Generate impression based on findings. | Female; 87 years old. Reason: history metastatic renal cancer, on no therapy, assess for progression History: none CHEST:LUNGS AND PLEURA: Reference right lower lobe pulmonary nodule measures 1.4 x 1 cm, unchanged since prior study on 1/11/15 when it measured 1.4 x 1 cm (series 5/84). Reference right middle lobe nodule measures 3 mm, unchanged since prior study on 10/13/14 when it measured 3 mm (series 5/64). No new suspicious pulmonary nodules or masses. Mild bibasilar subsegmental atelectasis. No pleural effusions.MEDIASTINUM AND HILA: Reference subcarinal lymph node measures 1.4 x 1.1 cm, not significantly changed since 10/13/14 when it measured 1.4 x 1.3 cm (series 3/45).CHEST WALL: Reference calcified left chest wall lesion measures 1.3 x 1.2 cm, mildly increased since 10/13/14 when it measured 0.7 x 0.7 cm (series 3/72).ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. Status post cholecystectomy with unchanged mild intra-and extra hepatic biliary ductal dilation.SPLEEN: Status post splenectomy.PANCREAS: Surgical clips about the tail the pancreas.ADRENAL GLANDS: Stable incompletely characterized right adrenal gland nodule.KIDNEYS, URETERS: Status post left nephrectomy with surgical clips in the nephrectomy bed, but there is no enhancing soft tissue to suggest local tumor recurrence.Right renal mass measures 3.5 x 2.9 cm, previously 3.5 x 2.9 cm (series 3/101).RETROPERITONEUM, LYMPH NODES: Stable prominent retroperitoneal lymph nodes. Reference right retrocaval lymph node measures 2.3 x 1.1 cm, previously 2.3 x 1.1 cm (series 3/100).BOWEL, MESENTERY: Fat and bowel-containing ventral hernia without evidence of bowel obstruction. BONES, SOFT TISSUES: Lytic lesion in L1 vertebral body and posterior elements causing severe central canal stenosis, not significantly changed.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prominent cystic lesions in the expected locations of the adnexa bilaterally, stable since 2006.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: Lytic lesion in L1 vertebral body and posterior elements causing severe central canal stenosis, not significantly changed.OTHER: No significant abnormality noted. | 1. Mild increase in left chest wall index lesion. Other index lesions are not significantly changed. No new sites of disease.2. Stable appearance of lytic L1 vertebral body lesion causing severe central canal stenosis. MRI would be more sensitive for cord pathology if clinically indicated. |
Generate impression based on findings. | Male 13 years old Partial physeal arrest. Status post surgeryVIEWS: Left wrist AP and lateral 3/17/15 (two views) Cast material obscures fine bone detail. Round lucency over the medial distal physis of the left radius is related to postsurgical changes. Alignment is anatomic. Distal physis of the left radius and ulna appears to be open. | Postsurgical changes as described. |
Generate impression based on findings. | Right hydronephrosis.EXAMINATION: Right and left retrograde pyelogram 03/17/15 Lower pole right ureter was injected. The lower pole ureter is normal in caliber. There is a transition between the lower pole ureter and the renal pelvis which is dilated. The calyces are dilated. The right upper pole ureter was injected and subtends two or three calices. The left ureter and pelvicaliceal system are normal. | Right duplicated ureters with lower pole UPJ obstruction. |
Generate impression based on findings. | History of osteoradionecrosis of the mandible, with left-sided jaw swelling after tooth extraction. He is on nearly completed 6 weeks of Augmentin therapy with no progression. No new swelling and no new pain. Panorex was done on December 30, 2014. He is status post chemoradiation for T3N2b left oral tongue cancer. Compare to prior measurements. Redemonstrated are post-treatment changes of the left neck. Evaluation of the tongue is somewhat limited by streak artifact from dental amalgam. However, there is no definite evidence of mass lesions or significant cervical lymphadenopathy. The thyroid and major salivary glands are unchanged. There is mild thickening of the major cervical vessel walls, likely representing post-treatment changes. There is interval increase in linear lucencies and increase in periosteal reaction of the left hemimandible, suspicious for fracture. There is no fluid collection. There are degenerative changes of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. No evidence of recurrent disease or cervical lymphadenopathy. 2. Again seen are findings suggestive of osteoradionecrosis of the left hemimandible. Compared to prior, there is mild increase in associated lucency, including linear lucency involving the cortex which is suspicious for fracture. No fluid collections in the surrounding soft tissues. |
Generate impression based on findings. | Male, 7 years old. Abdominal pain. ABDOMEN:LUNG BASES: No focal pulmonary opacities. No pleural effusions.LIVER, BILIARY TRACT: No focal liver lesions. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder is normal.SPLEEN: Not enlarged.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys enhance symmetrically, with no pelvicaliceal dilatation.A circumaortic left renal vein is noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction.The appendix is visualized and normal in appearance.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distended and normal in appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction.The appendix is visualized and normal in appearance.Small to moderate feces.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. |
Generate impression based on findings. | 52 year old female status post right lumpectomy in 2012 for invasive ductal carcinoma, presents today for routine follow up. Patient received neoadjuvant chemotherapy, radiation, and Herceptin. No current breast complaints. No family history of breast cancer. Three standard views of both breasts, and a laterally exaggerated right craniocaudal view, were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker has been placed on a scar overlying the far posterior upper outer right breast, with expected underlying postsurgical changes, including surgical clips. There is partial visualization of a port in the left upper chest wall. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female; 88 years old. Reason: left hip pain. Orthopedic plate and dynamic screws affix the left proximal femur in near anatomic alignment. No evidence of hardware complication or loosening. No acute fracture or dislocation. Mild degenerative changes affect the left hip. Mild degenerative changes are also seen in the right hip and lower lumbar spine on the AP view of the pelvis. | Postsurgical and degenerative changes as described above. |
Generate impression based on findings. | Male 9 years old Reason: post-op . Status-post hardware removal.VIEWS: Right ankle AP, lateral and oblique 3/17/15 (3 views) Interval removal of right tibial distal epiphyseal screw. No evidence of complications related to the procedure. Healed fracture is in anatomic alignment. | Healed fracture in anatomic alignment, after hardware removal. |
Generate impression based on findings. | 58 year old female. Evaluate for progression of disease. Ovarian cancer. CHEST:LUNGS AND PLEURA: Right lower lobe micronodule, unchanged, likely postinflammatory.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes. No lymphadenopathy.Normal heart size without pericardial effusion. Mild coronary artery calcification.CHEST WALL: Right cardiophrenic lymphadenopathy has resolved, with residual subcentimeter lymph nodes. Right chest wall port tip in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Peripheral 1.7 x 1.7 cm hypodensity in the right hepatic lobe (series 3, image 87), suspicious for a subcapsular metastasis, not significantly changed.Soft tissue encasing the lateral and posterior aspect of the liver, consistent with peritoneal disease, similar to prior. Previously seen perihepatic trace ascites has resolved.SPLEEN: No significant abnormality noted. Interval resolution of previously seen trace perisplenic ascites.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral parapelvic cysts and extrarenal pelvises. RETROPERITONEUM, LYMPH NODES: 1.6 x 1 cm lymph node posterior to the gastric antrum, previously 2.2 x 1.1 cm (series 3, image 92). Another lymph node anterior to the antrum is mildly increased in size at 1 x 0.9 cm, previously 0.7 x 0.5 cm (series 3, image 92). Mildly enlarged retroperitoneal lymph nodes, not significantly changed.Extensive peritoneal metastases, overall decreased in size from prior. For reference, an omental mass has a thickness of 2 cm, previously 2.8 cm (series 3, image 121).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Near complete resolution of abdominopelvic ascites. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal disease involving the distal ileum and sigmoid colon mesentery, not significantly changed in soft tissue component though associated loculated pockets of ascites has resolved. This peritoneal mass is confluent with the right aspect of the uterus.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Significant decrease in extensive peritoneal metastatic disease. Interval resolution of right cardiophrenic lymphadenopathy and decreased size of a perigastric lymph node. Another perigastric lymph node is mildly increased in size, of unclear clinical significance. |
Generate impression based on findings. | 64 years, Female. Reason: s/p NGT placement History: s/p NGT placement Limited study, pelvis is excluded from field of view. There is a nasogastric tube with its tip projecting over the fundus of the stomach. Again seen are multiple dilated loops of small bowel measuring up to 4.5 cm in diameter, compatible with patient's known small bowel obstruction. No definite transition point is identified on this limited study. | Nasogastric tube with its tip projecting over the fundus of the stomach. |
Generate impression based on findings. | There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or diffusion-weighted abnormalities. There are no extraaxial fluid collections. The ventricles and sulci are normal in size. Sulcation appears normal. There is normal myelination. Midline structures including the corpus callosum are within normal limits. Flow voids are present within the major vessels indicating patency. Minimal ethmoid air cell opacity. Otherwise paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain. | MRI of the brain appears within normal limits. Specifically, no structural abnormalities within the basal ganglia are seen as clinically questioned. |
Generate impression based on findings. | Male, 3 years old. Evaluate stool burden, colonic distension History: Imperforate anus, constipation, now with pain with stoolingVIEW: Abdomen AP (one view) 3/17/20 15, 1353 Gastrostomy tube in place in the left upper quadrant. Redemonstration of surgical changes in left upper quadrant. Ascending colonic enema catheter in the right lower quadrant.Moderate to large colonic stool burden greater in the left hemiabdomen. No evidence of bowel obstruction.Sacral malformation again seen. | Moderate to large stool burden, predominantly in the descending colon. |
Generate impression based on findings. | Female; 88 years old. Reason: osteoarthritis History: knee pain and swelling Left knee: No acute fracture or dislocation. Moderate medial and patellofemoral compartment joint space narrowing and small joint effusion.Right knee: No acute fracture or dislocation. Mild medial and patellofemoral compartment joint space narrowing. No joint effusion. | Bilateral osteoarthritis, left greater than right. No acute fracture is evident. |
Generate impression based on findings. | Male 83 years old; Reason: 83 year old with a history of urothelial cancer. please assess for disease progression **CT UROGRAM, DELAYED VIEWS 3D VIEW RECONSTRUCTION* History: urothelial cancer The images are somewhat limited by motion artifact.CHEST:LUNGS AND PLEURA: Left apical lung nodule measures 1.5 x 1.5 cm (series 80984 , image 25), previously measuring 1.5 x 1.5. As has been previously documented, this has increased compared to more remote studies. For example 06/04/12 where this measured 1.0 x 1.1 cm.The nonspecific cluster of nodules in the right lower lobe (series 80984 , image 65 ) are unchanged and warrant continued attention on follow-up imaging.No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart size is normal without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy. Multiple rib deformities are suggestive of healed fractures.ABDOMEN:LIVER, BILIARY TRACT: Scattered subcentimeter hypoattenuating lesions are too small to characterize and are unchanged compared to prior study. Calcifications suggestive of prior granulomatous process.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No suspicious renal lesion. Mild enhancement of the wall of the left ureter suggestive of chronic inflammation. Bilateral urinary diversion to a right lower quadrant ileal conduit.RETROPERITONEUM, LYMPH NODES: Mild aortic and branch vessel calcific arteriosclerosis.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy with ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable rectal distention without rectal wall thickening.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable left apical lung lesion. As has been mentioned previously, this demonstrates interval growth compared to remote studies and a primary lung cancer is not excluded.2.No evidence of metastatic disease. |
Generate impression based on findings. | 59 year old female who was recalled from screening mammogram for technical repeat of the left MLO view for skinfold versus architectural distortion. Additional history was obtained at the time of examination of remote injury in the left axillary region. On physical examination, a scar is present in the lower left axillary region. A single left MLO view was performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. A linear marker has been placed on a scar overlying the left axillary region. This area corresponds to the area of questioned architectural distortion on the prior examination, which, given difference in positioning, is not suspicious on today's examination. Benign appearing lymph nodes are projected over the left axilla. | Scar formation in the left axillary region accounting for the finding on prior mammogram. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 61 years old Reason: evaluate for esophageal stricture History: solid food dysphagia. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. There is a small hiatal hernia that was nonobstructive to a barium pill. During the exam, there was trace amount of spontaneous reflux to the distal third of the esophagus which cleared rapidly. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 6:33 minutes. | 1. Small hiatal hernia nonobstructive to barium pill. 2. Trace amount of spontaneous reflux with rapid clearance. |
Generate impression based on findings. | 68-year-old asymptomatic female presents for diagnostic mammogram. Personally history of laryngeal squamous cell carcinoma. Family history of breast carcinoma in her sister at unknown age, and a paternal aunt at age 52. Three standard views of both breasts 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. Bilateral benign calcifications are present, including a stable cluster within the central inner left breast. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 70 year-old male with hypoechoic right testicular lesion, follow-up ultrasound. RIGHT TESTIS: Measures 2.5 cm x 1.8 cm x 3.9 cm and is slightly heterogeneous in echotexture. Hypoechoic lesion is again seen measuring 9 mm x 8 mm x 6 mm unchanged.LEFT TESTIS: 3.0 cm x 2.2 cm x 4.5 cm. Normal echotexture with no focal lesions. RIGHT EPIDIDYMIS: 1.2 cm x 1.2 cm x 1.2 cm, no significant abnormality noted. LEFT EPIDIDYMIS: 1.1 cm x 1.5 cm x 0.9 cm, no significant abnormality noted. | Heterogeneous echotexture of the right testicle with a focal hypoechoic lesion unchanged. Findings are suspicious for neoplastic etiology and less likely infectious given stability in size and appearance of the lesion. Another consideration is a focal infarct, however this is also less likely given stability in size of the lesion as well as the right testicle itself. |
Generate impression based on findings. | Status post fracture.VIEWS: Right forearm AP and lateral 3/17/15 (two views) Cast material obscures fine bone detail. Healing fracture of both forearm bones with periosteal reaction , callus formation and palmar angulation, is unchanged in alignment. | Healing both forearm bones fractures, unchanged in alignment. |
Generate impression based on findings. | 82-year-old male with history of head and neck cancer and chemoradiation therapy. Compared to previous. LUNGS AND PLEURA: Moderate to severe centrilobular and paraseptal emphysema. Scattered bilateral pulmonary micronodules, some calcified, stable in size and number. Right middle lobe and lingular scarring again noted. Status post right lower lobe wedge resection.MEDIASTINUM AND HILA: Right atrial enlargement is noted. No pericardial effusion. Moderate aortic, aortic valve and coronary calcifications are present. No significant mediastinal or hilar lymphadenopathy. Status post tracheostomy and thyroidectomy. CHEST WALL: Moderate degenerative changes affect the visualized spine. No suspicious focal osseous lesion. Healed right fifth and sixth rib fractures.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Exophytic left renal cyst and other bilateral subcentimeter renal hypodensities, too small to further characterize. | No evidence of metastatic disease. |
Generate impression based on findings. | Reason: evaluate ILD History: cough shortness of breath, fibrosis LUNGS AND PLEURA: Scattered reticular opacities with peripheral groundglass predominantly in the lung bases. No honeycombing is present. No pleural effusion or pneumothorax. Mild mosaic attenuation on expiratory sequence is compatible with air trapping. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy.Main pulmonary artery is enlarged measuring 3.3 cm suggestive of pulmonary artery hypertension.Mild cardiomegaly. No pericardial effusion. Mild coronary artery calcification.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Mild grade 1 anterolisthesis of T2 over T3. Mild degenerative disease affects the thoracic spine, worst at T9-T10.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Moderate to large hiatal hernia. Partially visualized sclerosis of the L2 vertebral body. | Interstitial reticular opacities with groundglass predominantly in the lung bases are most compatible with fibrosing NSIP, although atypical UIP related to connective tissue disease may be considered in the correct clinical context.. |
Generate impression based on findings. | 15 year-old male with cerebral palsy and concern for hip subluxationEXAMINATION: Pelvis AP and frog leg 3/17/15 The femoral heads are well seated within the acetabula bilaterally. No fracture. Plate and screw device affix the lateral aspect of the left proximal femoral metadiaphysis. Right coxa valga deformity. | The femoral heads are well seated within the well formed acetabula without evidence of subluxation. |
Generate impression based on findings. | Reason: h/o tonsil and thyroid ca, h/o CRT, compare to previous, measurements pls History: none. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. Few scattered micronodules, some of which are calcified. No suspicious pulmonary nodules. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. Mild coronary calcifications. No mediastinal or hilar lymphadenopathy. Status post thyroidectomy.CHEST WALL: Moderate degenerative changes affect the visualized thoracic spine. No suspicious focal osseous lesion.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 significant abnormality noted.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: Kidneys enhance symmetrically. Subcentimeter bilateral renal hypodensities, too small to further characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications affect the abdominal aorta. No significant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Small hiatal hernia. Bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: No suspicious focal osseous lesion.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Clinical question: 84-year-old male with AMS, evaluate for bleed. Signs and symptoms: A mass, respiratory failure, nonverbal. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes.Prominence of the cortical sulci, CSF displaces and mildly of the ventricular system remains within normal range for patient's stated age of 84.Very subtle findings of age indeterminate small vessel ischemic strokes is noted.Calvarium demonstrates multiple burr holes and unremarkable otherwise.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Very minimal findings suggestive of age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | 50 year old female status post right lumpectomy in 2010 for DCIS, and left lumpectomy in 2012 for invasive ductal carcinoma, presents today for routine follow up. Patient received radiation in 2010, and radiation and chemotherapy in 2012. No current breast complaints. No family history of breast cancer. Three standard views of both breasts, with bilateral laterally exaggerated craniocaudal views, 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. Linear marker has been placed on a scar overlying the upper outer right breast with expected underlying postsurgical distortion and surgical clips. Additionally, a linear marker has been placed on a scar overlying the upper outer left breast, with expected underlying postsurgical distortion and surgical clips. A cylinder shaped biopsy clip is present within the upper central left breast. Bilateral benign calcifications are unchanged. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Surgical clips are present within the left axilla. | Stable postsurgical changes in both breasts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Additionally, given the patient's history and breast density, annual screening MRI may be considered. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 75 years old Reason: Does this man have a Zenker's diverticulum? History: Pharyngoesophageal dysphagia in a 75 year old man. Some times the pills he swallowed come back up. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus and gastric cardia/fundus revealed showed no strictures. A focal segment of narrowing just distal to the thoracic inlet passed contrast and distended well and is likely due to an aortic impression rather than an anatomic stricture. During the exam, there was small volume silent aspiration, but no spontaneous reflux. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave with proximal escape and return after 5 seconds. The patient was unable to swallow barium pill, which remained in hypopharynx, even after 2 cups of water, and coughed it back up.TOTAL FLUOROSCOPY TIME: 8:47 minutes. | 1. Small volume silent aspiration. 2. Esophageal dysmotility as described above.3. Barium pill remained in hypopharynx. A oropharyngeal motility study is recommended for further evaluation. |
Generate impression based on findings. | 8-year-old male with history of fall, pain and swellingVIEWS: Right ankle AP, oblique lateral (3 views) 3/17/15 Significantly increased space between the talus and calcaneus with adjacent soft tissue swelling and joint effusion is suggestive of a ligamentous injury. The posterior aspect of the talocalcaneal joint is measures up to 4 mm. No fracture is identified. | Significant separation of the talocalcaneal joint with adjacent soft tissue swelling and effusion is suggestive of subtalar ligamentous injury. |
Generate impression based on findings. | Female; 48 years old. Reason: TSA evaluation, bilateral wrist pain. Right shoulder: Reverse ball socket total shoulder arthroplasty is again noted and in near anatomic alignment. No evidence of hardware complication or loosening. No acute fracture or dislocation. Heterotopic bone formation under the AC joint is unchanged since the prior exam.Right wrist: Moderate soft tissue swelling without acute fracture or dislocation. There is negative ulnar variance.Left wrist: Moderate soft tissue swelling without evidence of acute fracture. However, the first carpometacarpal joint is dislocated and this appears to be chronic. Negative ulnar variance is present with sclerosis of the lunate, suggestive of AVN. Surgical clips are noted in the anterior soft tissues of the wrist. | 1.Bilateral negative ulnar variance and sclerosis of the left lunate, suggestive of Kienbock's malacia. 2.First left carpometacarpal joint dislocation which appears chronic. 3.Total right shoulder arthroplasty in near anatomic alignment. |
Generate impression based on findings. | Right shoulder pain, no injury. Patient complains of popping with external rotation of shoulder. The bones of the shoulder appear normal. No acute fracture is evident. Glenohumeral alignment is within normal limits. No large joint effusion is present. The rotator cuff muscle bulk appears to be within normal limits. The remaining soft tissues are unremarkable. | No specific CT findings to explain the patient's symptoms. If there is continued concern for rotator cuff or labral injury, MRI may be considered for further evaluation. |
Generate impression based on findings. | There is minimal grade 1 anterolisthesis of C4 on C5 measuring 2 mm. The cervical spine is otherwise in normal alignment, with mild reversal of the normal cervical lordosis centered at C4-C5. There is moderate narrowing of the C5-C6 disk C6-C7 disk, with diffuse disk desiccation throughout the cervical spine. The remaining vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There are endplate degenerative changes at C5-C6 and to a lesser degree at C6-C7, including minimal enhancement. There is abnormal cord signal within the lateral aspect of the cord just below the C5-C6 level, at the none 701/14-15, with suggestion of both slight volume loss of the left aspect of the cord. There is no pathological enhancement.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a mild diffuse posterior osteophyte disk complex with mild bilateral facet arthropathy and ligamentum flavum thickening. There is mild-moderate central spinal canal stenosis there is bilateral uncovertebral hypertrophy contributes to moderate to severe bilateral foraminal narrowing.At C4-C5, there is trace uncovering of the disk with right sided uncovertebral hypertrophy. There is mild right facet arthropathy. Moderate-severe right foraminal narrowing is present, as well as mild to moderate central spine stenosis.At C5-C6, there is a mild diffuse posterior osteophyte disk complex as well as mild ligamentum flavum thickening. There is deformity of the cord especially along the left ventral aspect and moderate central spinal canal stenosis. There is severe left and moderate to severe right foraminal narrowing.At C6-C7, there is a left paracentral/foraminal posterior osteophyte disk complex which flattens the left ventral cord. There is moderate left foraminal narrowing as there is also mild left greater than right uncovertebral hypertrophy.At C7-T1, there is a trace this bulge and mild right uncovertebral hypertrophy and facet arthropathy, with mild to moderate right foraminal narrowing.There is small amount of fluid in the right mastoid air cells. | 1. Overall, moderate spondylotic changes most prominent at C5-C6 where there is moderate-severe central spinal stenosis as well as severe left and moderate-severe right foraminal narrowing.2. Cord signal abnormality just caudal to this level with suggestion of volume loss at least on the left side. Findings likely represent myelomalacia relating to the above central spinal canal narrowing.3. Additional moderate-severe bilateral foraminal narrowing at C3-C4 and on the right at C4-C5.4. Minimal degenerative grade 1 anterolisthesis of C4 on C5. |
Generate impression based on findings. | Female 45 years old Reason: Please evaluate the transplanted kidney for size, echogenicity and hydronephrosis History: History of kidney transplant. Decline in renal function and pain at the kidney transplant site TRANSPLANTED KIDNEY: The kidney measures 11.2 cm. No shadowing calculi or hydronephrosis is present. Renal cortical echogenicity within normal limits. No perinephric fluid collection.Right iliac artery peak systolic velocity measures 104 cm/sec.At level of anastomosis, tortuous appearance, velocity measures 219 to 246 cm/sec.Peak systolic velocity of renal artery measures 257 cm/sec proximally, 172 cm/sec at midportion and 205 cm/sec distally. At hilum, velocity measures 70 cm/sec.Segmental arterial resistive indices measure 0.66 to 0.72.Arcuate arterial resistive indices measure 0.64 to 0.69.Patent renal vein.BLADDER: Visualized bladder unremarkable. | Increased velocity at level of anastomosis, measuring 219 to 246 cm/sec (but improved from 1/2013 ultrasound study when measured 440 cm/sec) and gradient across anastomosis measures 2.1 to 2.4, assessment however was suboptimal due to vessel tortuosity at this level and these values are equivocal. While underlying anastomotic narrowing cannot be entirely excluded, considered less likely given the normal intrarenal resistive indices. Correlation with patient's clinical history/laboratory values recommended. |
Generate impression based on findings. | Male 84 years old; Reason: lung mass History: lung mass ABDOMEN:LUNG BASES: Please see report of CT chest same date.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Exophytic nodule closely related to the pancreatic tail. This mass has similar attenuation to the spleen and may represent accessory splenic tissue.ADRENAL GLANDS: Nonspecific adrenal nodular thickening which is indeterminate particularly given the presence of a lung mass.KIDNEYS, URETERS: Subcentimeter hypoattenuating lesions within the right kidney are too small to characterize.RETROPERITONEUM, LYMPH NODES: Moderate calcific arteriosclerosis of the abdominal aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Fat attenuation lesion within the left psoas muscle may represent intramuscular lipoma.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Suprapubic catheter in situ. Bladder wall thickening. High attenuation posterior inferiorly within the bladder may represent hypertrophied superior portion of prostate gland.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate rectal distention with above-average stool burden throughout the colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Nonspecific adrenal nodular thickening which is indeterminate particularly given the presence of a lung mass.2.Exophytic nodule off the pancreatic tail with similar enhancement characteristics to spleen, may represent accessory splenic tissue. |
Generate impression based on findings. | Pain and inability to bear weight. Question of intertrochanteric fracture. No acute fracture of the left femur is identified. There is irregularity of the greater trochanter which is likely related to sequela of a previously noted fracture in this region. Mild to moderate osteoarthritis affects the left hip with small osteophyte formation and acetabular subchondral sclerosis. No large left hip joint effusion is seen.Surgical clips are noted within the abdomen. | No evidence of an acute femur fracture. |
Generate impression based on findings. | ACL repair. MCL repair Two views of the left knee reveal a screw in the medial condyle consistent with ligament repair. There is an additional small sideplate on the lateral femoral condyle. Two additional bone defects caused by orthopedic hardware are seen in the proximal tibia. No change from previous exam of February 2 | Intact hardware from ligamentous repair. No acute abnormalities. |
Generate impression based on findings. | 46 year old female. History of hemangioendothelioma of vertebrae and liver and bilateral pelvic pain. Measure using recist criteria. CHEST:LUNGS AND PLEURA: Mild interstitial thickening in the anterior aspect of the left anterior lobe, unchanged.Nodular soft tissue thickening along the left major fissure and multiple nodular opacities in the left lower lobe, unchanged.1 x 1.3 cm right lower lobe groundglass nodule (series 5, image 44), unchanged dating back to 2009, may represent focal fibrosis versus AIS.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Numerous peripheral hepatic lesions, not significantly changed. Reference lesions as follows:1. Segment 4a (series 3, image 96): 1.5 x 1.6 cm, previously 1.4 x 1.5 cm. 2. Segment 7 (series 3, image 91): 2.7 x 4.2 cm, previously 2.7 x 4 cm.3. Segment 8 (series 3, image 87): 1.3 x 4.8 cm, previously 1.2 x 4.8 cm.4. Segment 6 (series 3, image 102): 1.9 x 4.5 cm, previously 1.9 x 4.3 cm. As mentioned on prior exam, this lesion is confluent with a more anterior dimension and long axis measurement is no longer reliable.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: Scattered small retroperitoneal lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination with no new sites of disease. |
Generate impression based on findings. | Male 79 years old History: History of lung cancer, re-stageRADIOPHARMACEUTICAL: 9.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 109 mg/dL. Today's CT portion grossly demonstrates right lower lobe consolidation, with pleural thickening. Postradiation fibrotic changes are again noted. Previously identified right lower lobe mass is not discretely seen on today's examination. Right posterior hepatic hypoattenuating lesion most likely a cyst, is unchanged. Right perinephric stranding and renal calcifications, similar to most recent CT. Prostate is enlarged, unchanged. Atherosclerotic calcification of the aorta. Degenerative changes in the spine.Today's PET examination demonstrates diffusely increased activity in the right lower lobe consolidation. Adjacent to this there are two focal areas of peripheral ringlike increased activity, with the larger with a ring like area of activity with SUV of 7.1. Left AP window non-enlarged lymph node with mildly increased activity is unchanged. Right hilar and right mediastinal lymph nodes have decreased in activity. Cystic lesion in the right lower kidney demonstrates peripheral FDG uptake, which could represent tumor or perhaps a cyst with adjacent renal parenchyma. | 1.Diffusely increased activity in right lower lobe consolidation, which most likely represents post treatment changes.2.Two focal areas of increased activity adjacent to post treatment changes in right lower lobe with SUV of 7.1. Residual/recurrent tumor cannot be excluded.3.Cystic right renal lesion with peripheral FDG uptake, which could represent tumor or cyst with adjacent parenchyma. |
Generate impression based on findings. | 69-year-old asymptomatic female presents for diagnostic examination. History of abnormal mammogram. Family history of breast carcinoma in her maternal aunt at age 60. 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. Bilateral asymmetries are unchanged. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Pain after ski injury. Three views of the left shoulder reveal no acute fracture or dislocation. There is sclerosis along the superior cortex of the humeral head, best seen on the grayshee view, which may be degenerative but is unusual for the patient's age. | Sclerosis about the superior cortex of the humeral head may be degenerative but is unusual for the patient's age; MRI of the shoulder is recommended to evaluate for internal derangement. |
Generate impression based on findings. | Lung CA follow-up CHEST:LUNGS AND PLEURA: Left upper lobe solid spiculated nodule slightly decreased in size, measuring 18 x 23 mm, previously 20 x 26 mm (5/43). There is a new small component of subsegmental atelectasis laterally.Emphysema. No pleural fluid or pneumothorax. No new nodules.MEDIASTINUM AND HILA: Low left paratracheal (AP window) lymphadenopathy measures 16mm, previously 15-mm (3/36). Other small lymph nodes unchanged. No pericardial fluid or visible coronary artery calcifications..CHEST WALL: Right chest port tip at the superior cavoatrial junction.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation unchanged.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: Stable soft tissue micronodule in the right pararenal fat (3/122), unchanged the patient's initial examination of 4/19/2013, likely benign.Atherosclerotic calcification of the abdominal aorta with mild focal infrarenal ectasiaBOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Focal anterior (non-dependent) gastric wall thickening seen on series 3 image 89 and coronal image 78, appearing more pronounced compared to previous studies; an underlying lesion cannot be ruled out.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Minimal decrease in size measurements of left upper lobe spiculated nodule compatible with malignancy. Low left paratracheal lymphadenopathy not significantly changed. Subtle increase in size and nodular appearance of the anterior distal gastric wall of unclear etiology; an underlying lesion cannot be excluded in the absence of complete gastric distention with oral contrast. If further evaluation is clinically warranted, this may be further assessed with direct visualization or an upper GI fluoroscopy examination. |
Generate impression based on findings. | Pressure ulcers. Evaluate for osteomyelitis. Three views of the right ankle show a soft tissue defect at the lateral malleolus. There is cortical irregularity and periosteal reaction of the lateral and inferior distal fibular tip underlying the soft tissue defect, best seen on the oblique view. No acute fracture is evident. No ankle joint effusion is seen. | Osteomyelitis of the distal fibular tip. |
Generate impression based on findings. | Status-post resection of thyroid gland and left neck dissection. No abnormal enhancement or soft tissue mass. Reference submandibular lymph nodes measuring 6 mm bilaterally, stable from prior study (series 6 image 31). Small right 3-4 mm level 3 lymph node is also unchanged. The parotid and submandibular glands are unremarkable. No cervical lymphadenopathy by CT size criteria. The airway is patent. The imaged portion of the paranasal sinuses and mastoid air cells are clear. The imaged orbits are unremarkable. Limited examination of the intracranial contents are unremarkable.Major cervical vessels are grossly patent. Centrilobular emphysema at the lung apices. Left apical pulmonary micronodule appearing similar to prior study. Please see same day chest CT report for additional details. Mild degenerative disk disease of the lower cervical spine. | No evidence of locoregional tumor recurrence in the neck. No significant cervical lymphadenopathy. |
Generate impression based on findings. | Right total knee arthroplasty pain. Four views of the right knee show a total knee arthroplasty device with resection of the proximal tibial plateau. There is lucency around the cement-bone interface of both the femoral and tibial components of the prosthesis, most predominately of the medial femoral component; comparison to prior radiographs if available would be helpful. No acute fracture is evident. There is heterotopic bone formation about the lateral knee. A left total knee arthroplasty is noted. Bone length radiographs demonstrated a 2 degree valgus deformity of the knee. Two orthopedic screws affix the medial malleolus of the tibia. | Lucency surrounding the bone-cement interface of the right total knee arthroplasty raises the question of loosening; comparison to prior radiographs would be helpful if available. |
Generate impression based on findings. | 84-year-old male with lung mass. LUNGS AND PLEURA: Large , heterogeneously enhancing, centrally necrotic subpleural mass in the posterior segment of the right upper lobe measures 6.2 x 6.2 cm (series 20359, image 42). Extension is seen to the right posterior fifth and sixth ribs, evidenced by osseous destruction. No other suspicious pulmonary nodules or masses are identified. A right lower lobe granuloma is noted. There is nonspecific broad-based but focal pleural thickening in the posterior left lower lobe; this is atypical of pleural plaque and of uncertain etiology.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. Severe coronary calcifications. Moderate calcifications of the thoracic aorta. Calcified bilateral hilar and subcarinal lymph nodes. Aspirated debris is noted in the right mainstem bronchus.CHEST WALL: Extension of tumor to the fifth and sixth ribs, as above. Otherwise, no suspicious focal osseous lesion. Lower cervical spine degenerative changes. Patient is cachectic.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left adrenal nodularity is suspicious for metastatic disease. | 1.Large right upper lobe subpleural mass with invasion of the fifth and sixth ribs is highly suspicious for malignancy.2.Left adrenal nodularity, suspicious for metastasis. |
Generate impression based on findings. | Female; 79 years old. Reason: S/p Left TKA Postsurgical changes status post total knee arthroplasty which is in near anatomic alignment. No acute fracture or dislocation. Midline surgical staples. | Total knee arthroplasty hardware in near anatomic alignment. |
Generate impression based on findings. | Female 44 years old Reason: rule out tracheoesophageal fistula History: vomiting/coughing. not tolerating any po. Scout radiograph of the chest was obtained. Please refer to same day chest radiograph for complete thoracic findings.Limited study as patient had small volume swallows. Water-soluble contrast evaluation did not reveal a tracheo-esophageal fistula as clinically questioned. Single contrast evaluation of the esophagus and gastric cardia/fundus revealed no mass or sinus tract. There may be an anterior cervical web of the esophagus, however this is nonobstructive. During the exam, the patient had coughing episodes, but no frank aspiration was identified. TOTAL FLUOROSCOPY TIME: 3:30 minutes | 1. No tracheo-esophageal fistula, mass, or sinus tract in this limited study.2. Possible nonobstructive anterior cervical web. |
Generate impression based on findings. | Reason: f/u LUL nodules, tobacco use history, COPD History: lung nodule LUNGS AND PLEURA: No pleural effusion or pneumothorax. Central airways are patent. Minimal left basilar atelectasis. Mild centrilobular emphysema. Slight interval decrease in left apical nodules suggestive of resolving post inflammatory changes. Additional micronodules are unchanged. No suspicious nodules or masses. Subpleural fat deposition on the left.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. The heart is normal. No pericardial effusion. Severe coronary artery calcification. Mediastinal lipomatosis.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy. Minimal gynecomastia.Moderate degenerative disease affects the thoracic spine. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Abdominal muscle diastases. No adrenal gland nodules. Low-attenuation in the liver compatible with fatty infiltration. | 1. Interval decrease in left upper lobe cluster of micronodules. Stable unchanged micronodules. No suspicious nodules. 2. Fatty infiltration of the liver and deposition of intrathoracic and intra-abdominal fat disproportionate to degree of subcutaneous fat, correlate for hypercortisolism. |
Generate impression based on findings. | The patient submitted outside mammogram dated 1/11/12, 3/11/13. Submitted outside study was compared to the current mammogram dated 3/4/15. Right axillary lymph nodes are not visualized on the prior studies, and one of left axillary lymph nodes is partially visualized on the study of 1/11/12. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male; 23 years old. Reason: right ankle pain Diffuse soft tissue swelling is noted about the ankle. No acute fracture or dislocation is identified. However, slight widening of the medial tibiotalar gutter is noted on the stress view compared to unstressed views. | Soft tissue swelling and slight widening of the medial tibiotalar joint space on the stress view. No acute fracture identified. |
Generate impression based on findings. | Caroli's disease and renal failure. Kidney transplant. Pre-kidney and liver transplant evaluation for line placement during surgery. Color and spectral Doppler were performed.INTERNAL JUGULAR VEINS: Internal jugular veins have normal waveforms. Blood flow is in the direction of the heart. The veins are compressible.SUBCLAVIAN VEINS: Blood flow is toward the heart. Waveforms are normal.BRACHIOCEPHALIC VEINS: Blood flow is toward the heart.SUPERIOR VENA CAVA: Blood flow is toward the heart.OTHER: None | Normal examination without thrombosis. |
Generate impression based on findings. | 17-day-old male with distended abdomen and emesisVIEW: Abdomen AP (one view) 3/17/15 Nasogastric tube tip and proximal sidehole within the gastric body. Nonobstructive bowel gas pattern. No pneumatosis, free air, or portal venous gas. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female; 72 years old. Reason: please eval knee for signs of OA . please include skyline view to assess posterior patella History: clinical signs of patellofemoral syndrome and OA. No acute fracture or dislocation. Mild osteoarthritis is noted about the right knee. Vascular calcifications are seen in the posterior soft tissues. Left total knee arthroplasty without evidence of complication is identified on the frontal views. | Mild osteoarthritis without fracture. |
Generate impression based on findings. | Male 16 years old Reason: Evaluate for further tumor spread History: Newly diagnosed sarcomaRADIOPHARMACEUTICAL: 6.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion grossly demonstrates postsurgical changes of laminectomy involving the cervical and upper thoracic spine. Vertebral artery foramina and neural foramina are enlarged in the left upper cervical spine. There is a left anterior paraspinal soft tissue mass adjacent to the enlarged vertebral artery foramina at C4. Changes status post sternotomy and anterior mediastinal surgical changes, with pericardial fluid and drain. Left lower lobe consolidation/atelectasis.Today's PET examination demonstrates increased activity in the left pedicle and lateral mass adjacent to postsurgical changes at the C4 and C5 levels. There is mildly increased, heterogeneous FDG uptake in the soft tissue mass in the left anterior paraspinal soft tissues at the C5-6 level. There is a circular area continuous increased activity in the surgical bed surrounding laminectomy changes most consistent with postsurgical changes. Increased activity in the anterior mediastinum, most likely due to postsurgical changes. Linear area of increased activity in the right lower chest wall which be due to postsurgical changes. | 1.Postsurgical changes in the cervical spine and upper thoracic spine, as well as the sternum and anterior mediastinum.2.Left paraspinal mass with heterogeneous FDG uptake, suggest surveillance imaging with MR if clinically indicated because of lower level of uptake. |
Generate impression based on findings. | The patient submitted outside mammogram dated 1/11/12, 3/11/13. Submitted outside study was compared to the current mammogram dated 3/4/15. Right axillary lymph nodes are not visualized on the prior studies, and one of left axillary lymph nodes is partially visualized on the study of 1/11/12. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female; 61 years old. Reason: Evaluate for evidence of spinal stenosis and assess degree of degenerative disc disease History: worsening back pain. No acute fracture or malalignment. Small anterior osteophytes are noted in the lower lumbar spine, but the vertebral body heights and disk spaces are preserved. Sclerosis of the lower facet joints is consistent with degenerative disease but not significantly changed. | Mild degenerative changes as described above, without acute superimposed abnormality. |
Generate impression based on findings. | 65 year old man with hypertension, hyperlipidemia presenting with atypical chest pain but limited exercise capacity.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and goes onto form the left anterior descending artery. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is dense calcification of the proximal LAD, resulting in a 50-70% stenosis. There is dense calcification of the mid LAD, resulting in an approximately 50% stenosis. The distal LAD is small, has mild to moderate calcification, and no obvious obstruction. RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a left circumflex artery, posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery. There is are several small calcified, non-obstructive plaques in the vessel.LCx: The left circumflex coronary artery is small and non-dominant. It arises anomalously from the right coronary artery with a retro-aortic course and then ultimately in the AV groove. It gives rise to a small obtuse marginal branch. The vessel has no obvious obstruction; however, the small obtuse marginal branch is densely calcified. Left Ventricle: Normal LV size with normal LV systolic function. There is mild left ventricular hypertrophy.Right Ventricle: Normal RV size.Left Atrium: The left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus. The inter-atrial septal membrane bows into the right atrium suggesting increased left atrial pressure.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic valve. There is minimal calcification of the anterior mitral leaflet.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. There are no severe coronary artery stenoses present. 2. There are stenoses of intermediate severity (50-70%) in the proximal and mid left anterior descending artery. 3. The left circumflex arises anomalously from the right coronary artery with a retro-aortic course. 4. Mild left ventricular hypertrophy with evidence of increased left atrial pressure. Normal global LV systolic function.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Female, 6 years old. Post-op bilateral Achilles' tendon lengthening and talectomy on 1/29/2015VIEWS: Right foot lateral and left foot lateral (two views) 3/17/20 15, 1454 Overlying casting material obscures fine osseous detail.Redemonstration of postsurgical changes, with two K wires in the left foot and 3 K wires in the right foot, similar in appearance to the prior exam. The talus has been resected bilaterally, and there appears to be bilateral pes cavus deformity. | Stable postsurgical changes as detailed above. |
Generate impression based on findings. | Reason: osteosarcoma with lung mets compare to last CT and measure using RECIST criteria 1.1 History: pre chemo. LUNGS AND PLEURA: Numerous bilateral masses, nodules, and micronodules, some partially ossified. Some are increased in size, though no definite new lesions are identified. For example, a medial lingular nodule measures 16 mm (series 4, image 42), from previously 10 mm. The reference right posterior costophrenic angle mass measures 34 x 22 mm (series 4, image 77), from previously 32 x 20 mm.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. Stable enlarged prevascular lymph node. Calcified right suprahepatic, paracaval partially ossified lymph node has increased in size. Right chest wall port catheter tip at the superior cavoatrial junction.CHEST WALL: No suspicious focal osseous lesion. Asymmetrically bulky right breast tissue; while stable, attention on subsequent imaging is warranted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | Numerous bilateral pulmonary osteosarcoma metastases, some increased in size. |
Generate impression based on findings. | 76-year-old female. Unexplained weight loss. History of multiple myeloma and GIST tumor. Refusing therapy for GIST. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Three scattered subcentimeter arterially enhancing foci in the liver, too small to characterize, may be THADs; special attention on follow-up scans. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Polypoid mass with a coarse calcification arising from the posterior stomach is 3.7 x 2.1 cm, previously 3.7 x 1.9 cm (series 7, image 19), consistent with known GIST.BONES, SOFT TISSUES: Diffuse osseous lytic lesions consistent with history of multiple myeloma. Stable compression deformities in the upper lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Postsurgical findings of hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Diffuse osseous lytic lesions consistent with history of multiple myeloma. Stable compression deformities in the upper lumbar spine. Severe degenerative changes of the bilateral hips.OTHER: No significant abnormality noted | 1. No significant change in known gastric GIST. 2. Three subcentimeter arterially hyperenhancing foci in the liver, too small to characterize, may be perfusion abnormalities; special attention on follow-up scans.3. Extensive osseous changes of multiple myeloma with stable lumbar compression deformities. |
Generate impression based on findings. | Male; 50 years old. Reason: s/p MVA with possible left acromion fracture. Need axillary, ap, scapular Y view (3 views) There is no acute fracture or dislocation. Alignment is anatomic. No significant degenerative changes are noted. | No acute fracture or dislocation. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter as well as in the pons, which are nonspecific. There is no diffusion abnormality to suggest acute infarct. 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 mild mucosal thickening of the bilateral anterior ethmoid air cells. There is complete opacification of the right maxillary sinus. | 1. Moderate amount of abnormal T2/FLAIR hyperintense signal within the periventricular and subcortical white matter, which is nonspecific, but favored to represent chronic small vessel ischemic disease and/or vasculopathy related to lupus. No large infarcts.2. Diffuse opacification of the right maxillary sinus. |
Generate impression based on findings. | Male 57 years old Reason: 57yo M w/ duodenitis, concerning for duodenal perf History: rule out duodenal perforation. Limited study was performed, and reduces sensitivity of mucosal masses or lesions. Additionally, retained contrast in the colon from prior study limits the study. However, within these limitations, single contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours, no lesion or evidence of scarring. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a proximal escape at the thoracic inlet with subsequent return approximately 15 seconds later.The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal without evidence of scarring or chronic peptic ulcerative disease. The duodenal bulb and sweep were within normal limits. There was no evidence of duodenal perforation.TOTAL FLUOROSCOPY TIME: 8:09 minutes | 1. Esophageal dysmotility as described above. 2. No evidence of duodenal perforation, scarring, or chronic peptic ulcerative disease. |
Generate impression based on findings. | 73 years, Female. Reason: 73 yo female with abdominal pain and constipation. Please assess for signs of constipation. History: upper abdominal pain, constipation Nonobstructive bowel gas pattern with a slightly greater than average stool burden. | Slightly greater than average stool burden. |
Generate impression based on findings. | Female 2 years old Reason: fracture/post-op VIEWS: Left elbow AP and lateral 3/17/15 (two views) Cast material obscures fine bone detail. Three K wires are affixing a healing supracondylar fracture to near-anatomic alignment. | Healing fracture, in near anatomic alignment after pinning and casting. |
Generate impression based on findings. | 79 years, Male. Reason: 79 yom abdominal pain, eval obstruction, perforation History: abdominal pain. The pelvis is excluded from the field of view. There is a Dobbhoff tube with its tip projecting over the antropyloric region of the stomach. Nonobstructive bowel gas pattern. However, pneumoperitoneum cannot be entirely excluded in a supine study. Mediastinal clips are again noted. Cardiomegaly. Please refer to concomitant chest radiograph report for further details. | Nonobstructive bowel gas pattern. However, pneumoperitoneum cannot be entirely excluded in a supine study. |
Generate impression based on findings. | 54 year old female status post right mastectomy in 2012 for IDC and DCIS, presents today for routine follow up. Patient is currently on tamoxifen. History of benign left breast excisional biopsy, and more recent left breast core needle biopsy. No current breast complaints. Family history of breast carcinoma in her paternal grandmother in her 70s. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A biopsy clip is noted within the central lower right breast. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | There is unchanged encephalomalacia of the left middle frontal gyrus, likely representing prior infarct. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is mild progression of scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with mild age-indeterminate small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. No acute intracranial hemorrhage. 2. Mild age-indeterminate small vessel ischemic changes. Chronic left frontal infarct. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and there are no contraindications, MRI of the brain is recommended. |
Generate impression based on findings. | 77-year-old with history of left breast cancer status post mastectomy. No current complaints. 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Area of focal asymmetry in the right upper outer quadrant is unchanged.Benign appearing lymph nodes are projected over the right axilla. | 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: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 68 years old; Reason: hx of bladder cancer s/p radical cystectomy with ileal conduit urinary diversion, evaluate for metastatic disease with delayed imaging History: see above ABDOMEN: LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. Simple left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenal diverticulum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy with ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left hip replacement hardware with associated streak artifact limits evaluation of the pelvis.OTHER: No significant abnormality noted. | 1.No evidence of metastatic disease. |
Generate impression based on findings. | Male 74 years old Reason: history of metastatic prostate cancer, on enzalutamide, PSA rising assess extent of disease History: none Numerous osseous metastases in the cervical spine, thoracic spine, lumbar spine, pelvis and ribs appear similar to prior examination. No new focal osseous lesions are identified. | Extensive osseous metastatic disease, with no significant interval change, and no evidence of new osseous lesions. |
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