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Generate impression based on findings. | Male 5 days old Reason: where is PICC tip History: PICC placedVIEW: Chest and abdomen AP (two views) 3/17/15 1514 hrs NG tube tip is at the stomach. UVC unchanged. Right upper extremity PCVC terminates at the right external iliac vein.Cardiac silhouette size is normal. Persistent bilateral diffuse lung haziness with no focal opacities, effusions or pneumothorax.Normal abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval placement of right lower extremity PCVC as described.Persistent bilateral diffuse lung haziness. |
Generate impression based on findings. | Female; 66 years old. Reason: eval for disease progression. please compare to previous CT 9/9/14 History: history of GIST, on adjuvant Gleevec CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified nodules are unchanged. No suspicious pulmonary or masses.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver, unchanged. No suspicious hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction. Postsurgical changes involving the small bowel segments on the left side.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. | No evidence of recurrent of metastatic disease. |
Generate impression based on findings. | The patient is status post endoscopic sinus surgery with bilateral maxillary antrostomy and right partial ethmoidectomy, and middle turbinectomy. Scattered areas of polypoid mucosal thickening in the maxillary sinuses are stable from 2014, and the frontal and sphenoid sinuses are otherwise clear. The ethmoid air cells are also clear, improved from 2014. The mastoid air cells and middle ears are clear. The nasal septum is midline. The lamina papyracea are intact and the bilateral orbits are normal. The partially visualized brain is normal. The partially visualized salivary glands and parapharyngeal soft tissues appear normal. There is a small periapical lucency over a left incisor. | 1.Mild paranasal sinus disease as described above.2.Postoperative changes as described above. |
Generate impression based on findings. | 78-year-old male. Hematuria, painless. ABDOMEN:LUNG BASES: Calcified nodule left lung base consistent with prior infection. Scattered micronodules in the right middle lobe, likely postinflammatory.LIVER, BILIARY TRACT: Small cyst in the right hepatic lobe. Focal 1.6 x 2.1 cm small hypoattenuation in segment 4 of the liver adjacent to the ligamentum teres is incompletely characterized, may represent a third inflow phenomenon though is more bulbous than expected. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Coarse calcification in the left adrenal gland, may be from remote hemorrhage.KIDNEYS, URETERS: Bilateral renal cysts. No renal or ureteral stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild calcified atherosclerotic disease of the aorta.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine. Sclerotic foci in the bilateral ilia, suggestive of bone islands. OTHER: No significant abnormality noted | 1. No renal or ureteral stones. CT urography w/wo contrast may be considered to exclude a mass as a cause of patient's hematuria if clinically warranted.2. 2.1 x 1.6 cm hypoattenuating focus in the liver is incompletely characterized. MRI liver wwo contrast as clinically warranted for further evaluation. |
Generate impression based on findings. | 59 years, Male. Reason: evidence of SBO, stool burden History: re-starting TF, questionable amount of BMs Less than average stool burden. Nonobstructive bowel gas pattern. Right sided tube may be overlying the patient. Note is made of a suprapubic catheter. | Less than average stool burden. |
Generate impression based on findings. | Male; 56 years old. Reason: DH Large Cell NHL History: Evaluate extent of disease CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Mild bibasilar subsegmental atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 1.8 x 1.8-cm hypoattenuating suspicious lesion in the anterior midpole of the right kidney does not meet the criteria for a simple cyst and had increased FDG activity on prior PET scan (series 3/133). There is a right renal simple cyst just lateral to this lesion. Additional tiny hypoattenuating lesions at the inferior pole the right kidney are too small to accurately characterize. Hypoattenuating lesion at the anterior midpole of the left kidney is too small to accurately characterize. RETROPERITONEUM, LYMPH NODES: Massive conglomerate upper abdominal retroperitoneal lymphadenopathy, which was FDG avid on recent PET scan and compatible with tumor. For future reference, left para-aortic tumor at the level of the SMA origin measures 15.4 x 12.8 cm (3/106). The tumor mass causes lateral displacement of the left kidney and spleen and anterior displacement of the pancreas.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: Small fat containing right inguinal hernia.OTHER: Mild pelvic ascites. | 1. Massive conglomerate upper abdominal retroperitoneal lymphadenopathy, which was FDG avid on recent PET scan and compatible with tumor.2. Suspicious right renal lesion. |
Generate impression based on findings. | 20-Year-old with decreased mobility from MVA in January with acute onset shortness of breath and dizziness. PULMONARY ARTERIES: Technically adequate exam for evaluation of pulmonary embolism. No pulmonary embolus is identified. Mild pleural thickening at the bases, right greater than left, may relate to prior trauma/surgery given the clinical history.LUNGS AND PLEURA: Mild subsegmental atelectasis/scarring in the right lung base. Trace right pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits. No pericardial effusion. No coronary calcifications detected. Low density attenuation posterior to a healing manubrial fracture may represent small hematoma.CHEST WALL: Healing manubrial fracture.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Postoperative changes of right hepatic lobe partial resection. Inferior right hepatic lobe fluid collection, incompletely evaluated. | 1.No evidence of pulmonary embolism.2.Incompletely evaluated the inferior right hepatic lobe fluid collection. Differential considerations include biloma versus abscess versus seroma. Correlation with outside imaging is recommended; otherwise dedicated abdominal cross-sectional imaging may be considered if clinically indicated.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female, 47 years old. Evaluate for radiopaque foreign object. No unexpected radiopaque foreign object is identified. Towel clips are seen in the right upper and left upper quadrants. Pelvic surgical clips are compatible with patient's recent pelvic surgery. Small amount of pneumoperitoneum is likely post-procedural. Multiple round opacities likely represent superficial neurofibromas seen on recent CT. | No unexpected radiopaque foreign object is identified. These findings were discussed by telephone with Dr. Rex Haydon, the attending surgeon, on 3/17/2015 at 1507. |
Generate impression based on findings. | 14-year-old female with history of sickle cell disease, with midline thoracic painVIEWS: Thoracic spine AP, lateral, swimmers (3 views) 3/17/15 The vertebral body heights and disk spaces are maintained. No fracture or subluxation. Surgical clips are noted in the right upper quadrant. | The vertebral body heights and disk spaces are maintained. No fracture or subluxation. |
Generate impression based on findings. | Male 57 years old; Reason: eval for abscess History: delay return of bowel function ABDOMEN:LUNG BASES: Moderate bilateral pleural effusions with compressive atelectasis. The pleural effusions demonstrate scalloping along the atelectatic lung raising the possibility of malignant effusions. Cardiomegaly.LIVER, BILIARY TRACT: Poorly circumscribed hypoattenuating lesions in the right hepatic lobe likely metastases. The reference segment 6 lesion measures 2.3 x 3.2 cm (series 3, image 49), previously 2.5 x 3.1 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged mesenteric lymph nodes.BOWEL, MESENTERY: Enteric feeding tube tip in the gastric body. There is persistent dilatation of bowel loops (up to 4.7 cm) without clear transition point. There is a lower quadrant ostomy. Unremarkable appearance of the colonic anastomosis. There is a 5.8 x 7.8 cm loculated fluid collection in the pelvis exerting mass effect on the sigmoid colon/rectal stump. Additional 10.4 x 4.5 cm loculated fluid collection in the right lower quadrant. There is no gas within these collections to suggest superinfection however continued follow up is recommended as developing infection cannot be excluded. Diffuse mesenteric edema.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Reduced intra abdominal ascites. Diffuse anasarca.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Air within the bladder, presumably secondary to Foley catheter.LYMPH NODES: Stable enlarged pelvic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Diffuse bowel dilatation without clear transition point. Favor ileus given the recent surgical procedure however given the degree of persistent bowel dilatation obstruction cannot be completely excluded.2.Loculated fluid collections as detailed above. Continued follow up is recommended as developing infection is not excluded.3.Stable appearance of hypoattenuating liver lesions.4.Bilateral pleural effusions with scalloping pattern raising the possibility of malignant effusions. |
Generate impression based on findings. | Female 10 days old Reason: Where is PICC tip . Respiratory distress.VIEW: Abdomen and chest AP (two views) 3/17/15 at 1529 hrs ET tube terminates at the thoracic inlet. NG tube tip is at the stomach. UVC terminates at the right atrium. Right lower extremity PCVC tip at the the lower, infrahepatic IVC.Cardiac silhouette size is normal. Large lung volumes and diffuse haziness with no focal opacities, effusions or pneumothorax.Normal abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval placement of PCVC as described.Bilateral diffuse lung haziness but no focal opacities. |
Generate impression based on findings. | Female; 30 years old. Reason: fevers No acute fracture or dislocation. All paranasal sinuses are well aerated without air-fluid levels. Enteric tube is partially visualized. | No radiographic evidence of acute sinusitis. |
Generate impression based on findings. | Male; 68 years old. Reason: preop MVR endoscopic History: SOB VESSELS:DESCENDING THORACIC AORTA AT LEVEL OF HIATUS: 2.3 X 2.7 cmSUPRARENAL ABDOMINAL AORTA: 2.1 X 2.1 cmINFRARENAL ABDOMINAL AORTA: 1.4 X 1.8 cmRIGHT COMMON ILIAC ARTERY: 13 X 10 mmRIGHT EXTERNAL ILIAC ARTERY: 11 X 10 mmRIGHT COMMON FEMORAL ARTERY: 11 X 10 mmLEFT COMMON ILIAC ARTERY: 14 X 11 mmLEFT EXTERNAL ILIAC ARTERY: 12 X 11 mmLEFT COMMON FEMORAL ARTERY: 11 X 10 mmMild atherosclerotic plaque of the abdominal aorta. The celiac artery, SMA, and IMA are widely patent. Variant origin of the left hepatic artery from the celiac trunk. Bilateral renal arteries are patent with three left renal arteries seen.ABDOMEN:Lack of portal venous phase imaging limits evaluation for solid organ pathology. Moderate motion artifact limits evaluation for bowel pathology.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesions are too small to characterize but most likely benign cysts. Prominence of the common bile duct, likely normal in this patient status post cholecystectomy. Minimal pneumobilia, which may be due to prior sphincterotomy.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: Subcentimeter retroperitoneal and mesenteric lymph nodes are nonspecific but not pathologically enlarged by CT size criteria.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatomegaly with the prostate gland measuring up to 5.1 x 3.9 cm (series 5/359).BLADDER: Mild circumferential bladder wall thickening, which may be due to chronic outlet obstruction from the prostatomegaly.LYMPH NODES: Subcentimeter retroperitoneal and mesenteric lymph nodes are nonspecific but not pathologically enlarged by CT size criteria.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Small fat-containing inguinal hernias, right greater than left.OTHER: No significant abnormality noted. | 1. Abdominal aorta and branch vessels are patent as detailed above.2. Prostatomegaly. |
Generate impression based on findings. | Status post lumbar fusion. Assess implants. Again seen are posterior stabilization rods with screws entering the T10 through S1 vertebrae, with an additional screw entering the right ilium. There is no evidence of hardware complication. There is a leftward scoliosis of the lumbar spine with laminectomies. Severe multilevel degenerative disk disease appears similar to that seen on the prior study. Densities along the lateral aspect of the spine presumably represent bone graft material | Post-surgical changes as described above. |
Generate impression based on findings. | The right submandibular gland appears somewhat heterogeneous and displays lobulated contours. In addition, the right submandibular gland appears to be small than the left. There is minimal fat stranding adjacent to the right submandibular gland. There is no evidence of radioattenuating calculi. There is no evidence of significant cervical lymphadenopathy. The thyroid and major salivary glands are otherwise unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is a 3-4 mm right upper lobe pulmonary nodule. | 1. The right submandibular gland appears somewhat heterogeneous and displays lobulated contours. In addition, the right submandibular gland appears to be small than the left, but no radioattenuating calculi are apparent. The constellation of findings may represent chronic sialadenitis. MRI may be helpful for further evaluation, if there are no contraindications.2. No significant cervical lymphadenopathy. 3. Nonspecific 3-4 mm right lung nodule. A baseline chest CT may be useful for further evaluation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 67-year-old female with history of lung cancer status post chemoradiation . Evaluation of preop for open right lower lobectomy. CHEST:LUNGS AND PLEURA: Redemonstrated spiculated superior segment right lower lobe mass measuring 26 x 19 mm (series 6, 50), previously 31 x 20 mm. New surrounding groundglass opacity may represent hemorrhage. No new suspicious pulmonary nodules are identified. No pleural effusion is present.MEDIASTINUM AND HILA: Heart size is normal. Small pericardial effusion not significant change. A right hilar lymph node measures 10 mm (series 5 on image 42), from previously 12 mm. No coronary calcifications are detected.CHEST WALL: No suspicious focal osseous lesion. Moderate degenerative changes affect the visualized spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Enhancing right inferior hepatic lobe lesion previously described to represent a hemangioma. Otherwise no suspicious hepatic lesion. Cholelithiasis noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No adrenal thickening or nodularity.KIDNEYS, URETERS: The kidneys enhance symmetrically. Subcentimeter right renal hypoattenuating lesions, too small to further characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small, nonenlarged retroperitoneal lymph nodes are noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: No suspicious focal osseous lesion. Focal skin thickening is seen in the posterior left flank (series 5, 116). This area was also PET positive. Clinical correlation is recommended; in the absence of inflammation, metastasis cannot be excluded.OTHER: No significant abnormality noted. | Spiculated superior segment right lower lobe mass, compatible with known primary lung neoplasm, slightly decreased in size. New surrounding groundglass opacity may represent interval hemorrhage. |
Generate impression based on findings. | Male; 63 years old. Reason: eval for dislocation vs fracture History: right shoulder/AC joint pain s/p trauma; pt has baseline R brachial plexus injury making exam limited. No acute fracture or dislocation identified. Alignment is anatomic. | No acute fracture identified. However, if clinical suspicion persists, CT can be considered for further evaluation. |
Generate impression based on findings. | Female, 17 years old. Abdominal pain, distention. Evaluate for bowel distention, stool burden, free airVIEW: Abdomen AP upright (one view) 3/17/2015, 1525 Right femoral catheter in place.Nonobstructive bowel gas pattern.Small stool burden.No evidence of free air. | No evidence of obstruction or free air. |
Generate impression based on findings. | Status-post CDH repair.VIEWS: Chest AP/lateral (two views) 3/17/15 at 1534 hrs. Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. Both diaphragms appears to be intact. | Normal examination. |
Generate impression based on findings. | Female; 39 years old. Presents with left lower extremity pain. No acute fracture or dislocation in the left hip or femur. Alignment is anatomic. | Normal examination. |
Generate impression based on findings. | Female; 82 years old. Reason: loose TEA? History: pain Hardware components of a total elbow arthroplasty device are in near anatomic alignment. The proximal radius has been resected. Lucency along the radial aspect of the humeral component may represent device loosening. Extensive heterotopic ossification is present about the elbow joint. Tubular radiopaque foreign body of unknown etiology projects into the joint space. | 1.Postsurgical changes status post total elbow arthroplasty, with lucency along the radial aspect of the humeral component that may represent hardware loosening. 2.Tubular radiopaque foreign body of unknown etiology projects into the joint space. |
Generate impression based on findings. | Right shoulder pain, acromioclavicular joint. Three views of the right shoulder show no acute fracture or dislocation. The acromioclavicular joint appears normal. There is vacuum disk phenomenon of the glenohumeral joint. | No specific findings to account for the patient's shoulder pain. |
Generate impression based on findings. | Healthy female with left wrist pain for 8 weeks, no improvement with splint/NSAID. Pain at the left wrist, medial anterior ulnar area per urgent care evaluation. Evaluate for fracture or DJD. Three views of the left wrist reveal no acute fracture or malalignment. The bones appear normal. | No specific radiographic findings to account for the patient's pain. |
Generate impression based on findings. | Male; 17 years old. Reason: eval ACJ History: ACJ pain No acute fracture or dislocation. Alignment is anatomic. | Normal examination. |
Generate impression based on findings. | Male; 54 years old. Reason: right hip pain No acute fracture or dislocation. Moderate bilateral degenerative changes are noted. Surgical staples in the superficial soft tissues overlying the proximal right femur. Two orthopedic screws enter the sacrum on the AP view of the pelvis. | Moderate bilateral degenerative changes without acute fracture evident. |
Generate impression based on findings. | Female; 54 years old. Reason: Evaluate for stress fracture at base of 5th metatarsal. History: Right foot pain No acute fracture or dislocation. Alignment is anatomic. Incidental note is made of an accessory navicular and os trigonum. | No acute fracture or dislocation. |
Generate impression based on findings. | Male; 17 years old. Reason: scaphoid fx History: s/p ORIF Headless cannulated screw affixes the scaphoid in near anatomic alignment. There is no evidence of hardware complication or loosening. The fracture line is indistinct, compatible with interval healing. No new fracture is identified. | Healing scaphoid fracture in near anatomic alignment s/p ORIF. |
Generate impression based on findings. | Female, 3 years old. Evaluate stool burden. History: constipation, hx cloacaVIEW: Abdomen AP (one view) 3/17/2015, 1543 Nonobstructive bowel gas pattern.Below-average stool burden, predominantly in the area of the cecum. Decreased from the prior exam.No pneumatosis, portal venous gas, or free air.Abnormal sacral morphology again noted. | Decrease in stool burden. No evidence of obstruction. |
Generate impression based on findings. | Male; 26 years old. Reason: lumbar pain. No acute fracture or malalignment. The vertebral body heights are preserved. No significant degenerative changes. | Normal examination. |
Generate impression based on findings. | 43-year-old female with cavitary lesion on TB therapy. Evaluate cavitary lesion for improvement. LUNGS AND PLEURA: Interval decrease in size of the left lower lobe lesion, measuring 9 x 14 mm from previously 12 x 14 mm. No cavitation is evident. No new areas of consolidation, suspicious nodules, or pleural effusion is present.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No coronary calcifications are detected. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No suspicious focal osseous lesion.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Increased attenuation of the mesentery centrally is noted at the inferior edge of the field of view. This is of uncertain etiology and incompletely evaluated. There are no other findings to suggest intraperitoneal tuberculosis such as lymphadenopathy or ascites. Cholelithiasis noted. | 1.Improving left lower lobe lesion.2.Misty mesentery centrally seen at the inferior edge of the field of view, incompletely evaluated. This may be further evaluated with CT chest and abdomen on the next study; however if abdominal symptoms are currently present, CT abdomen could be considered at this time. |
Generate impression based on findings. | 15-year-old male history of fractureVIEWS: Right ankle AP, oblique and lateral (3 views) 3/17/15 Interval removal of screws traversing the distal tibia and fibula. Horizontal lucencies traverse the distal fibula and distal tibia with surrounding sclerosis represent screw tracks. Very small flecks of residual metal are adjacent to the medial tip of the distal screw track. The distal tibia and fibula are in anatomic alignment. No new fracture. The ankle mortise joint is normal. | Interval removal of screws traversing the distal tibia and fibula. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Superior paramediastinal fibrosis likely secondary to radiation. Stable central emphysema.Improved aeration of the lower lobes with only minimal residual scarlike opacity adjacent to calcification in the left lower lobe (6/87). Subsegmental atelectasis lingula and right lower lobe. Stable mild bronchial wall thickening. No suspicious pulmonary nodules or interval pleural effusion.MEDIASTINUM AND HILA: There is debris in the esophagus to the superior field of view. Dependent mucus layers at the carina.Heart size is normal. No pericardial effusion. Several calcified mediastinal lymph nodes without mediastinal or hilar lymphadenopathy.CHEST WALL: Phonation device is in place, unchanged. Right inferolateral rib deformity from callus of prior fracture. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Bilateral Bochdalek hernias. | No evidence of metastatic disease. |
Generate impression based on findings. | 78 year-old female with gradual onset of hoarseness over last 10 years. Evaluate for compression of the recurrent laryngeal nerve. LUNGS AND PLEURA: No focal consolidation, pleural effusion, or suspicious pulmonary nodules.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No coronary calcifications are detected. Mild atherosclerotic calcifications affect thoracic aorta. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Moderate degenerative changes affect the visualized spine. No suspicious focal osseous lesion is identified. Possible T9 hemangioma.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. There appear to be parapelvic cysts in the left kidney, which is incompletely imaged and therefore mild hydronephrosis cannot be excluded. | 1.No mediastinal mass or adenopathy is present.2.There appear to be parapelvic cysts in the left kidney, which is incompletely imaged and therefore mild hydronephrosis cannot be excluded. |
Generate impression based on findings. | Surgery for Blount's disease.VIEWS: Left tibia fibula AP/lateral (two views) 03/17/15 Ilazarov device remains in place. No broken components are seen. Lucency is noted around the second screw in the proximal tibia however this is unchanged in appearance. Alignment at the osteotomy of the proximal tibia is unchanged. Periosteal reaction/callus formation is noted at the osteotomy site. The fibular osteotomy site is obscured. | Continued healing of the tibial osteotomy. |
Generate impression based on findings. | 14-year-old male with newly diagnosed Crohn's disease and history of partial small bowel obstructions, with abdominal pain and feeding intolerance.EXAMINATION: MR enterography without and with IV contrast 3/17/15 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: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Narrowing of the terminal ileum with wall thickening is present. There is dilatation of the bowel proximal to the stenosis of the terminal ileum. The terminal ileum enhances on postcontrast images consistent with acute inflammation.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Moderately distended with fluid.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: The SI joints are normal. The previously noted phlegmon along the right gluteal cleft is no longer present.OTHER: A small amount of fluid is present within the pelvis which likely relates to the active inflammatory bowel disease. | Inflammatory changes of the terminal ileum, consistent with active inflammatory bowel disease, causing stenosis with bowel dilatation. |
Generate impression based on findings. | Reason: head and neck cancer, locally advanced, rule out metastatic disease History: mass at base of tongue LUNGS AND PLEURA: No suspicious nodules or masses. Small micronodule in the right apex, probably a granuloma. No pleural effusion or pneumothorax. Minimal dependent bibasilar atelectasis.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes. No hilar lymphadenopathy.The heart size is normal. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy.Mild degenerative disease affects the thoracic spine. No suspicious osseous lesions.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 2-year-old female. Evaluate for hip subluxation.VIEWS: Pelvis AP, frog leg (two views) 3/16/2015, 1025 The osseous structures and joint spaces are normal.The femoral head ossification centers are well directed into the acetabula.The right acetabular roof is slightly less horizontal than the left. | No developmental hip dysplasia. |
Generate impression based on findings. | Redemonstrated are postoperative findings related to bilateral frontal craniotomy. The right frontal approach ventricular catheter is in stable position with its tip in the left ambient cistern. The right parietal approach ventriculostomy catheter is also in stable position, with tip just at the right of midline in the ventricular body, with a surrounding area of periventricular cystic encephalomalcia. There is no significant change in the ventricular system remains markedly diffusely dilated. There is an associated left parietal porencephalic cyst and marked thinning of the brain parenchyma diffusely. There is an unchanged punctate calcification along the posterior margin of the right lateral ventricle. There is unchanged diffuse mild prominence of the extra-axial spaces. There is no acute intracranial hemorrhage, midline shift, or mass effect. There is redemonstration of premature fusion of calvarial sutures. | 1. No acute intracranial hemorrhage.2. No significant interval change in the diffusely dilated shunted ventricular system.3. Redemonstration of premature fusion of calvarial sutures likely related to chronic shunting.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 69 years old Male. Reason: 67 year old man with right renal mass, diagnosed with lymphoma History: 67 year old man with right renal mass, diagnosed with DLBC lymphoma from laprascopic surgery in need of PET scan. RADIOPHARMACEUTICAL: 15.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates interval enlargement in the retroperitoneal and infiltrative right renal mass. Several small lymph nodes are seen in the retroperitoneal cavity. There is interval increased size of a lymph node in the retroperitoneal cavity at paracaval region just above the aortic of rotation. Stable soft tissue densities of the mesentery.Today's PET examination demonstrates new area of increased metabolic activity in the increasing mass in the retroperitoneal cavity and the right kidney. The SUVmax in the mass is 16.0. There is also intense FDG uptake in the several lymph nodes in the retroperitoneal cavity at paracaval region above the aortic bifurcation.There is interval near complete resolution of abnormal FDG uptake in the mesentery.Physiological physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.New FDG avid mass and lymph nodes in the retroperitoneal cavity, consistent with recurrence of lymphoma.2.Interval near complete resolution of abnormal FDG uptake in the mesentery. |
Generate impression based on findings. | Female; 67 years old. Reason: S/p Lt THA with anterior approach. Postsurgical changes status post left total hip arthroplasty, which is in near anatomic alignment. No acute fracture or dislocation is identified. Gas in the subcutaneous soft tissues and a surgical drain are also noted. Right hip is unremarkable on the AP view of the pelvis. | Left total hip arthroplasty in near anatomic alignment. |
Generate impression based on findings. | Male, 6 years old. Evaluate for fecal impaction History: encopresisVIEW: Abdomen AP (one view) 3/17/2015, 1621 Moderate stool burden. Moderate stool within a normal sized rectal ampulla. Nonobstructive bowel gas pattern. | Moderate stool burden. No evidence of fecal impaction. |
Generate impression based on findings. | Male; 86 years old. Reason: 86-year-old male with metastatic small cell bladder cancer. History: Abdominal pain and left groin pain. CHEST:LUNGS AND PLEURA: New 4-mm right apical pulmonary nodule, suspicious for metastasis. Additional scattered pulmonary micronodules, some of which are calcified, are stable. Severe emphysema. No pleural effusions.MEDIASTINUM AND HILA: No significant abnormality noted -- no adenopathy.CHEST WALL: Right anterior chest wall Port-A-Cath unchanged with tip of catheter in the distal superior vena cava. ABDOMEN: Lack of IV contrast limits ability to evaluate solid parenchymal organs and vascular structures. Within these limitations, the following observations can be made:LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Gallbladder and biliary tract appear normal.SPLEEN: Punctate calcified granulomata. No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable appearance of atrophic with benign appearing cysts. Stable appearance of right kidney upper pole cyst. Lack of IV contrast limits ability to characterize renal lesions or detect small masses. No abnormal calcifications. No hydronephrosis. No perinephric fluid collections.RETROPERITONEUM, LYMPH NODES: Small distal lumbar aortic aneurysm is unchanged measuring 3.1 cm in maximal diameter. No retroperitoneal masses or adenopathy are seen.BOWEL, MESENTERY: Postsurgical changes are seen from prior ileal conduit diversion. No bowel destruction. No free mesenteric fluid. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystectomy with right abdominal conduit urinary diversion. Previously described intrapelvic mass in the resection bed is no longer visualized, likely due interval radiation treatment. Slightly increased lytic appearance of left superior pubic ramus (series 8028/63), most likely due to radiation change though underlying increased tumor cannot be excluded.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mesenteric mass within the pelvis measures 1.9 x 2 cm, previously 3.0 x 2.5 cm (series 3/153). No new mesenteric masses are seen. Bowel wall thickening of small bowel loops in the pelvis as well as a soft tissue density obscuring the fat planes between the bowel loops, likely related to radiation change with tumor considered less likely.BONES, SOFT TISSUES: Slightly increased lytic appearance of left superior pubic ramus (series 8028/63), most likely due to radiation change though underlying increased tumor cannot be excluded.OTHER: No significant abnormality noted | 1. New 4-mm right apical pulmonary nodule, suspicious for metastasis.2. Interval decreased size of mesenteric mass and resolution of left anterior intrapelvic mass, status post radiation treatment.3. Slightly increased lytic appearance of the left superior pubic ramus, likely due to radiation change though underlying increased tumor cannot be excluded.4. New bowel wall thickening of small bowel loops in the pelvis and soft tissue density obscuring the fat planes between the bowel loops, likely due to radiation change with tumor considered less likely. |
Generate impression based on findings. | Female 58 years old Reason: known lung mets, ? uptake right shoulder on WBS, not confirmed on x-ray, rule out other disease, also WBS suboptimal as pt did not follow low iodine diet as requested History: mild SOBRADIOPHARMACEUTICAL: 13.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 81 mg/dL. Today's CT portion grossly demonstrates postsurgical changes in the thyroid bed. Calcified mediastinal and hilar lymph nodes. Calcified pulmonary nodules bilaterally. Fluid level is noted in the left maxillary sinus.Today's PET examination demonstrates increased activity in the right nasopharynx, likely due to inflammation. Increased FDG activity in the right vocal cord, likely physiologic. Small foci of increased activity in multiple right ribs at the costochondral junction, which may be due to trauma. Small focus of increased activity in the skin superficial to the left mandible, likely due to inflammation. | 1.No definite evidence of FDG avid tumor. |
Generate impression based on findings. | 73-year-old male with tonsil cancer CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. No pleural effusion or pneumothorax.No suspicious nodules or masses. Calcified nodules are unchanged. MEDIASTINUM AND HILA: Reference right paratracheal lymph node is unchanged in size measuring 8 mm (series 4, image 35). Reference left paratracheal lymph node measures 13 mm, previously 8 mm (series 4, image 23). On the prior study dated 11/24/2014, the lymph node measured 5 mm.Reference subcarinal lymph node is unchanged measuring 10 mm (series 4, image 53).Additional scattered prominent mediastinal lymph nodes are similar in size when compared to the prior exam. Several mediastinal and hilar lymph nodes contain calcification and may be related to prior granulomatous disease.The heart size is normal. No pericardial effusion. Severe coronary artery calcification.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy.No suspicious osseous lesions.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Relative low attenuation of the liver may reflect fatty infiltration.SPLEEN: Unchanged calcified granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta with ectasia of the infrarenal aorta just above the bifurcation measuring up to 3.5 cm. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Severe degenerative disease affects the lumbar spine with ankylosing of the L3 and L4 vertebral bodies. OTHER: No significant abnormality noted. | Reference left paratracheal lymph node is increased in size as described above, suspicious for a nodal metastasis. Otherwise, no significant interval increase in size of additional mediastinal or hilar lymph nodes. |
Generate impression based on findings. | Female, 7 years old. Blounts disease. Evaluate bone length.VIEWS: Left knee AP (one view) and Mechanical axis/standing lower extremities 3/17/2015, 1624 Again seen are findings of Blount's disease with fragmentation and deformity of the medial epiphysis. There are postsurgical changes of a resection of a bony bridge through the medial physes with two guide pins superior and inferior to the defect. The medial tibial plateau height is unchanged. The left lateral tibial epiphysiodesis is without radiographic evidence of hardware complication. Stable epiphyseal and medial metaphyseal sclerosis.Left genu varus, with the left femoral head lower than the right by at least 2 cm. | Stable postsurgical appearance of the left knee. Left genu varus. Left femoral head lower than the right. |
Generate impression based on findings. | 61 year old woman with atypical chest pain, referred to rule out obstructive coronary disease.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. 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 are no significant stenoses in the LAD.LCx: The left circumflex coronary artery is dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches and the posterolateral branch. The PDA is not well seen. There are no significant stenoses in the LCx.RCA: The right coronary artery is small but arises normally from the right sinus of Valsalva. It is the non-dominant coronary artery supply. There are no significant stenoses in the right coronary artery.Left Ventricle: Normal left ventricular size and wall thickness.Right Ventricle: Mild dilation of the right ventricle. 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. No inter-atrial septal defect is noted; however, there is a patent foramen ovale.Right atrium, vena cavae, and coronary sinus: The right atrial volume is mild increased. The inferior vena cava is dilated. The superior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.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. There is moderate burden of epicardial fat. | 1.There are no significant coronary artery stenoses present. 2. No coronary calcification is present. 3. Patent foramen ovale is noted. 4. Mild RV and RA dilation. 5. Moderate burden of epicardial fat noted.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. | 75 years, Female. Reason: evaluate for free air History: abdominal pain, nausea No radiographic evidence of intraperitoneal free air. No dilated loop of bowel to suggest obstruction. | No radiographic evidence of intraperitoneal free air. |
Generate impression based on findings. | 84 year old female. Abdominal pain. Evaluate for malignancy. Lack of intravenous contrast limits evaluation for solid organ.ABDOMEN:LUNG BASES: Calcified nodule in the right lower lobe consistent with prior infection.LIVER, BILIARY TRACT: Small left hepatic cyst. There is a subcentimeter hypoattenuating hepatic focus, too small to characterize. Calcified hepatic foci, likely healed granulomatous disease. Cholecystectomy clips.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Large exophytic cyst arising from the anterior right kidney. Few subcentimeter hypodense foci in both kidneys are too small to characterize.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: No small bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Minimal degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | No specific evidence of malignancy or other significant findings to explain the patient's symptoms within limits of noncontrast exam. |
Generate impression based on findings. | Female 88 years old Reason: Evaluate with PET History: Right middle lobe pulmonary noduleRADIOPHARMACEUTICAL: 13.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 94 mg/dL. Today's CT portion grossly demonstrates coronary artery calcifications. Splenic artery calcified pseudoaneurysm. Cholecystectomy clips. Low attenuation lesion in the right kidney, probable cyst. Diverticulosis without evidence of diverticulitis. Post surgical changes of right lower lobe wedge resection. Right middle lobe subpleural nodule is again noted. Degenerative changes in lumbar spine.Today's PET examination demonstrates two foci of increased activity in the right middle lobe nodular opacity with SUV of 5.7. High suspicion for primary lung neoplasm. There are two foci of increased activity in the right hilum and faint activity of increased uptake in the left hilum. Two punctate foci of increased activity in the right upper lobe with no CT correlation, which is nonspecific. Increased activity in the L1-2 endplate adjacent to osteophyte formation consistent with degenerative changes. | 1.Findings highly suspicious for primary lung neoplasm with nodal metastases.2.Nonspecific right upper lobe punctate FDG avid foci with no CT correlation. |
Generate impression based on findings. | Ankle injury.VIEWS: Right ankle AP/lateral/oblique (3 views) 03/17/15 Soft tissue swelling laterally has almost completely resolved. No joint effusion is identified. No fracture is seen. | Resolving soft tissue swelling. No bone abnormality. |
Generate impression based on findings. | 66 years, Female. Reason: r/o ileus, colonic distention History: ABD distention There is a Dobbhoff tube with its tip projecting over the antrum of the stomach. Additional enteric tube seen with tip overlying the antrum of the stomach, adjacent to Dobbhoff tube tip. Nonobstructive bowel gas pattern. Nerve stimulator device seen. Please refer to same day chest radiograph for additional findings. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 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 are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with stable mild chronic small vessel ischemic changes. Previously seen focus of hypoattenuation in the right cerebellar hemisphere, which likely corresponds to the presumed metastasis demonstrated on prior MRI brain, not well evaluated on this study. There is no extraaxial fluid collection. There are calcifications of the cavernous portion of the bilateral carotid arteries. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is debris in the right external auditory canal, likely representing cerumen. | 1. No acute intracranial hemorrhage or mass effect. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and no contraindications, MRI of the brain is recommended. 2. Right cerebellar enhancing lesion presumably representing metastasis better seen on prior MRI. |
Generate impression based on findings. | Interspinous fusion device is again seen. There is a similar appearance of bony bridging along the bone graft components. There is slight increased confluence of ossific density to the left of the L4 spinous process, just dorsal to the polygonal shaped bone graft. Lucency remains along the margins of the more anteriorly located interspinous spacer.The scout lateral view and the sagittal reformatted images demonstrate the lumbar spine to be in stable alignment. There is trace grade 1 anterolisthesis of L3 on L4. The vertebral body and disk space heights are stable. Air within the left ventral epidural space at L5-S1 has resolved.There is no acute fracture.Previously described scattered spondylotic changes are similar, with findings most prominent along the lower lumbar spine. There is up to moderate spinal stenosis at L4-5 and moderate bilateral foraminal narrowing at this level. There is additional moderate-severe bilateral foraminal narrowing at L5-S1.Limited views through the retroperitoneum demonstrate no gross abnormalities. | 1. Interspinous fusion device at L3-L4 with suggestion of stable osseous bridging ventral to the screw, with slight increased confluence of ossific density along the left aspect of the L4 spinous process. Stable trace degenerative grade 1 anterolisthesis at this level.2. Previously described mild to moderate multilevel spondylotic changes are similar, with up to moderate central spinal canal stenosis at L4-L5 as well as moderate bilateral foraminal narrowing at this level and moderate-severe bilateral foraminal narrowing at L5-S1. |
Generate impression based on findings. | 64 year old female. Metastatic ovarian cancer on IRB 13-1323. Needs reevaluation and comparison to previous. CHEST:LUNGS AND PLEURA: Scattered micronodules, unchanged and favored to be post inflammatory.MEDIASTINUM AND HILA: Scattered small mediastinal lymph nodes, unchanged. No lymphadenopathy.Nonspecific small thyroid nodule, unchanged.Normal heart size without pericardial effusion. No visible coronary artery calcification.Small right cardiophrenic lymph node, unchanged.CHEST WALL: Right chest wall port tip terminates in the SVC.ABDOMEN:LIVER, BILIARY TRACT: Two hypodense liver lesions in the hepatic dome without significant interval change from immediate prior, new from 7/2013 and suspicious for metastases. Reference lesion is 10 x 7 mm (series 3, image 75), unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Subcentimeter hypoattenuating foci in the kidneys are too small to characterize, unchanged.RETROPERITONEUM, LYMPH NODES: Retroperitoneal surgical clips.BOWEL, MESENTERY: Prominent right upper quadrant mesenteric lymph nodes (series 3, image 125), unchanged; special attention on follow-up scans. Surgical sutures in the rectum. No bowel obstruction.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: Pelvic surgical clips. New borderline enlarged presacral lymph node that is 1 x 1 cm (series 3, image 159), previously subcentimeter. Other small pelvic lymph nodes, unchanged.BOWEL, MESENTERY: Surgical sutures in the rectum. No bowel obstruction.BONES, SOFT TISSUES: Two sclerotic lesions in the right ilium, unchanged from 2013, likely benign.OTHER: No significant abnormality noted. | Stable hepatic lesions suspicious for metastases. New borderline enlarged presacral lymph node. |
Generate impression based on findings. | Evaluation is limited by lack of intravenous contrast and motion artifact. There is a lesion measuring approximately 2.0 x 1.6 cm in the right cingulate gyrus with associated restricted diffusion at its inferior aspect. There is mass effect with downward effacement of the lateral ventricles. There is a moderate amount of surrounding T2 hyperintense signal in the right frontal lobe, which crosses the corpus callosum into the left cingulate gyrus. There are foci of susceptibility artifact, which may represent a small amount of blood product versus mineralization. The basal cisterns remain patent. There is no midline shift or uncal herniation. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Calvarium is intact. | 1. Evaluation is limited by lack of intravenous contrast. There is 2.0 cm mass centered at the right cingulate gyrus with restricted diffusion at the inferior aspect, which may represent a neoplasm. Infection is also a differential consideration although majority of the mass does not have restricted diffusion to suggest pyogenic abscess. There is extensive surrounding vasogenic edema and local mass effect without midline shift or uncal herniation. Recommend post-contrast imaging for further evaluation.2. Foci of susceptibility effect in the lesion may represent a small amount of blood products or mineralization. Recommend comparison with outside CT if available. |
Generate impression based on findings. | Female; 64 years old. Reason: bilateral hand, knee, and hip pain. Hips: Mild to moderate degenerative changes noted in the bilateral hips. No acute fracture or dislocation. Alignment is anatomic.Knees: Mild osteoarthritis affects the bilateral knees. No acute fracture or dislocation. No knee joint effusion.Hands: No acute fracture or dislocation. Alignment is anatomic. | Mild degenerative changes without acute fracture evident. |
Generate impression based on findings. | Male; 63 years old. Reason: low back pain; evaluate for DDD History: symptoms of possible spinal stenosis. There is severe degenerative disk disease of the lower lumbar spine with vacuum disk phenomena and marked disk space narrowing. Severe facet joint osteoarthritis is also noted. Slight loss of height of L3 and L4 vertebral bodies, not significantly changed. No acute fracture identified. | Stable but severe degenerative disk disease involving the lumbar spine as described above. |
Generate impression based on findings. | 49 year-old female with elevated liver enzymes, right upper quadrant pain. Evaluate vasculature. PORTAL VENOUS: Vein is patent with appropriate hepatopetal flow. Main portal vein peak velocity measures 0.5 m/sec. Left portal vein peak velocity measures 0.2 m/sec. Right portal vein peak velocity measures 0.4 m/sec.HEPATIC ARTERIES: Patent with appropriate directional flow. Common hepatic artery peak velocity measures 1.0 m/sec and resistive index measures 0.7. Right hepatic artery peak velocity measures 1.2 m/sec and resistive index measures 0.6. Left hepatic artery peak velocity measures 0.9 m/sec and resistive index measures 0.6.HEPATIC VEINS: Patent with appropriate directional flow.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow. | Patent hepatic vasculature. Please refer to ultrasound abdomen exam from same day for additional findings. |
Generate impression based on findings. | Status post corpectomy with fusion Evaluation of the cervicothoracic junction is limited due to overlying anatomy. The patient has undergone C4corpectomy. There is an anterior plate with screws entering the C3 and C5 vertebrae, with spacer devices at C3/4 and C4/5. I see no hardware complications. There is a grade 1 retrolisthesis of C3. Moderate-severe degenerative disease affects the C5/6 and C6/7. There is a surgical drain in the anterior soft tissues. The prevertebral soft tissues are edematous. | Postoperative changes of corpectomy and fusion as described above. |
Generate impression based on findings. | Recurrent polyarthritis. SLE. Evaluate for erosion/rheumatoid arthritis overlap. Three views of the right hand are provided. Mild osteoarthritis affects the interphalangeal joints. I see no erosions or other specific radiograph features of rheumatoid arthritis. There is a small ossicle dorsal to the carpus that may reflect old trauma, but is of doubtful current clinical significance.3 views of the left hand are provided. Mild osteoarthritis affects the distal interphalangeal joints. I see no erosions or other specific radiographic features of rheumatoid arthritis.Three views of the right foot are provided. The bones appear slightly demineralized. Mild osteoarthritis affects the first metatarsophalangeal joint. There is a lucency within the navicular tuberosity; I cannot tell if this represents a cyst, erosion, or postoperative defect, but in any case it is appears similar to that seen on the prior study. I otherwise see no findings to suggest rheumatoid arthritis. Note is made of an os peroneum, a normal variant. There is also an ossicle in the distal Achilles' tendon, unchanged.Three views of the left foot are provided. The bones appear slightly demineralized. There is perhaps mild narrowing of the first metatarsophalangeal joint which may be degenerative in etiology, but I see no erosions or other specific radiographic features of rheumatoid arthritis. There is a small ossicle in the distal Achilles' tendon. There is an os peroneum, a normal variant. | Lucency within the tuberosity of the right navicular bone is nonspecific and could represent a cyst, chronic erosion, or postoperative defect. It is unchanged from the prior study. I see no evidence of disease progression. |
Generate impression based on findings. | 68 year old man with mitral regurgitation. Patient referred to assess cardiovascular anatomy prior to "robotic" mitral valve surgery.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has moderate tortuosity. No protruding aortic calcification, atheroma or thrombus is noted in the thoracic aorta. No aortic coarctation is noted. There is no significant atherosclerosis the proximal brachiocephalic vessels. Aortic Valve: The aortic valve is trileaflet with normal leaflet excursion. There is no aortic valve calcification. Mitral Valve: No mitral annular calcification is noted. There is significant billowing/ prolapse of the P2 mitral valve segment.Left Ventricle: The left ventricular end-systolic volume is normal. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. Right Ventricle: Visually the right ventricular end-systolic volume is within normal limits.Atrium: The left atrium is moderately dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus. The left atrial appendage is medially directed. The right atrium is normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. The interatrial septum is deviated into the right atrium, suggesting increased left atrial pressure.Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is mild calcification of the proximal and mid LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is no calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is mild calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Mitral valve prolapse is noted. 2. Mild coronary calcium. 3. Moderate left atrial dilation. 4. Variant left atrial appendage anatomy. 5. Increased left atrial pressure. 6. Moderate thoracic aortic tortuosity.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. The abdomen/ pelvis CTA will be reported separately. |
Generate impression based on findings. | Postoperative changes are seen from previous anterior cervical fusion of C5 through C7. An interbody spacer with metallic marker is present at C6-C7, with complete osseous fusion anteriorly. There remains linear lucency along the posterior aspect of the disk space. A ring type interbody spacer/graft is present at C5-C6 with a few radiating lucencies as seen on 4/34. Complete osseous fusion is just at this level as well.The scout lateral view and the sagittal reformatted images demonstrate normal alignment of the cervical spine, with straightening of the normal cervical lordosis. The remaining vertebral body and disk space heights are well-maintained.There is no acute fracture.At C1-C2, there is a normal relationship of the dens with the arch of C1.There is moderate developmental narrowing of the cervical spinal canal diffusely.C2-3: Moderate congenital spinal canal stenosis.C3-4: There is a minimal diffuse posterior osteophyte disk complex. Right greater than left uncovertebral joint hypertrophy. Moderate spinal canal stenosis.C4-5: Moderate central/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 mild-moderate central spinal canal stenosis. C7-T1: No significant neuroforaminal or spinal canal stenosis.The visualized intracranial structures and lung apices appear normal. | 1. Anterior cervical fusion postoperative changes from C5 through C7, without evidence of instrumentation complication or fracture. Osseous fusion visualized at these levels.2. Moderate developmental narrowing of the cervical spinal canal with superimposed minimal spondylotic changes resulting in up to moderate spinal canal stenosis at C3-C4 and C4-C5. |
Generate impression based on findings. | Patient with acute intracranial hemorrhage associated with adjacent aneurysms in posterior circulation.PROCEDURES: 1) cerebral angiogram 2) Embolization of intracranial cerebral aneurysms and right superior cerebellar artery supply to AVM. 3) xpert CT reconstruction Right vertebral artery prior to embolization:The superior cerebellar arteries are enlarged. There is an arteriovenous malformation present at the quadrigeminal plate cistern with supply from the vermian branches of the superior cerebellar arteries bilaterally. There are 3 aneurysms present along the ambient segment of the vermian branch of the right superior cerebellar artery.There is relatively slower flow in the posterior circulation. There is transient reverse filling of the left vertebral artery. The right p1 segment is hypoplastic. There is transient reverse filling of the left PCOMA.Left vertebral artery: The left vertebral artery has aortic arch origin and is the non-dominant vertebral artery. There is opacification of the basilar artery and the left posterior cerebral artery. (The right p1 segment is hypoplastic). There is transient reverse filling of the left PCOMA. The superior cerebellar arteries are enlarged. There is an arteriovenous malformation present at the quadrigeminal plate cistern with supply from the vermian branches of the superior cerebellar arteries bilaterally. There are 3 aneurysms present along the ambient segment of the vermian branch of the right superior cerebellar artery.Right common carotid artery: There is no evidence for stenosis at the carotid bifurcation on the basis of NASCET criteria. No evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior, middle and posterior cerebral arteries. Venous and parenchymal phases were within normal limits. There is no supply to the AVM.Left common carotid artery: There is no evidence for evidence for carotid stenosis on the basis of NASCET criteria. No evidence for carotid dissectionLeft internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no evidence for evidence for aneurysm, AVM on this injection. Intraprocedural angiograms:Intraprocedural arteriograms demonstrate that the arteriovenous malformation is fed by superior cerebellar artery branches. Venous drainage is deep venous drainage into the vein of Galen.The three aneurysms were embolized using onyx-18.Final arteriogram:The superior cerebellar arteries are enlarged. There is occlusion of the vermian branch of the right superior cerebellar artery along with the aneurysms. The hemispheric branch remains patent.There is an arteriovenous malformation present at the quadrigeminal plate cistern with supply from the vermian branch of the left superior cerebellar artery. | 1.Quadrigeminal plate cistern arteriovenous malformation. Supply is via superior cerebellar artery branches without anterior circulation supply. There is deep venous drainage.2.Embolization of a dysplastic right vermian artery supply to the AVM with embolization of three aneurysms along its course.3.Findings were discussed with Drs Awad and Ardelt during and at the end of the procedure. |
Generate impression based on findings. | Back pain status post MVA, low mid back. Is there a fracture? I see no fracture or malalignment. Note is made of tiny vertebral body osteophytes. Intervertebral disk spaces are within normal limits. Vertebral body heights are preserved. | No fracture evident. |
Generate impression based on findings. | Reason: Evaluate IVH and possible ischemia There is a 12-mm hematoma present in the right midbrain associated with intraventricular blood involving the third ventricle and to a lesser degree lateral ventricles. The temporal horns of the lateral ventricles are dilated.There is embolic material present in the right ambient and quadrigeminal plate cisterns.A ventriculostomy has been placed. It enters the right frontal lobe and courses into the right lateral ventricle with tip in the region of foramen of Monro air AP and lateral ventricles have not changed in size.There is redemonstration of a hypodense focus in the right basal ganglia.Periventricular and subcortical white matter hypodensities of a moderate degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses demonstrate a mucous retention cysts along the maxillary sinuses. The patient is intubated. There is partial opacification of the nasal cavity. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Right midbrain hematoma associated with intraventricular blood. There is slightly more blood in the lateral ventricles now.2.Status post ventriculostomy tube placement. The lateral ventricles are stable in size.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Hypodensity in the right basal ganglia likely represents lacunar infarct - age indeterminant. |
Generate impression based on findings. | Clinical question : Evaluate for stroke. Signs and symptoms: AMS Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is extensive periventricular and subcortical low attenuation of white matter consistent with advanced age indeterminate small vessel ischemic strokes. There is mild ex vacuo dietitian lateral ventricles and with maintained midline.Focus of encephalomalacia in the right anterior temporal lobe is also noted likely representing a focus of chronic ischemic stroke.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Advanced age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Evaluate for stroke. Signs and symptoms: Mental status changes similar to prior stroke presentation. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Hemorrhage? Signs and symptoms: Possible new seizure. Unenhanced head CT:There is no detectable acute intracranial process. CT however these intensity for early detection of acute nonhemorrhagic ischemic strokes.Examination demonstrates very subtle periventricular low attenuation of white matter and a tiny focus of low-attenuation in the left thalamus and right basal ganglia. Findings likely representing age indeterminate small vessel ischemic strokes considering the stated age of 75.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces are otherwise for age.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes |
Generate impression based on findings. | Clinical question: Rule out CVA. Signs and symptoms: Headache, history of sickle cell and moyamoya. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status post fat and head trauma. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: 34-year-old female newly diagnosed bilateral occipital subarachnoid hemorrhage, monitoring. Signs and symptoms: As above. Nonenhanced head CT:Examination demonstrates interval increased subarachnoid hemorrhage and with increased extent. On the current exam hemorrhage is noted in bilateral occipital lobes and extending to parietal occipital fissures bilaterally. In addition there is hemorrhage in the subarachnoid space in the right anterior frontal region and along the convexity and along the interhemispheric fissure with internal increased since prior study.There is no associated parenchymal edema or mass effect and ventricular system remain normal in size with maintained midline. The gray -- white matter the initiation is preserved. There is no hemorrhage in the basal cistern or the sylvian fissures. There is also no detectable hemorrhage in the posterior fossa. | 1.Interval increased subarachnoid hemorrhage in bilateral occipital lobes and right frontal since prior exam.2.Stable and unremarkable exam otherwise. |
Generate impression based on findings. | Male 8 years old Reason: fall History: swelling and painVIEWS: Left wrist AP, lateral and oblique 3/17/15 (3 views) There is a greenstick fracture of the distal metaphysis of the left radius with minimal palmar and lateral angulation. | Greenstick fracture of the distal radius as described. |
Generate impression based on findings. | Clinical question: Intracranial abnormality. Signs and symptoms: Congestion. Unenhanced head CT:There is menisci acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits and with well pneumatized bilateral mastoid air cells and middle ear cavities.Maxillofacial CT:Frontal sinuses demonstrate findings suggestive of acute on chronic sinusitis (left greater than right).Bilateral ethmoid sinuses demonstrate patchy opacification (left greater than right).Sphenoid sinus demonstrate mild findings of acute sinusitis with occluded bilateral sphenoethmoidal recessesmaxillary sinuses demonstrate extensive opacification of the left secondary to acute on chronic sinusitis and with complete occlusion of left ostiomeatal unit. Mild mucosal thickening of the right maxillary sinus with occluded ostiomeatal unit is noted.Images through the nasal passage demonstrates increased soft tissue density within the nasal passage (left greater than right) without evidence of bony changes in the finding could represent diffuse mucosal thickening however overlapping polyposis cannot be entirely excluded. There is mild leftward nasal septum deviation. | 1.Unremarkable nonenhanced head CT.2.Acute on chronic pansinusitis |
Generate impression based on findings. | 8-month-old male history of trauma concern for pneumothorax, fractureVIEWS: Chest and abdomen AP, cervical spine AP and lateral (4 view) 3/17/15 Chest: The aortic arch cardiac apex, and stomach are left-sided. Cardiothymic silhouette is normal. No focal pulmonary opacities. No pneumothorax or pleural effusion.Abdomen: Disorganized bowel gas pattern. No pneumatosis, free air, or portal venous gas.Cervical spine: Cervical spine is visualized through C6. No fracture or subluxation. Mild thickening of the adenoids. | Normal chest. Disorganized bowel gas pattern. C7 is not visualized. |
Generate impression based on findings. | 4-year-old male with worsening cough: Concern for pneumoniaVIEWS: Chest AP/lateral (two views) 3/18/15 The cardiothymic silhouette is normal. Mild bronchial wall thickening consistent with bronchiolitis/reactive airway disease pattern. No pleural effusion or pneumothorax. No pulmonary opacity. | Bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | 64-year-old female presents for routine screening mammography. Two standard digital views of both breasts, repeat right MLO view and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications are again noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | RFO trigger: R/O RFO RFO trigger: Pregnant and BMI over 50 Suspected RFO location: abdomen Name of suspected RFO: lapAttending Surgeon name/pager: Della torre Body Mass Index (BMI): 51.48 Skin staple line projects over the lower pelvis. Epidural catheter enters the T12-L1 intervertebral space and terminates at the L2-3 intervertebral space. Clips project over the left and right lower quadrants. No unexpected radiopaque foreign object identified. | No unexpected radiopaque foreign object identified.These findings were discussed by telephone with Dr. Della Torre, the attending surgeon, on 3/17/2015 at 19:22. |
Generate impression based on findings. | Male 4 months old Reason: ETT placement History: ARDSVIEW: Chest AP (one view) 3/18/15 at 746 hours ET tube terminates thoracic inlet. NG tube tip is at the stomach. Cardiac silhouette size is top normal or mildly enlarged. Right and left upper lobes and bibasilar opacities, likely atelectasis or pneumonia, on a background of diffuse lung haziness (left-to-right shunt). No effusions or pneumothorax. | Multifocal opacities, likely atelectasis as described. |
Generate impression based on findings. | Male, 10 years old. Evaluate fecal load, appendix, any signs of obstruction History: abd pain, vomiting x2daysVIEW: Abdomen AP (one view) 3/17/2015, 2235 Nonobstructive bowel gas pattern.Small to moderate stool burden. | Below-average stool burden, without evidence of obstruction. |
Generate impression based on findings. | Female, 14 years old. Reason: pain s/p fall History: painVIEWS: Right ribs AP and obliques (4 views total) 3/17/2015, 2327 No acute or healing rib fractures.The aortic arch, cardiac apex, and stomach are left-sided. The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax.Partially visualized nonobstructive bowel gas pattern. | No rib fractures identified. |
Generate impression based on findings. | Male 4 months old Reason: ETT placement History: Down syndrome, respiratory distress.VIEW: Chest AP (one view) 3/17/15 at 2205 hrs. ET tube tip is below thoracic inlet. Cardiac silhouette size is top normal. Right upper, left upper and bibasilar opacities, likely atelectasis on a background of diffuse lung haziness. No effusions or pneumothorax. | ET tube placement.Multifocal opacities as described. |
Generate impression based on findings. | 70 years, Male. Reason: Hx of esophageal cancer History: Bilious vomiting Bilateral nephroureteral stents in place, with distal tips terminating in the distribution of the urinary bladder. There is a generalized absence of bowel gas. Left basilar atelectasis and bilateral pleural effusions are present. | Absence of bowel gas. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of ovarian cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable intramammary lymph node in the left upper outer breast. Benign right breast calcifications are again noted. | 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. | History of gout in the past. Painful elbow. Question of joint effusion. Four views of the right elbow reveal no acute fracture or malalignment. No joint effusion is identified. An olecranon spur is noted with soft tissue swelling about the olecranon, which is in the region of the olecranon bursa. | 1. No joint effusion.2. Soft tissue swelling in the region of the olecranon bursa may represent bursitis. |
Generate impression based on findings. | Female 18 years old Reason: eval new right PICC History: CF with pulmonary exacerbation, needs IV antibioticsVIEW: Chest AP (one view) 3/17/15 at 1649 hrs. Right upper extremity PICC terminates at the RA/SVC junction. Cardiac silhouette size is normal. Peribronchial thickening and possible upper lobe bronchiectasis. No focal opacities, effusions or pneumothorax. | Interval central line placement as described.Persistent lung changes of cystic fibrosis. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhagic transformation or edema. Known right posterior cerebral artery infarct. Signs and symptoms: Therapeutic heparin drip. Nonenhanced head CT:Examination redemonstrates a subacute nonhemorrhagic in the entire distribution of right PCA. No evidence of hemorrhagic transformation as questioned clinically. Similar to prior exam stroke results in regional mass-effect and without deviation of midline.Large subacute nonhemorrhagic right cerebellar ischemic stroke in the distribution of right superior cerebellar artery branch with regional mass-effect is again noted and without interval change. The 4th ventricle remains within normal size and similar to prior exam. CSF spaces slight cisterns remain patent.Mild age indeterminate small vessel ischemic strokes in the periventricular white matter of cerebral hemispheres are also again noted. | 1.No detectable acute intracranial hemorrhage and in particular no evidence of hemorrhagic transformation of previously known strokes. 2.Subacute nonhemorrhagic ischemic stroke in the entire distribution of right PCA.3.Subacute nonhemorrhagic right superior cerebellar artery territory stroke as detailed.4.Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her sister at age 36. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a small asymmetry in the right medial breast not seen on prior studies. A few benign calcifications are present in the left breast. No suspicious microcalcifications or areas of architectural distortion are present. | Small asymmetry in the right medial breast could represent overlapping tissue, but requires further evaluation with spot compression and possible ultrasound.Given her breast density and family history in a young aged sister, referral to cancer risk clinic could also be considered, as the patient may benefit from screening MRI.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 15-year-old female with fall onto outstretched handVIEWS: Right elbow AP, oblique, lateral; right shoulder internal rotation and external rotation (5 views) 3/17/15 No fracture or malalignment within the elbow. No joint effusion.No fracture or malalignment of the shoulder. The humeral head is well seated in the glenoid fossa. | Normal examinations. |
Generate impression based on findings. | Pain. Question of fracture. Three views of the right hand reveal no acute fracture or malalignment. No soft tissue swelling is seen. The patient is unable to fully extend the fingers. | No acute fracture is evident. |
Generate impression based on findings. | 78 years, Male. Reason: NGT History: NGT Pelvis is not included in field of view and motion artifact limits evaluation. There is a nasogastric tube with its tip projecting over the fundus of the stomach. Nonobstructive bowel gas pattern. | Nasogastric tube with its tip projecting over the fundus of the stomach. |
Generate impression based on findings. | 41-year-old female. GI bleed status post stem cell transplant, evaluate for perforation and infection. CHEST:LUNGS AND PLEURA: Moderate bilateral pleural effusions with adjacent atelectasis.Patchy ground glass opacities and septal lines suggestive of pulmonary edema.Focal area of ground glass nodularity in the left upper lobe may represent superimposed atypical infection.MEDIASTINUM AND HILA: Small pericardial effusion.Right chest wall port tip terminating at the cavoatrial junction.Left IJ catheter tip in SVC.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Contracted gallbladder with wall thickening and mucosal enhancement, nonspecific in the setting of ascites. No focal hepatic lesion or biliary ductal dilatation.SPLEEN: Splenomegaly measuring 14.7 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Ill-defined wedge-shaped hypoattenuating foci in both kidneys suggestive of pyelonephritis. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Enteric tube is coiled in the stomach with tip directed superiorly in the body. No small bowel obstruction or evidence of perforation.BONES, SOFT TISSUES: Small broad-based umbilical hernia containing a small bowel loop without evidence of obstruction.OTHER: Moderate amount of abdominopelvic ascites.PELVIS:UTERUS, ADNEXA: Post surgical findings of bilateral tubal ligation in Essure placement.BLADDER: Foley catheter terminates in a collapsed bladder.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate amount of abdominopelvic ascites. | 1. Bilateral wedge-shaped hypoattenuating foci kidneys suggestive of pyelonephritis.2. Moderate bilateral pleural effusions with pulmonary edema. Findings suggestive of superimposed atypical infection in the left upper lobe.3. Moderate amount of abdominopelvic ascites.Findings were communicated to Dr. Waite-Marin over the phone at time of dictation. |
Generate impression based on findings. | Male 9 years old Reason: evaluate central line position History: port removal, central line insertionVIEW: Chest AP (one view) 3/17/15 at 1829 hrs Interval feeding tube and Port-A-Cath removal and placement of left upper extremity double-lumen catheter, tip the at the RA/SVC junction.Cardiac silhouette size is normal. Persistent small lung volumes, no focal opacities, effusions or pneumothorax. | Interval Port-A-Cath and feeding tube removal and placement of central line as described. |
Generate impression based on findings. | 78 years, Female. Reason: Is there a partial small bowel obstruction? History: 78 year old woman had total hysterectomy 1-26-13 for endometrial carcinoma followed by radiation therapy. Now she has lower abdominal distention, increased borborygmi and flatus. Moderate/large stool burden distributed throughout the colon. Suggestion of cecal bowel wall thickening, although this may reflect adjacent bowel loops. No evidence of pneumoperitoneum. Three orthopedic screws traverse the left femoral neck. There are moderate degenerative changes lower lumbar spine and bilateral hips. | Moderate/large stool burden, with suggestion of possible cecal wall thickening. |
Generate impression based on findings. | Fell on concrete. Generalized pain. Question of fracture. Four views of the right knee reveal no acute fracture or dislocation. | No acute fracture is evident. |
Generate impression based on findings. | 56 years, Male. Reason: Evaluate for obstruction History: No bowel movement; nonspecific pain. Has GT. G-tube projects over the gastric body. Possible Dobbhoff tube tip is seen near the gastroesophageal junction. Nonobstructive bowel gas pattern with greater than average stool burden. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 87 years, Female. Reason: H/o chron's disease with ileostomy, worsening abdominal distension and abdominal pain History: abdominal distension Paucity of bowel gas, scattered air-fluid levels and linearly distributed foci of gas in the right lower quadrant suggestive of possible bowel obstruction. Right midline abdominal ostomy in place. No evidence of pneumoperitoneum. | Findings suggestive of possible bowel obstruction, this could be further evaluated with a dedicated CT examination. |
Generate impression based on findings. | Fall. Evaluate for fracture. Three views of the left hand show no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | 47-year-old female with left shoulder pain status post fall. Three views of the left shoulder demonstrate normal articulation of the glenohumeral joint. No fracture is evident. Chronic left upper lung opacities are better evaluated on recent chest radiograph. | No evidence of fracture or dislocation. Please refer to recent chest radiograph regarding pulmonary findings. |
Generate impression based on findings. | Female 9 years old Reason: pneumonia; h/o rheumatic heart disease History: chest painVIEWS: Chest AP/lateral (two views) 3/18/15 749 hours. Cardiac silhouette size is the normal. Subsegmental atelectasis of the right upper lobe or thickening of the minor fissure is noted no effusions or pneumothorax. | Subsegmental atelectasis on the right upper lobe versus thickening of the minor fissure as described. |
Generate impression based on findings. | 44-year-old female with chest pain, evaluate pulmonary embolism PULMONARY ARTERIES: Pulmonary artery opacification is diagnostic quality with no evidence of pulmonary embolus. The pulmonary artery measures 2.6 cm in diameter which is within the limits of normal. LUNGS AND PLEURA: No pneumothorax. Small pleural effusions, right greater than left.Interlobular septal thickening with groundglass opacity in bilateral lower lobes. Bronchial wall thickening and thickened lymphoid tissue surrounding the bronchi proximally. No pleural thickening or nodularity.Focal opacity in the anterior right middle lobe. No suspicious nodules or masses.Background mild to moderate centrilobular emphysema.MEDIASTINUM AND HILA: Mild cardiomegaly. Trace pericardial fluid. Mild coronary artery calcification.Increased lymphoid tissue in the hila, right greater than left. Mildly prominent scattered subcentimeter mediastinal lymph nodes.Central pulmonary veins are distended lower lobes, especially on the right.CHEST WALL: Right chest port tip is in the SVC.Lipoma is noted in the lateral left chest wall (series 7, image 216). Status post left mastectomy. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Centrally located masslike hypodensity in segment 8 of the liver new from 2011.Trace perihepatic ascites. Mild stranding of the fat and fascia in the upper abdomen. | 1.No evidence of pulmonary embolism.2.Interlobular septal thickening with groundglass opacity in bilateral lower lobes with bronchial wall thickening most compatible with pulmonary edema, possibly noncardiogenic. Mild to moderate centrilobular emphysema.3.Focal opacity in the right middle lobe anteriorly is most suggestive of early fibrosis (correlate for history of chest wall RT) or post-inflammatory etiology although infection cannot be entirely excluded.4.Centrally located hypodensity in segment 8 of the liver of unclear etiology, new from 2011; a metastatic lesion or less likely infection/abscess (in appropriate clinical context) cannot be entirely excluded in a patient with a history of malignancy. Consider further evaluation with ultrasound.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
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