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Generate impression based on findings. | History of right lumpectomy 5/2012 for invasive ductal carcinoma and DCIS found initially on stereotactic biopsy. Lumpectomy removed residual calcifications, but not marking clip as clip was displaced from biopsy site. Patient received radiation therapy. No new breast complaints. Three standard views of both breasts and laterally exaggerated right CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is a linear scar marker overlying the right breast and right axilla. There are stable postsurgical changes in the right breast including architectural distortion, surgical clips and volume loss in the lumpectomy bed. There is a stable percutaneous placed clip in the right breast at 12 o'clock, which was the displaced stereotactic biopsy clip, not targeted with the lumpectomy due to its location. There are scattered bilateral benign calcifications.No dominant mass, suspicious microcalcifications or new areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications are present. Normal size lymph nodes project in each axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. A few 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Chronic sinusitis, FESS. There are postoperative findings related to endoscopic sinus surgery. There is extensive pansinus opacification with associated sclerosis and thickening of the sinus walls. There is suggestion of polypoid opacities in the nasal cavity. There also appear to be scattered bubbly secretions. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. There is persistent dehiscence of the right superior orbital wall with stranding in the right superior extraconal orbit. The nasopharynx, facial soft tissues, and imaged intracranial structures appear to be unremarkable. There is a partially-imaged carious right maxillary molar. | 1. Findings related to endoscopic sinus surgery with extensive pansinonasal opacification suggestive of chronic sinusitis and nasal polyposis. 2. Persistent dehiscence of the right superior orbital wall with stranding in the right superior extraconal orbit.3. Partially-imaged carious right maxillary molar. |
Generate impression based on findings. | There is redemonstration of postoperative changes from previous laminectomy at the cervical thoracic junction. The plaque-like area of enhancing soft tissue along the left ventral epidural space spanning the T1 vertebral level again measures 7 mm in greatest thickness on 901/11, not significantly changed from the most recent comparison but again progressed since the prior measurements from the June and February 2014 exams. The previous exam did not entirely include the mass within the axial field of view. Sagittal postcontrast images appear to suggest that there is slightly greater thickness of the caudal aspect of the mass at the T1-T2 disk level as seen on 1001/9 compared to prior 10/8.There is again minimal mildly enhancing T1 hypointense abnormality in the left far lateral position at the C7-T1 level which may represent postoperative changes versus residual tumor, with redemonstration of a mildly expanded left C7-T1 foramen, at a level of previous tumor. There is nonenhancing T1 hypointensity within the proximal left foramen, which is unchanged. There is redemonstration of mild posterior scalloping of the T1 vertebral body margin. There is focal effacement of the left ventral CSF space, with apparent worsened mass effect upon the left ventral cord. This is best seen on axial T2 weighted images, 701/10. There is mild left foraminal narrowing at the T1-T2 level. There is overall moderate central canal narrowing at this level.The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are stable. No worrisome focal marrow signal abnormality is appreciated, with fatty marrow signal in the visualized vertebrae, consistent with previous radiation. Please note that sagittal fat sat postcontrast images are inhomogeneous along their caudal aspect. The spinal cord is otherwise of normal caliber and signal.Minimal degenerative changes appear similar to the prior examination. There is mild scattered fluid within the mastoid air cells bilaterally. There is minimal fluid signal within the trachea which may represent retained secretions. | 1. Overall, no significant interval change in appearance of the plaque-like enhancing mass in the ventral epidural space spanning the T1 level, although suggestion of perhaps subtle increase thickness of the caudal aspect of the tissue at the T1-T2 disk level, with direct comparison somewhat limited due to differences in technique. Compared to more remote exams, the mass has been progressive.2. Worsened mass effect upon the left ventral thecal sac and now upon the left ventral cord, with moderate central spinal canal stenosis. Mild left foraminal narrowing at T1-T2, and stable appearance of abnormalities in the left C7-T1 foramen which may in part be postoperative. |
Generate impression based on findings. | 64 year old female with right lumpectomy for IDC status post radiation and tamoxifen. History of left benign breast biopsy. Three standard views of both breasts and two right ML and one CC spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Architectural distortion, increased density, surgical clips, and nipple retraction in the right lumpectomy bed are stable. Dystrophic calcifications in the lumpectomy bed have slightly increased compared to prior. Two biopsy clips in the left breast and one biopsy clip in the right breast are unchanged in positions. Left lateral circumscribed subcentimeter mass is stable.No dominant mass or suspicious microcalcifications in either breast. | Postsurgical changes with slight increase in dystrophic calcifications in the lumpectomy bed. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 75 years old Reason: weight loss, diarrhea, B12 def. History: above Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 20 minutes. Fluoroscopic evaluation showed no ulcers, sinus tracts, fistulae, or dominant adhesion. Spiculation of the distal jejunum and ileal mucosal contour, in a picket fence type pattern, is nonspecific. However, given the history of postprandial angina, these findings are suspicious for chronic ischemic change, perhaps related to radiation and/or surgery. There is no evidence of bowel obstruction. Postsurgical changes are evident in the midline lower abdomen, consistent with prior small bowel resection and primary anastomosis. The terminal ileum and ileocecal valve were normal in appearance. TOTAL FLUOROSCOPY TIME: 3:59 minutes | 1.Spiculation of the distal small bowel mucosa, which is nonspecific; however, in the setting of postprandial angina, these findings are suspicious for chronic ischemic change, perhaps related to surgery and/or radiation.2.Decreased transit time. |
Generate impression based on findings. | Female, 13 years old. Eval for healing base of fifth metatarsal. History: foot painVIEWS: Right foot, AP, lateral, oblique (3 views) 3/18/2015, 1005 A nondisplaced fracture through the base of the fifth metatarsal showing focal sclerosis, compatible with healing fracture.Otherwise the osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Healing nondisplaced fracture through the base of the right fifth metatarsal. |
Generate impression based on findings. | Classical Hodgkin lymphoma s/p 6 cycles of ABVD now with new symptoms worrisome of recurrence in need of restaging. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is a right internal jugular venous catheter. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are bilateral maxillary sinus retention cysts. The imaged portions of the lungs are clear. | No significant lymphadenopathy in the neck. |
Generate impression based on findings. | Reason: Patient with severe SOB. Needs PE CT stat History: severe SOB, has lung cancer. ? PE. PULMONARY ARTERIES: Technically adequate exam for evaluation of pulmonary embolism. No pulmonary embolus is identified.LUNGS AND PLEURA: Moderate central lobular emphysema. Reference measurements are as follows (series 9):Right lower lobe mass abutting the mediastinum measures 5.5 x 5.1 cm (image 86), previously 5.2 x 5.1 cm though appears fuller than previously seen.Superior segment right lower lobe nodule measures 12 mm (image 61), previously 12 mm.Superior segment right lower lobe sub-solid nodule measures 4 mm (image 54), previously 3 mm.Right middle lobe nodule measures 6 mm (image 77), previously 6 mm.Left upper lobe nodule measures 16 mm (image 43), previously 12 mm.Some nodules have also decreased in size, for example a right lower lobe nodule measures 17 mm (image 88) from previously 25 mm.MEDIASTINUM AND HILA: Right IJ catheter tip at the superior cavoatrial junction. Heart size normal. No pericardial effusion. No coronary calcifications detected. There is again suggestion of mediastinal invasion by the right lower lobe mass, including of the left atrial wall. Occlusion of the right inferior pulmonary vein is again noted. Reference right paratracheal lymph node measures 15 mm (image 80, series 7), previously 14 mm. Small hiatal hernia noted.CHEST WALL: No suspicious focal osseous lesion. Chronic L1 compression deformity.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Questionable left adrenal nodularity, measuring 17 x 15 mm (image 242, series 7), previously 13 x 11 mm; metastasis not excluded and attention on follow up imaging is warranted. | 1.No evidence of pulmonary embolism.2.Right lower lobe mass, bilateral pulmonary metastases, and mediastinal adenopathy demonstrate mixed response since previous exam, with reference measurements as above.3.Left adrenal nodularity; metastasis not excluded.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Pain in right SI joint region and right low back pain with tenderness to palpation. Negative SLR. Question of basis of right-sided low back pain in a patient with gout and OA. AP view of the pelvis shows no acute fracture or malalignment. A punctate metallic density projects over the right greater trochanter and may represent foreign body.Five views of the lumbar spine show degenerative disk disease throughout the spine, most predominantly at L3/L4, with small anterior osteophyte formation. There is sclerosis of the facet joints of the lower lumber spine. Atherosclerotic calcification of the abdominal aorta is noted. | Degenerative changes as noted above. |
Generate impression based on findings. | 49-year-old male. Microscopic hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal or ureteral stones. No renal or ureteral mass is identified. Complete opacification of the collecting systems on delayed imaging without focal lesion.RETROPERITONEUM, LYMPH NODES: Mild calcified atherosclerotic disease of the aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder is collapsed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality noted | No specific findings to explain the patient's hematuria. |
Generate impression based on findings. | Female 57 years old Reason: crohns of the TI, stricturing disease, s/p multiple resections. with RUQ pain and stricture of TI noted on recent colonoscopy History: RUQ abdominal pain.Movie Series #8 and 26. Scout radiograph showed a nonobstructive bowel gas pattern with air fluid levels in the left hemicolon.Transit time to the residual right colon was 30 minutes. There has been an ileocectomy. There appears to be a wide, pliable, side-to-side anastomosed loop of small bowel which is attache to the ascending colon.Fluoroscopic evaluation showed the jejunum to be normal and mobile. In the right lower quadrant a few focal areas of nonobstructive or dynamically significant adhesions were seen. There was a focal segment of narrowing at the site of a small bowel anastomosis in the right lower quadrant corresponding to the patient's site of maximal tenderness. This area measured approximately 3.1 cm in length and measured 0.8 cm in width at maximal dilation (Series 27, images 1 and 2 and ). There were small pseudosacculations in this focal segment compatible with chronic Crohn's scarring. No dilation of the proximal or distal bowel was seen to suggest a dynamically significant narrowing. Otherwise, there was normal mucosa throughout the small bowel, with no ulcers, sinus tracts, or fistulae and no evidence of active inflammatory bowel disease. No separation of bowel loops was present to suggest fibrofatty proliferation. No internal hernias or ventral hernias were evident. TOTAL FLUOROSCOPY TIME: 9:36 minutes. | Focal area of narrowing at the site of prior anastomosis as described above without evidence of active disease. |
Generate impression based on findings. | Male 6 years old Reason: assess for constipation or obstruction History: abdominal pain, sickle cellVIEWS: Abdomen AP supine and upright 3/18/15 (two views) Normal abdominal gas pattern. No evidence of obstruction or free air. No ascites. | Normal examination. |
Generate impression based on findings. | Status post left total hip arthroplasty (anterior approach). AP view of the pelvis and single view of the left hip show a total hip arthroplasty device situated in anatomic alignment. A surgical drain is noted within the soft tissues of the left hip. Foci of air are postoperative. No fracture is evident. | Left total hip arthroplasty as above. |
Generate impression based on findings. | Male, 4 months old. Evaluate ng tube positionVIEW: Abdomen AP (one view) 3/18/2015, 1018 Nasogastric tube curled in the gastric fundus, with distal side port below the level of the GE junction. Right femoral catheter.Scattered air filled, somewhat featureless loops of bowel, with gas seen within the rectum.No evidence of obstruction or free air.Bibasilar pulmonary opacities. | Nasogastric tube terminates in the stomach. |
Generate impression based on findings. | 58 year old female who was recalled from screening mammogram for asymmetry in the left upper breast. Family history of breast cancer diagnosed in mother at age 40, maternal aunt, and maternal second cousin. An ML, MLO, left exaggerated CC lateral view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Asymmetry in question in the left superior posterior breast adjacent to the pectoralis muscle partially persists on the full field view and disperses into normal breast tissue on the spot compression view. No definite correlate identified on the CC view. | Asymmetry in the left posterior-superior breast partially persists on full-field view, needs further evaluation with 6 month follow-up to confirm stability. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Reports left greater than right hand numbness, when lying down at night, relieved with upright. Evaluate for for cervical DJD. Two views of the cervical spine show degenerative disk disease with disk space narrowing at C4/C5, C5/C6, and C6/C7. There are small anterior osteophytes. Alignment is anatomic. No acute fracture is evident. | Degenerative changes of the lower cervical spine as described above. |
Generate impression based on findings. | 7-year-old female with knee pain during sports, evaluate for fractureVIEWS: Left and right knee left lateral, right lateral, AP, skiers, sunrise (5 views) 3/18/15 No fracture or malalignment. No joint effusion. A lucent lesion with predominantly narrow zone of transition and sclerotic borders is eccentrically located in the right epiphysis extending to the metaphysis. The border of the lateral superior portion of the lesion is less well defined. No periosteal reaction | Epiphyseal/metaphyseal lesion could represent an early giant cell tumor, infection, fibrous cortical defect, or infarction; however malignancy such as chondroblastoma cannot be excluded. MRI is recommended to further evaluate. No fracture or malalignment. |
Generate impression based on findings. | Male; 56 years old. Reason: chronic pancreatitis History: (non calcific, 2/2 alcohol and TG) w extensive splenic and portal DVT ABDOMEN:LUNG BASES: Minimal bibasilar dependent subsegmental atelectasis. Low density of the cardiac blood pool, suggestive of anemia.LIVER, BILIARY TRACT: Diffuse hepatic steatosis, increased since prior study. No focal liver lesions. Stable mild perihepatic ascites.SPLEEN: No focal splenic lesions. Occluded splenic vein.PANCREAS: Hypoenhancement of the pancreatic body and tail, which appear more atrophic compared to prior study, most compatible with pancreatic necrosis. Improved peripancreatic free fluid and fatty stranding since prior study.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Findings suggestive of pancreatic necrosis involving the body and tail. Improved peripancreatic free fluid and fatty stranding. Occluded splenic vein.2. Diffuse hepatic steatosis. |
Generate impression based on findings. | Evaluate point tenderness ventral, lateral wrist. Question of fracture or bone island. Three views of the right wrist reveal no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | Male 56 years old; Reason: 56 year old man with history of OLT for cirrhosis. Has history of HCC and marginal zone lymphoma. Compare to prior CT scans for lymphadenopathy. History: None Evaluation limited by lack of intravenous contrast.CHEST:LUNGS AND PLEURA: Interval resolution of bilateral pleural effusions. Biapical emphysematous changes. Redemonstrated 7-mm nodule in the left upper lobe (stable compared to prior study 4:29). New 5-mm nodule just inferior to this one (3:42)New 9-mm ovoid nodule in the left lung apex (3:24). Bandlike scarring/atelectasis at lung bases. Other scattered micronodules are also seen.MEDIASTINUM AND HILA: Interval removal of endotracheal tube.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: 8.1 x 7.4 cm posterior right hepatic subcapsular collection likely related to evolving hematoma seen on prior chest CT from 10/1/2014. Status post orthotopic liver transplant.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing bilateral punctate renal stones.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Thinning of the right lateral abdominal wall musculature with herniation of intraperitoneal contents.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Multilevel compression deformities again seen. Progression/new T6 vertebral body compression from 9/13/2014.OTHER: Inferior vena caval filter noted in place within the distal inferior vena cava near the bifurcation, with at least two legs extending outside the lumen, one of which seems to be just posterior to the origin of the right common iliac artery. Apex appears angulated. | 1.New pulmonary nodules and stable pulmonary nodules as described above are indeterminate.2.Progression of T6 vertebral body compression fracture.3.Inferior vena caval filter placement as described above. Consultation with interventional radiology is suggested.4.No definite lymphadenopathy. |
Generate impression based on findings. | Reason: left pleuritic pain, CT abdomen demonstrating LLL consolidation. h/o lung cancer on RIGHT. History: pain, shortness of breath LUNGS AND PLEURA: Postsurgical changes of a left upper lobectomy. The central airways are patent. Moderate to severe centrilobular emphysema. Small left pleural effusion and atelectasis of the left lower lobe with air bronchograms. No endobronchial lesion is evident.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the aorta and its branch vessels. Severe coronary artery calcification. The ascending aorta is aneurysmally dilated measuring 4.4 cm.The heart size is normal. No pericardial effusion.Scattered subcentimeter mediastinal lymph nodes.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. Degenerative changes to the thoracic spine. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small hiatal hernia. Common bile duct dilatation measuring up to 13 mm with mild central intrahepatic biliary dilatation appears increased since the prior exam. | 1.Left lower lobe atelectasis and small pleural effusion. No suspicious findings to support recurrence. Recommend serial imaging to ensure resolution. 2.Postsurgical changes of a left upper lobectomy. Moderate to severe centrilobular emphysema.3.Aneurysmal dilatation of the ascending aorta.4.Common bile duct dilatation with mild intrahepatic biliary duct dilatation. Recommend dedicated cross-sectional abdominal imaging if there is clinical concern. |
Generate impression based on findings. | 74-year-old female with history of multiple myeloma, status post stem cell transplant. SKULL: Two views of the skull are within normal limits.CERVICAL SPINE: Two views of the cervical spine demonstrate degenerative disk disease of the lower cervical spine, including severe disk space narrowing at C6-7 and moderate disk narrowing at C5-6, with anterior vertebral body osteophyte formation. No discrete myelomatous lesions identified. Calcifications at the right carotid bifurcation are unchanged.THORACIC SPINE: Single view of the thoracic spine demonstrates a moderate wedge deformity of the C7 vertebral body, unchanged. No discrete myelomatous lesions identified. LUMBAR SPINE: Two views of the lumbar spine demonstrate grade 1 anterolisthesis of L4 on L5, with moderate disk space narrowing. The remainder of the lumbar spine is unremarkable without evidence of myelomatous lesions. Atherosclerotic calcification of the distal aorta is noted.RIBS: No significant abnormality noted.PELVIS: Single view of the pelvis demonstrates right bipolar hemiarthroplasty. A calcified fibroid is present in the pelvis.UPPER EXTREMITY: Bilateral high-riding humeral heads suggests chronic rotator cuff tears. Mild degenerative disease affects the bilateral acromioclavicular joints. A well corticated ossicle distal to the right medial epicondyle may relate to remote trauma versus heterotopic bone formation. No discrete myelomatous lesions identified.LOWER EXTREMITY: The aforementioned right bipolar hemiarthroplasty is again demonstrated. There are arterial vascular calcifications in the legs. No discrete myelomatous lesions identified. | Stable degenerative arthritic changes as described above. No discrete myelomatous lesions are identified. |
Generate impression based on findings. | 54-year-old female. Cervical cancer. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Motion artifact limits accurate measurement of reference lymph nodes. Precarinal lymph node is 1.2 x 1 cm (series 3, image 38), unchanged. Right hilar reference node is 1.6 x 1.4 cm (series 3, image 38), previously 1.7 x 1.5 cm. Small prevascular lymph node 9serise 3, image 27), hypermetabolic on prior PET is not significantly changed. No new lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Increased size of a soft tissue metastasis posterior to the left psoas muscle with new invasion into the lateral aspect of the L5 vertebral body and left transverse process (series 3, image 134). It measures 3.1 x 2.9 cm, previously 1.8 x 1.5 cm. There is mild encroachment of the left L5-S1 neural foramina.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Increased size of soft tissue metastasis posterior to the left psoas muscle now invading the left L5 vertebral body and transverse process. Intrathoracic lymphadenopathy is stable. No new sites of disease. |
Generate impression based on findings. | 13-year-old male status post like lengthening procedure. Follow up evaluation. Three views of the right knee demonstrate normal anatomic alignment with open growth plates.Three views of the left knee demonstrate postsurgical changes related to epiphysiodesis. Again noted is a lucency at the distal aspect of the tibial component and the prosthesis cement interface, unchanged from prior exam. The prosthesis appears intact, without evidence of fracture. Two views of the left femur demonstrate resection of the distal two thirds of the femur with expandable prosthesis in place. | 1.Postsurgical changes as detailed above.2. Stable lucency at the distal aspect of the tibial component.3. Growth plates remain open on the right. |
Generate impression based on findings. | Frontal sinus: The frontal sinuses and right frontoethmoidal recess are clear. There is mild mucosal thickening of the left frontoethmoidal recess. Anterior ethmoids: There is minimal opacification of a right anterior ethmoid air cell, which are otherwise clear. There is moderate mucosal thickening of the left anterior ethmoid air cells.Maxillary sinuses: There is mild mucosal thickening of the right maxillary sinus. There is near complete opacification of the left maxillary sinus, which is mildly hyperdense. The right ostiomeatal unit is clear. The left ostiomeatal unit is opacified.Posterior ethmoids: The right posterior ethmoid air cells are clear. There is minimal opacification of a few left posterior ethmoid air cells, which are otherwise clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is mild left to right nasal septal deviation with small right-sided spur. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Predominantly left-sided paranasal sinus disease with hyperdense material in the left maxillary sinus, which likely represent inspissated secretions. However, fungal colonization cannot be entirely excluded. |
Generate impression based on findings. | 60 year-old female with right knee pain, status post fall. Four views of the right knee demonstrate small tricompartmental osteophytes, consistent with mild osteoarthritis, similar to prior exam, although direct comparison is unable to be made, given lack of weight-bearing views. There is no acute fracture or malalignment. No evidence of joint effusion. | Stable mild osteoarthritis; no evidence of fracture or malalignment. |
Generate impression based on findings. | Male; 60 years old. Reason: Evaluate for obstruction History: Abdominal pain ABDOMEN:LUNG BASES: Mild bibasilar subsegmental atelectasis and/or scarring. No visible coronary artery calcifications. Minimal amount of oral contrast within the distal esophagus, raising the question of gastroesophageal reflux. LIVER, BILIARY TRACT: Mild hepatomegaly with the right lobe of the liver measuring 19-cm in length. No focal liver lesions. No biliary dilation.SPLEEN: No significant abnormality notedPANCREAS: Acute pancreatitis with diffusely increased size of the pancreas and moderate peripancreatic free fluid around the body and tail. No pancreatic duct dilation. Mild heterogeneity of the distal pancreatic tail is likely due to insinuating fluid though early necrosis cannot be excluded. No evidence of hemorrhage. No splenic artery pseudoaneurysm evident. Patent splenic vein.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal simple cysts. Additional subcentimeter hypoattenuating lesions in both kidneys are too small to characterize but likely additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral femoral head subchondral sclerosis and lucency in an appearance typical for avascular necrosis.OTHER: No significant abnormality noted | 1. Moderate acute pancreatitis as detailed above.2. Bilateral femoral head AVN, which can be due to alcohol use, steroids, or trauma among other etiologies. |
Generate impression based on findings. | 30-year-old female with history of left groin pain. An IUD is present in the pelvis. Very small lucencies around the bilateral femoral necks and intertrochanteric regions are worrisome for metastatic bone lesions. There is no acute fracture or malalignment. No significant soft tissue swelling. The sacroiliac joints and lower lumbar spine are unremarkable. | Very small lucencies around the bilateral femoral necks and intertrochanteric regions are worrisome for metastatic bone lesions; MRI including both proximal femurs is recommended for further characterization. |
Generate impression based on findings. | 69 year-old female with bilateral leg pain. Four nonweightbearing views of the left knee demonstrate no significant osteoarthritis. No evidence of fracture or malalignment.Four nonweightbearing views of the right knee demonstrate no significant osteoarthritis. No evidence of fracture or malalignment.Two views of the left hip demonstrate normal anatomic alignment. No fracture is evident and there is significant soft tissue swelling.Two views of the right hip demonstrate normal anatomic alignment. No fracture is evident and there is significant soft tissue swelling.Four views of the lumbar spine demonstrate significant disk disease at L5-S1 with vacuum phenomenon. Alignment is anatomic. The vertebral body heights are preserved. No evidence of acute fracture. | Degenerative disk disease at L5-S1. Otherwise, unremarkable examination of the lumbar spine, hips, and knees. |
Generate impression based on findings. | Extensive postoperative are again seen from previous cranial vault reconstruction. There has also been evidence of previous suboccipital decompression. However, there is worsening of the abnormal caudal extent of the cerebellar tonsils below the level of the neo-foramen magnum, with increasingly pointed appearance. The cerebellar tonsils now extend down to the lower margin of the anterior arch of C1, previously only to the upper margin. There is no crowding of the CSF space at these levels. There is mild flattening of the ventral pons with increased linear configuration of the brainstem and upper cervical cord. The cerebellum also now has a more vertical appearance to the crowding.CSF flow imaging demonstrates no detectable CSF flow within the cord ventricle or cerebral aqueduct. Trace biphasic flow is identified along the dorsal upper cervical spinal canal, just caudal to the cerebellar tonsil tip. This is decreased since the prior exam. There is ventral biphasic flow identified.The ventricles and sulci are within normal limits. There is now effacement of the suprasellar cistern with slight change in orientation of the pituitary tissue within the sella which may result from associated mass effect from the carotid suprasellar structures. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal fluid within the right mastoid air cells. There is mild mucosal thickening in the maxillary sinuses. There is a persistent mucous retention cyst within the left paramedian nasopharyngeal soft tissues. | 1. Postoperative changes from Chiari decompression, with worsened caudal extension of the now pointed cerebellar tonsils below the level of the neo-foramen magnum. Worsened accompanying CSF flow imaging findings, with essentially lack of flow at the level of the neo-foramen magnum with only trace dorsal flow noted along the upper cervical spinal canal, just caudal to the cerebellar tonsil tip.2. Associated flattening of the pons and change in configuration of the cerebellum secondary to the extensive crowding and brain sagging, with now effacement of the suprasellar cistern.3. Stable ventricular size. |
Generate impression based on findings. | 35-year-old female with history of left knee pain. Four views of the left knee demonstrate no acute fracture or malalignment. No significant joint effusion. | No evidence of fracture or significant joint effusion. |
Generate impression based on findings. | Reason: had rul on earlier ct--has had mucous clearance bronchoscopically--change? History: cough LUNGS AND PLEURA: No significant interval change in peribronchial nodular and reticular peripheral/subpleural opacities in the bronchovascular distribution bilaterally. Focal consolidation in the right middle lobe is not significantly changed. There is persistent bronchiectasis central airways are patent. Unchanged left basilar atelectasis/scarring. Mild mucous impaction of the distal bronchioles. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes. The heart size is normal. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: Status post left mastectomy with ipsilateral axillary lymph node dissection. No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. Mild degenerative disease affects is thoracic spine. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hypodense lesion in the left kidney not seen on the exam likely represents a benign cyst. Scattered nonspecific, subcentimeter para-aortic and retroperitoneal lymph nodes. | No significant interval change in diffuse peribronchial nodular and reticular peripheral/subpleural opacities in the bronchovascular distribution. Findings may represent sarcoidosis. |
Generate impression based on findings. | 41-year-old male with history of left ankle injury 3 months ago (never imaged), continued pain. Three views of the left ankle demonstrate well-corticated ossicles distal to the medial and lateral malleoli, which may relate to remote trauma. No acute fracture or malalignment identified. A normal variant os trigonum is present posterior to the talus. | No acute fracture or malalignment is evident. |
Generate impression based on findings. | 19 year-old male with history of fifth metacarpal fracture. Two views of the right hand redemonstrate a fracture through the distal diaphysis of the fifth metacarpal, in near-anatomic alignment. Progressive callus formation and periosteal reaction along the fracture is indicative of interval healing. The fracture line appears less distinct when compared to prior exam. | Interval healing of fifth metacarpal fracture, in near-anatomic alignment. |
Generate impression based on findings. | 57-year-old male. New diagnosis of metastatic prostate cancer. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Scattered bilateral pulmonary micronodules are indeterminate, for reference a lingular nodule is 4 mm (series 5, image 54). MEDIASTINUM AND HILA: Mildly enlarged right hilar lymph nodes, including a 1.3 x 1.4 cm node (series 3, image 47). Scattered small mediastinal lymph nodes.No pericardial effusion. No visible coronary artery calcification.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter right renal hypoattenuating focus, too small to characterize, likely a cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: Bilateral pelvic lymphadenopathy. A right internal iliac lymph node is 1.4 x 1.5 cm (series 3, image 181) and a left internal iliac lymph node is 1.1 x 1.3 cm (series 3, image 184).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Two small sclerotic foci in the right ilium (series 3, image 160) and one in the left femoral head, nonspecific.OTHER: No significant abnormality noted | 1. Pelvic lymphadenopathy suspicious for local metastases. 2. Mildly enlarged right hilar lymph nodes.3. Scattered micronodules are indeterminate, favored to be post-inflammatory; special attention on follow-up scans.4. Nonspecific small sclerotic foci in the right ilium and left proximal femur, correlate with same day bone scan. |
Generate impression based on findings. | Female, 11 years old. Evaluate shunt History: headacheVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 3/18/2015, 1029 An orphaned intracranial catheter fragment is similar in appearance to the prior CT exam dated 04/2009.The ventriculoperitoneal shunt catheter tip is intracranial, with catheter tubing coursing through the skull, and approaches the valve without kinking.Distal to the valve, the catheter courses down the right aspect of the neck and the anterior right chest, without sharp turns or evidence of kinking.The tubing makes loops at the level of its entrance into the abdominal cavity, and in the pelvis near its tip. No evidence of kinking.The craniofacial osseous structures and neck soft tissues are normal.The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax.Nonobstructive bowel gas pattern. | No radiographic evidence of VP shunt malfunction. |
Generate impression based on findings. | Male 77 years old; Reason: Abdominal pain and diarrhea, evidence of colitis? Also pain in epigastrium, crampy, evaluated biliary tract ABDOMEN:LUNGS BASES: Status post sternotomy. Right lower lobe subcentimeter calcified granuloma. Small right middle lobe atelectasis/scarring.LIVER, BILIARY TRACT: Sites of possible small focal fatty infiltration along ligament teres and in hepatic segment 3. No intrahepatic or extrahepatic biliary duct dilatation. Visualized gallbladder unremarkable. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renal hypoattenuating lesions, too small to characterize.RETROPERITONEUM, LYMPH NODES: Moderate to severe aortobiiliac atherosclerotic disease. Moderate adherent thrombus seen involving proximal SMA, mild to moderate origin narrowing. Celiac artery patent. Contrast opacification of IMA.BOWEL, MESENTERY: Sigmoid colon diverticulosis without evidence of acute diverticulitis. No significant colonic wall thickening or paracolic fat stranding seen to suggest acute colitis. Duodenal diverticulum. Some fecal material suggested in distal ileum, may reflect incompetent ileocecal valve. Contrast did not reach colon, likely secondary in part to timing of exam. Mildly prominent small bowel in upper abdomen, likely normal peristalsis. PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged prostate, measuring, measuring 5.1 cm in transverse dimension.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine, most severe in lumber spine region, and scoliosis present. | 1. Sigmoid colon diverticulosis without evidence of acute diverticulitis. No significant colonic wall thickening or paracolic fat stranding seen to suggest acute colitis. Duodenal diverticulum. Some fecal material suggested in distal ileum, may reflect incompetent ileocecal valve. Contrast did not reach colon, likely secondary in part to timing of exam. 2. No biliary duct dilatation. 3. Enlarged prostate. |
Generate impression based on findings. | There is no evidence of acute intracranial hemorrhage. There is no mass, edema, or midline shift. There are bilateral patchy areas of white matter hypoattenuation including the frontal periventricular white matter, right internal capsule, and corona radiata. No hydrocephalus or extra axial collections. There is near complete opacification of the right maxillary sinus. The remaining paranasal sinuses, ethmoid air cells, mastoid air cells, and middle ears are clear. Evidence of bilateral intraocular lens replacement. Calvarium is intact. | 1.No acute intracranial hemorrhage or mass effect. If there is continued suspicion for structural lesion, consider MRI for more sensitive evaluation.2.Patchy white matter hypoattenuation which is compatible with chronic small vessel ischemic disease. |
Generate impression based on findings. | History stress fracture, pain in the mid diaphysis. Two views of the right tibia and fibula are unremarkable. No radiographic abnormalities. Two views of the left tibia and fibula reveal sclerosis in the mid diaphysis of the tibia consistent with a stress fracture.. | Negative right tibia and fibula. Mid diaphyseal sclerosis in the left tibia consistent with the history of stress fracture |
Generate impression based on findings. | 85 years, Male. Reason: r/o obstruction History: abdominal distension There is a nonobstructive bowel gas pattern. Absent right kidney shadow. Surgical clips project over the right midline abdomen. Mild degenerative changes affect the bilateral hips and lower lumbar spine. | Mild ileus-type gas pattern. |
Generate impression based on findings. | 15-year-old male with history of fractureVIEWS: Right hand PA, oblique and lateral (3 views) 3/18/15 Again seen is a predominantly transverse fracture of the distal fifth metacarpal with volar angulation of the distal fracture fragment. New periosteal reaction consistent with healing. | Healing boxer's fracture. |
Generate impression based on findings. | Male; 70 years old. Reason: patient with a history or urothelial cancer, status post chemotherapy, please assess for disease progression History: urothelial cancer Lack of intravenous and oral contrast limits sensitivity for solid organ and bowel pathology, respectively.CHEST:LUNGS AND PLEURA: Stable right lower lobe nonspecific 6-mm pulmonary nodule (series 5/69). Stable probable intrapulmonary lymph node along the right minor fissure (series 5/63). Additional scattered pulmonary micronodules are stable. No new suspicious pulmonary nodules or masses.Stable scarring along the anterior right upper lobe. No consolidations.Stable bilateral calcified and noncalcified pleural plaques, likely related to prior asbestos exposure. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar adenopathy seen. Normal heart size. No pericardial effusion. Severe coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy. No suspicious osseous lesions. New mild left gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable subcentimeter hypodense left renal lesion, likely a cyst. Status post right nephroureterectomy.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Fat-containing umbilical hernia is present. L2 vertebral body hemangioma is noted. Severe degenerative changes are seen throughout the lumbar spine, most notably at L2-L3 and L5-S1.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Small fat-containing bilateral inguinal hernias. | 1. Stable nonspecific right lower lobe pulmonary nodule. No new suspicious pulmonary nodule or mass.2. Status post right nephroureterectomy. No evidence of residual or recurrent disease. |
Generate impression based on findings. | 60 year-old female. Pain. Evaluate for hernia. EPIC history: h/o ventral hernia with pain near hernia. Small umbilical hernia on physical exam. Lack of intravenous contrast limits evaluation for solid organ pathology.CHEST:LUNGS AND PLEURA: A micronodule in the right upper lobe is unchanged from 2006 and benign. Faint clustered ground less opacities in the right middle lobe likely represents aspiration and/or infection.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy within limits of noncontrast exam.No visible coronary artery calcification. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. Previously seen calcific density adjacent to the gallbladder fossa is no longer visualized.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive bilateral renal stones. Renal cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical findings of Roux-en-Y gastric bypass. No bowel obstruction. Surgical staples in the left upper quadrant around the stomach and adjacent to the spleen.BONES, SOFT TISSUES: Postsurgical findings ventral hernia repair without evidence of recurrent hernia. Asymmetric fatty atrophy of the right rectus abdominis muscles. OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Post-surgical findings of ventral hernia repair without evidence of a recurrent hernia. No bowel obstruction.2. Faint groundglass opacities in the right middle lobe likely represent aspiration and/or infection. |
Generate impression based on findings. | Please note that axial T2 star images are somewhat limited by artifact. The cervical spine is in normal alignment, with slight straightening of the normal cervical lordosis. There is minimal disk narrowing at C4-C5 and C5-C6. The remaining vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is a slightly heterogeneous appearance of the bone marrow signal which is nonspecific. The spinal cord is of normal caliber and signal.At C2-C3, there is no significant disk pathology or stenosis.At C3-C4, there is a minimal central protrusion indents the ventral thecal sac. There is uncovertebral hypertrophy with moderate bilateral foraminal narrowing.At C4-C5, there is a mild posterior osteophyte disk complex with rightward prominence. There is a mild to moderate central spinal stenosis. Right-sided uncovertebral hypertrophy also contributes to moderate and severe right foraminal narrowing. There is mild to moderate left foraminal narrowing due to left uncovertebral hypertrophy. There is mass effect upon the right ventral cord which is deformed.At C5-C6, there is a mild diffuse posterior osteophyte disk complex with superimposed left paracentral disk protrusion. There is moderate spinal stenosis. Bilateral uncovertebral hypertrophy contributes to overall moderate-severe right and moderate left foraminal narrowing.At C6-C7, there is a mild posterior osteophyte disk complex with left paracentral shallow disk protrusion. There is flattening of the left ventral cord with mild-moderate central stenosis. There is moderate-severe left and moderate right foraminal narrowing, with bilateral uncovertebral hypertrophy.At C7-T1, there is no significant disk pathology or stenosis. | 1. Mild scattered cervical spondylotic changes with findings most prominent at C4-C5 where there is moderate-severe right foraminal narrowing with deformity of the right ventral cord as well as mild to moderate central spinal canal stenosis. There is likely impingement of the right ventral C5 nerve root, for which clinical correlation is recommended.2. Additional moderate-severe left foraminal narrowing at C6-C7 and right foraminal narrowing at C5-C6, with moderate central spinal canal stenosis at C5-C6. |
Generate impression based on findings. | Female 76 years old Reason: s/p surgical repair hiatal hernia 2012; now with burping, dysphagia History: s/p surgical repair hiatal hernia 2012; now with burping, dysphagia Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed postsurgical changes related to gastropexy. The previously seen hiatal hernia is substantially decreased in size now measuring approximately 2.5 x 2.8 cm.The esophagus is patulous and the gastroesophageal junction was fixedly opened. Reticulation of the distal esophageal mucosa was noted; however, poor contrast coating during the double contrast phase somewhat limits evaluation of this area. During evaluation of peristalsis, there was abruption of the primary wave at the level of the aortic arch, and proximal escape to the level of the cervical esophagus. Spontaneous gastroesophageal reflux was noted to the mid thoracic esophagus.TOTAL FLUOROSCOPY TIME: 4:01 minutes | 1.Postsurgical changes related to gastropexy with marked interval decrease in size of the hiatal hernia with only a small residual hiatal hernia present.2.Nonspecific reticulation of distal esophageal mucosa, incompletely evaluated secondary to poor contrast coating, may reflect changes related to esophagitis or possibly Barrett's esophagus. Further evaluation with direct visualization is recommended as clinically indicated.3.Spontaneous gastroesophageal reflux to the level of the mid thoracic esophagus.4.Mild minor motor abnormality. |
Generate impression based on findings. | 60 year-old male with history of lung cancer CHEST:LUNGS AND PLEURA: Moderate to severe centrilobular emphysema.Right apical mass contiguous with the posterior pleura measures 2.4 x 2.1 cm (series 5, image 97) previously 2.7 x 3.0 cm. No obvious osseous involvement.Surrounding interstitial thickening may reflect local tumor spread.Reference left upper lobe non-solid nodule with internal cyst (series 5, image 114) measures 17 mm, previously 18 mm.Reference lobulated left upper lobe solid nodule (series 5, image 129) measures 16 mm, previously 18 mm.Reference left lower lobe subpleural nodule is unchanged measuring 18 mm (series 5, image 254). No new nodules or masses.Frothy debris in the trachea may represent secretions or aspirated material.MEDIASTINUM AND HILA: Reference left hilar lymph node is currently not measurable and does not need to be measured. For future reference, a right hilar lymph node measures 12 mm, unchanged in size, previously measuring 12 mm (1/19/13 CT) and 13 mm (11/13/14 CT) . Heart size is normal. No significant mediastinal lymphadenopathy. No pericardial effusion. Severe coronary artery calcification. CHEST WALL: No suspicious osseous lesions. Mild degenerative disease affects the thoracic spine. No axillary, phrenic, or retrocrural lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Striated nephrogram bilaterally. No hydronephrosis or perinephric inflammation. Focal subcentimeter hypodense are too small to further characterize but presumably represent cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branch vessels without evidence of aneurysmal dilatation.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval decrease in size of right posterior apical mass. Additional nodules in the left lung are not significantly changed.2.Striated nephrogram pattern bilaterally may represent pyelonephritis; correlation with urinalysis is recommended. |
Generate impression based on findings. | Male 72 years old; Reason: prostate cancer, eval for metasttatic disease History: prostate cancer CHEST:LUNGS AND PLEURA: Couple punctate granulomas in the left lung.MEDIASTINUM AND HILA: Numerous cardiomediastinal lymph nodes are noted, none larger than 1 cm in short axis. The largest measures up to 7 mm retrocaval pretracheal node (4:28).CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Tiny hepatic hypodensity, too small accurately characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of metastatic disease. Please correlate with same day bone scan. |
Generate impression based on findings. | 79-year-old male. Prostate and bladder cancer. Evaluate for recurrence. Interval exam. Lack of intra-abdominal fat limits evaluation.ABDOMEN:LUNG BASES: Mild centrilobular emphysema.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable subcentimeter hypoattenuating foci in the kidneys, too small to characterize, likely cysts and unchanged.RETROPERITONEUM, LYMPH NODES: Moderate to severe calcified atherosclerotic disease of the abdominal aorta and branch vessels without aneurysm, unchanged.BOWEL, MESENTERY: Right lower quadrant ileal conduit, stableBONES, SOFT TISSUES: Degenerative changes in the thoracolumber spine most severe at L5-S1 again noted.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: Status post cystectomy.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Right lower quadrant ileal conduit, stable.BONES, SOFT TISSUES: Degenerative changes in the thoracolumber spine most severe at L5-S1. Sclerotic focus in the left pubic symphysis slightly increased in size compatible with a metastasis.OTHER: No significant abnormality noted | Left symphysis pubis metastasis, slightly increased in size. |
Generate impression based on findings. | 43 year old female recalled from screening mammography for round asymmetry in the right posterior lateral breast on CC view. MLO, ML, and CC spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Previously described round asymmetry in the posterior lateral right breast disperses into normal breast parenchyma on spot compression. Round mass with halo in the 12 o'clock position, anterior depth is noted. Scattered calcifications are stable.No dominant mass or areas of architectural distortion in the right breast. | Scattered breast cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Right greater than left base of tongue lesion seen on prior study is significantly decreased in size, with the right-sided mass now measuring 1.7 x 1.8 cm (series 10 image 36), previously 3.6 x 3.5 cm. The current measurement likely includes some normal lymphoid tissue in the lingual tonsils which is not delineated from the mass. There is also some residual prominent enhancing soft tissue along the left base of tongue projecting partially into the vallecula (10/38) which is nonspecific. Necrotic right level 2 lymph node on prior study is also significantly decreased in size now measuring 0.6 x 1.0 cm (series 10 image 33), previously 1.8 x 1.8 cm. There is borderline enlarged right level 1b lymph node now measuring 1.1 cm (series 10 image 37), previously 0.9 cm. Other scattered non-pathologically enlarged lymph nodes have decreased in size. The parotid, salivary, and thyroid glands are unremarkable. The airway is patent. There is no new cervical lymphadenopathy by CT size criteria. Right sternocleidomastoid muscle is atrophic. Partially imaged encephalomalacia of the right temporal lobe. There are scattered truncated teeth with residual roots. Right mandibular tooth with periapical lucency. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are unremarkable. Mild degenerative disc disease of the cervical spine worst at C4/5 level. Centrilobular emphysema of the lung apices. Right-sided chest port is partially visualized. | 1.Interval significant reduction in the size of the right base of the tongue lesion and right level 2 lymph node. Asymmetric enhancing tissue noted at left base of tongue which could represent residual tumor as previous tumor was noted across midline, versus lymphoid tissue.2.Borderline enlarged right level 1b lymph node with slight interval increased size. Attention on subsequent imaging. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are ultrasound images of left breast and both axillae (3/4/15), images from ultrasound guided left breast biopsy (3/12/15) performed at Northwestern Memorial Hospital. ULTRASOUND IMAGES OF LEFT BREAST AND BOTH AXILLAE (3/4/15):A lobulated, oval-shaped mass, measuring 25 x 19 mm, is visualized at 11 o'clock position, 3 cm from nipple, in the left breast. Increased blood flow is seen within the mass.There are a few benign appearing lymph nodes in the left axilla, and one benign appearing lymph node in right axilla. No suspicious features are present in any of the lymph nodes.IMAGES FROM ULTRASOUND GUIDED LEFT BREAST BIOPSY (3/12/15):Needle biopsy is performed for the left breast mass under ultrasound guidance, with appropriate needle placement. A coil clip is placed within the mass.Per outside radiology report, the pathology result of this biopsy was malignant; invasive ductal carcinoma grade 3. | Biopsy proven left breast IDC.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 64-year-old male with questionable cavitary mass. PULMONARY ARTERIES: Adequate pulmonary artery opacification without evidence of pulmonary embolus. Pulmonary artery is borderline enlarged measuring 29 mm. LUNGS AND PLEURA: Small left pleural effusion with bilateral dependent atelectasis. Mosaic attenuation of the lungs. Asymmetric faint peribronchovascular groundglass opacities in the right lung. No cavitary lesions.Debris is present within the trachea and left main bronchus. There is mild bronchial wall thickening predominately at the lung bases with peribronchial opacities suggestive of aspiration. Numerous pulmonary micronodules, the majority of which are calcified, statistically most likely granulomas.Probable subpleural lymph node along the right major fissure measuring 5-mm (11/72), this can be followed if the patient is at high risk for malignancy with CT in 4 months node although it is most likely a benign lesion.MEDIASTINUM AND HILA: Prominent subcarinal lymph nodes measuring up to 15 mm. Increased lymphoid tissue in the hila bilaterally. Severe coronary artery calcification. Heart size is normal. No pericardial effusion. CHEST WALL: Healing left posterior 11th rib fracture. Peripherally sclerotic lesions in the right scapula may represent infarcts and could represent the lesion seen on the recent chest radiograph. No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. Mild gynecomastia. The vertebral arteries are noted to have atherosclerotic calcification bilaterally, stenosis, especially on the right cannot be excluded.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism.2.Peripherally sclerotic lesions in the right scapula suspicious for skeletal infarcts and could represent the abnormality seen on chest radiograph. No cavitary pulmonary lesions. 3.Very mild peribronchovascular groundglass opacities in the right lung may reflect asymmetric pulmonary edema.4.Bronchial wall thickening and peribronchial opacities suggestive of aspiration.5.Mild thoracic lymphadenopathy, unclear etiology, 4 month follow up CT is suggested unless the referring clinical service can obtain and submit remote outside prior studies to document stability.6.Probable tracheobronchomalacia with mosaic attenuation suggestive of air trapping, likely due to small airways disease.7.Severe atherosclerotic calcification involving the vertebral arteries, stenosis cannot be excluded, consider CTA of the neck if further evaluation is required.8.5-mm sub-solid nodule right middle lobe may be followed by CT in 4 to 6 months, but is most likely a benign subpleural lymph node.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 49-year-old male. Classical Hodgkin's lymphoma status post 6 cycles of ABVD now with new symptoms. CHEST:LUNGS AND PLEURA: Scattered micronodules are likely postinflammatory, special attention on follow-up scans.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. No visible coronary artery calcification. Right chest wall port tip terminates at the cavoatrial junction.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Subcentimeter hypoattenuating foci in the kidneys are too small to characterize.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Scattered small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted | No lymphadenopathy in the chest, abdomen, or pelvis. |
Generate impression based on findings. | RFO trigger: R/O RFO Suspected RFO location: abdomen Name of suspected RFO: none Attending Surgeon name/pager: Dr. MIllis/8217 Body Mass Index (BMI): 33.9 Surgical drain tip projects over the midline upper abdomen. Pneumoperitoneum, presumably postoperative in etiology. Left retrocardiac opacity suggest atelectasis. No unexpected radiopaque foreign object identified. | No unexpected radiopaque foreign object.These findings were discussed by telephone with Dr. Millis, the attending surgeon, on 3/18/2015 at 11:52. |
Generate impression based on findings. | Clinical question: Intracranial stenosis. Signs and symptoms: Recent TIA like episodes. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Very subtle small foci of low attenuation of white matter in the subcortical and periventricular region is noted and consistent with previously known mild age indeterminate small vessel ischemic strokes.The cerebral cortex, cortical sulci, ventricular system and the CSF spaces are otherwise within normal for patient's stated age of 70.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and middle ear cavities. Minimal debris within the right external artery canal is noted. Neck CTA:The visualized aortic arch and the origins of major vessels are unremarkable. Brachial cephalic and bilateral subclavian arteries are unremarkable.The origins of bilateral vertebral arteries demonstrate tiny vascular calcification however without detectable vascular lumen compromise.Bilateral common carotid arteries including their origins are unremarkable however there is significant tortuosity of the common carotid arteries and in the thoracic space. Bilateral internal carotid arteries remain widely patent and unremarkable however demonstrate mild vascular calcification at the level of bifurcation. Incidental note is made of a larger right lobe of the thyroid containing multiple foci of low attenuation/cysts suggestive of goiter. Recommend follow up with dedicated imaging if clinically been necessary. Head CTA:Bilateral vertebral arteries are widely patent and unremarkable. Bilateral pica branches arise from vertebral arteries at the level of foramen magnum outside of the subarachnoid space which is a normal anatomical variation. Vascular artery and its distal branches are widely patent and unremarkable.Right internal carotid artery is patent across the skull base in its supraclinoid segment. There is a small vascular outpouching arising from the right supraclinoid internal carotid with medial and posterior projection and measuring at 3 mm in length, 2.4 mm in transverse axis and approximately 2 mm at the base. This finding could represent an infundibulum at the origin of the right anterior choroidal artery. Less likely possibility of an aneurysm cannot be entirely excluded.Right anterior cerebral artery and its branches as well as the anterior communicating arteries are unremarkable. Right middle cerebral artery and its branches are well visualized and unremarkable. There is anatomical variation of fetal origin of the right posterior cerebral artery.Next internal carotid artery is patent across the skull base and in the supraclinoid segment. Infundibulum at the origin of left posterior communicating artery is detected. The left anterior and middle cerebral arteries are patent and unremarkable. | 1.Unenhanced head CT demonstrates subtle findings of age indeterminate small vessel ischemic strokes and unremarkable otherwise minimal bilateral calcification2.Neck CTA demonstrate no evidence of hemodynamically significant vascular compromise. Mild vascular calcification at the origins of bilateral vertebral and common carotid bifurcations are noted. Enlarged right lobe of thyroid as detailed above.3.Intracranial CTA demonstrate no evidence of any vascular lumen compromise or distal vascular occlusion. Infundibulum or less likely an aneurysm at the origin of the right anterior choroidal artery. |
Generate impression based on findings. | 60-year-old female with a history of left breast invasive ductal carcinoma status post left mastectomy in 2010. She also had a benign right breast biopsy in 2013. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. In the upper outer right breast at 9 o'clock, there is a percutaneously placed clip in a benign subcentimeter mass. Scattered benign calcifications are also present.No dominant mass, suspicious microcalcifications or areas of architectural distortion in right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: 48 y/o female with breast cancer; surgery 2/20/15 in DCAM for Right breast SNBx History: breast cancer RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 0.51 mCi Tc-99m filtered sulfur colloid was injected in four peri-lesional sites. Two foci of increased activity are noted in the right axilla, representing the sentinel node(s). These regions were marked with an indelible marker. | Sentinel nodes identified in the right axilla. |
Generate impression based on findings. | Reason: prostate cancer, eval for bone mets No abnormal osseous foci are identified to indicate metastatic disease.Scattered areas of degenerative radiotracer uptake are present at the T8-9 vertebral level and along the right L4-5 facet which are confirmed on CT. Urine contamination is visualized which resolves on subsequent images. | No evidence of bone metastasis. |
Generate impression based on findings. | Chronic nasal congestion, cough and PND; polypoid tissue seen on left side along nasal floor under inferior turbinate. There is a nonspecific subcentimeter opacity in the left inferior meatus. The nasal septum is deviated slightly towards the right. There are postoperative findings related to endoscopic sinus surgery, including right uncinectomy and perhaps unroofing of a right lamellar concha bullosa. There is mild mucosal thickening in the maxillary sinuses and a small retention cyst in the right sphenoid sinuses. The other paranasal sinuses are clear. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | 1. Nonspecific subcentimeter opacity in the left inferior meatus. 2. Slight nasal septal deviation. 3. Postoperative findings related to endoscopic sinus surgery with a small amount of paranasal sinus opacification in a sporadic pattern. |
Generate impression based on findings. | 11 day old former 27 week twin gestational age patient with increased oxygen requirementsVIEW: Chest AP (one view) 03/18/15, 0736 Feeding tube tip is distal to proximal gastric body and not included on the image. Umbilical venous line tip is at junction of inferior vena cava and right atrium.Cardiothymic silhouette is normal. Hazy bilateral lung opacities persist. | Persistent hazy lung opacities. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in multiple sisters and aunts. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Sister with breast cancer. Two standard digital views of both breasts (obtained on 9 images) were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications and normal-sized left intramammary and bilateral axillary lymph nodes are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast cancer in her paternal grandmother and two aunts. 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. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Again noted are postoperative changes from prior left suboccipital craniotomy, including a linear surgical cavity and mild surrounding gliosis. There are scattered foci of susceptibility in the surgical bed consistent with chronic hemosiderin deposition. There is no abnormal enhancement to suggest tumor recurrence. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is suggestion of a tiny linear area of hypoenhancement within the posterior aspect of the anterior pituitary gland, abutting the posterior pituitary bright spot which may represent an incidental pars intermedia cyst. The remainder of the midline structures and craniocervical junction are within normal limits. There is mild scattered mucosal thickening in the ethmoid air cells and maxillary sinuses. | Continued stable appearance of postoperative changes within the posterior fossa, without evidence of tumor recurrence. |
Generate impression based on findings. | Right hand tingling. Neck stiffness. Severe degenerative disk disease affects C3/4 with anterior and posterior vertebral body osteophytes. Moderate to severe degenerative disk disease affects C5/6 with anterior and posterior vertebral body osteophytes. Moderate degenerative disk disease affects C6/7. There are perhaps minimal (1-2mm) retrolistheses of C3 and C4 that correct on flexion. | Degenerative disk disease as above. |
Generate impression based on findings. | Female 80 years old; Reason: baseline exam prior to starting new systemic therapy; please give bi-dimensional measurements History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: New small right greater than left pleural effusions. Index right lower lobe nodule measuring 2.6 cm seen on prior CT exam not well visualized, expected region obscured by right pleural effusion. Additional nodules also not well seen. Upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: Mild to moderate cardiomegaly. Atherosclerotic aortic calcifications. Index lymph node in pretracheal region measures 1.7 x 1.1 cm, image 40 series 3, previously measured 0.9 x 0.9 cm. Nonspecific pretracheal lymph node measuring 1.7 x 1.1 cm with fatty hilum. Additional smaller mediastinal lymph nodes present and also mildly increased in size.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Focal fatty infiltration along ligament teres.SPLEEN: New wedge-shaped hypoattenuation involving the lateral aspect of spleen, suspicious for infarct.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Interval improvement in previously seen right-sided hydronephrosis with right-sided nephroureteral stent now seen and exiting right-sided urostomy. Asymmetrically smaller right kidney with cortical scarring seen. Mild bilateral hydronephroureter, left greater than right (on left side, new; on right side, improved). Minimal urothelial wall enhancement on right side, may be reactive in etiology but nonspecific. Unchanged from earlier study are multiple subcentimeter left renal lesions, too small to characterize.RETROPERITONEUM, LYMPH NODES: Reference left retroperitoneal/paraaortic lymph node without significant change accounting for differences in technique, measuring 1.4 x 1 cm, image 145 series 3, previously measured 1.5 x 1.2 cm. Moderate to severe aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Moderate-sized hiatal hernia. No interval change in ill-defined right lower quadrant soft tissue attenuation, measuring 2 x 1.6 cm on image 183 series 3, previously measured 1.9 x 1.8 cm. Stable dystrophic calcification seen in right lower abdomen. Lower pelvic small bowel anastomotic suture material. PELVIS:UTERUS, ADNEXA: Previously visualized heterogeneous soft tissue enhancement in expected periurethral/perineal area not as well seen on current study, although moderate soft tissue fullness again present and some persistent heterogeneous enhancement seen anteriorly, more pronounced on left than on right, image 217 series 3.BLADDER: Status post cystectomy with associated surgical clips.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance, degenerative spinal disease. | 1. Interval improvement in previously seen right-sided hydronephrosis with right-sided nephroureteral stent now seen and exiting right-sided urostomy. Asymmetrically smaller right kidney with cortical scarring seen. Mild bilateral hydronephroureter, left greater than right (on left side, new; on right side, improved). Minimal urothelial wall enhancement on right side, may be reactive in etiology but nonspecific. 2. Mild interval increase in size of mediastinal lymph nodes, nonspecific. New small right greater than left pleural effusions. Index right lower lobe nodule measuring 2.6 cm seen on prior CT exam not well visualized, expected region obscured by right pleural effusion. Additional nodules also not well seen. 3. New wedge-shaped hypoattenuation involving the lateral aspect of spleen, suspicious for infarct.4. Stable retroperitoneal adenopathy and indeterminate ill-defined right lower quadrant soft tissue nodularity. 5. Improvement in ill-defined soft tissue enhancement in periurethral/perineal region as above, underlying infectious or neoplastic etiology are differential considerations and correlation with patient's clinical history and physical exam recommended.6. Moderate-sized hiatal hernia. |
Generate impression based on findings. | Evaluate dorsal soft tissue mass. There is a mass within the soft tissues of the foot dorsal to the metatarsal bases seen on the lateral view, which I suspect is approximately 1-2 cm in long axis. It is nonspecific and does not show mineralization or erosion of the underlying bone. There is a mild flat foot deformity. Mild osteoarthritis affects the ankle and midfoot. | Nonspecific dorsal soft tissue mass as described above. This can be further evaluated with ultrasonography or MRI if clinically warranted. |
Generate impression based on findings. | Left knee pain and crepitance. Osteoarthritis? Three views of the left knee are provided. Small osteophytes and mild medial compartment narrowing indicate mild osteoarthritis. The bones appear slightly demineralized. There is a moderate-sized joint effusion.Mild osteoarthritis affects the right knee as seen on the frontal view. | Osteoarthritis. |
Generate impression based on findings. | Right sided nasal obstruction; right sided nasal mass seen on exam. There is a polypoid opacity in the right nasal cavity with associated truncation of the middle and inferior turbinates. There are multiple polypoid opacities in the maxillary sinuses, moderate mucosal thickening in the sphenoid sinuses, and scattered opacification of the ethmoid sinuses. There is mild S-shaped nasal septum deviation with mild spur formation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | The findings are indicative of sinonasal polyposis. |
Generate impression based on findings. | Osteoarthritis of the left hip. Left hip pain. Please reevaluate. Severe osteoarthritis affects the hip, which has progressed when compared with the prior study. | Severe osteoarthritis. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with straightening of the normal lumbar lordosis. The vertebral body and disk heights are similar, with multilevel disk narrowing and desiccation, up to moderate-severe in degree at L4-L5. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L2 level.Sagittal images again demonstrate a trace disk bulge at T9-T10.At T10-T11, there is a mild disk bulge and minimal ligamentum flavum thickening resulting in overall moderate central spinal canal stenosis. There is also moderate bilateral foraminal narrowing.At T11-T12, there is a stable mild disk bulge with bilateral facet arthropathy and ligamentum flavum thickening with minimal central spinal canal stenosis and mild right foraminal narrowing.At T12-L1, there is a stable trace disk bulge without stenosis. Bilateral facet arthropathy and ligamentum flavum thickening is noted.At L1-L2, there is a prominent disk bulge and bilateral facet arthropathy and ligamentum flavum thickening. There is mild to moderate central spinal canal stenosis with slight bunching of the cauda equina nerve roots. There is mild to moderate right and mild left foraminal narrowing.At L2-L3, there is a similar appearance of the large disk bulge with significant bilateral facet arthropathy and ligamentum flavum thickening. There is overall severe central spinal canal stenosis, as well as moderate right and minimal left foraminal narrowing.At L3-L4, there is a moderate disk bulge with left-sided prominence, resulting in narrowing of the left lateral recess. There is prominent bilateral facet arthropathy and ligamentum flavum thickening with overall moderate central spinal stenosis as there is also proliferation of dorsal epidural fat at this level. There is moderate to severe left and mild right foraminal narrowing.At L4-L5, there is a stable mild disk bulge with bilateral severe facet arthropathy and ligamentum flavum thickening. There is narrowing of the left lateral recess. There is only mild central spinal canal stenosis with mild right and moderate left foraminal narrowing.At L5-S1, there is a stable diffuse disk bulge left greater than right facet arthropathy and ligamentum flavum thickening. There is indentation on the ventral thecal sac with slight narrowing of the lateral recesses. There is severe bilateral foraminal narrowing.There is a similar appearance of prominence of the right renal collecting system and the entire course of the visualized right ureter. There are several scattered T2 hyperintense rounded structures within the right kidney are nonspecific but most likely represent small cysts. The left kidney is not visualized. There is left paraspinal musculature atrophy. A rounded T2 hyperintense structure associated with the posterior right lobe of the liver, most likely a cyst. | 1. No significant interval change in multilevel severe spondylosis with up to severe central spinal canal stenosis at L2-L3 and multilevel high-grade foraminal narrowing as detailed above.2. Persistent prominence of the right renal collecting system including the entire visualized right ureter. Please correlate clinically. |
Generate impression based on findings. | Hand pain for 3 weeks. No trauma. Alcohol abuse. Rule out bony pathology. There are osteophytes at the second and third metacarpophalangeal joints. While this could reflect posttraumatic osteoarthritis, this finding can also be seen in patient's with CPPD arthropathy (although no chondrocalcinosis is evident) or hemochromatosis. I otherwise see no specific findings to account for the patient's hand pain. | Arthritic changes at the second and third MCP joints as above. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no acute intracranial hemorrhage or depressed calvarial fracture. There are scattered punctate areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with minimal age-indeterminate small vessel ischemic changes. There is no extraaxial fluid collection. There are mild atherosclerotic calcifications of the cavernous portion of the internal carotid arteries. Incidentally noted is an enlarged, partially empty sella. There is moderate mucosal thickening or mucus retention cyst of the right maxillary sinus. The visualized portions of the remaining paranasal sinuses and mastoids/middle ears are grossly clear. There is a left lens implant. | No acute intracranial hemorrhage or calvarial fracture. |
Generate impression based on findings. | Confusion, evaluate sinus disease No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. Mastoid air cells are clear. Calvarium is intact.Imaging was repeated due to motion degradation. Evaluation of the paranasal sinuses demonstrates minimal opacification involving the left posterior ethmoid air cells. Bilateral frontal, ethmoid, maxillary, and sphenoid sinuses are otherwise clear. Bilateral frontal recesses, sphenoethmoidal recesses, and the ostiomeatal units are patent. No findings to suggest aggressive sinonasal infection. There is leftward nasal septal deviation and prominent left septal spur. | 1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. No significant paranasal sinus disease. |
Generate impression based on findings. | 6-8 months of intermittent ache in the mid thoracic chest wall, posterior axillary line, around T5. Remote history of renal cancer in 2008. A marker was placed along the lateral aspect of the right lower rib cage. I see no underlying fracture or other specific findings to account for patient's pain. Moderate degenerative disk disease affects the thoracic spine. Severe degenerative disk disease affects the visualized lumbar spine. | Degenerative disk disease without rib fracture or other specific findings to account for the patient's rib pain. |
Generate impression based on findings. | Stage IVA HPV-positive right tonsil T2N2b squamous cell carcinoma with recurrent mediastinal adenopathy, currently enrolled in anti-PD1 MK3475/pembrolizumab clinical trial. Neck: There are post-treatment findings in the neck, including edema in the right oropharynx. There is no measurable residual right tonsil mass. However, there has been increase in size of right lower neck lymph nodes. For example, a right level 4 lymph node measures 10 mm in short axis, previously 3 mm. The thyroid and major salivary glands are unchanged. There is mild plaque at the left carotid bifurcation. There is multilevel degenerative spondylosis of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial mass or abnormal enhancement. There is a right basal ganglia chronic lacunar infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is mild opacification of the ethmoid sinuses. There is trace opacification of the bilateral mastoid air cells. There are bilateral lens implants. The skull and extracranial soft tissues are unremarkable. | 1. Post-treatment findings in the neck with increased right lower cervical lymphadenopathy, but no evidence of measurable right tonsil mass. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | Status post ORIF right distal fibular fracture, evaluate for healing. A side plate and screws affix a fracture of the distal fibula in near-anatomic alignment. The superior aspect of the fracture remains visible on the lateral view, although more distally the fracture is indistinct, suggesting some interval healing. There is also a trans-syndesmotic screw affixing the distal tibia and fibula, with slight widening of the articulation. I see no hardware complications. | Orthopedic fixation of distal fibular fracture as above. |
Generate impression based on findings. | Left hip pain Moderate osteoarthritis affects the hip. Mild degenerative arthritis also affects the visualized left sacroiliac joint. There are chronic enthesopathic changes along the iliac wing, ischium and trochanters. | Osteoarthritis. |
Generate impression based on findings. | There is straightening of the cervical lordosis on sagittal view and mild dextroconvex curve of the cervical spine on AP view, which is likely positional. There is no evidence of acute fracture of the cervical spine. There is suggestion of minimal posterior positioning of C2 with respect to C3 at the spinolaminar line as well as slightly decreased C2-3 interspinous space, which may be related to positioning. The vertebral body heights are preserved. There is moderate loss of disc height at C4-5, C5-6, and C6-7. There is a posterior disc osteophyte complex with moderate superimposed central disc extrusion at C3-4 and cranial extension of disc material measuring approximately 6-7 mm, which contributes to moderate spinal canal stenosis. There are posterior disc osteophyte complexes and mild left uncinate spurs at C4-5, C5-6, and C6-7. There is no significant spinal canal or foraminal stenosis at the other levels of the cervical spine. The paravertebral soft tissues are unremarkable. There is poor visualization of the partially imaged mediastinal fat, but the appearance is similar to the CT chest of 8/19/2013. | 1. No acute fracture of the cervical spine. 2. Suggestion of minimal posterior positioning of C2 with respect to C3 at the spinolaminar line and slightly decreased interspinous space at C2-3, which may be related to dextro convex positioning. MRI may be considered for evaluation of ligamentous injury, if there is continued clinical concern and if there are no contraindications. 3. Mild degenerative cervical spondylosis. Posterior disc osteophyte complex with moderate superimposed central disc extrusion at C3-4, contributing to moderate spinal canal stenosis. No significant spinal canal or foraminal stenosis at the other levels of the cervical spine. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with additional bilateral MLO views 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 intramammary lymph nodes are unchanged. | 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. | Bilateral hand contractures. Severe osteoarthritis? Three views of the left hand are provided. Evaluation of the digits is limited by the patient's flexion contractures. The soft tissues appear slightly edematous. Mild osteoarthritis affects the interphalangeal joints. There is chondrocalcinosis affecting the second, third and fifth metacarpophalangeal joints with mild associated degenerative arthritic changes. Chondrocalcinosis is also noted in the wrist. Severe osteoarthritis affects the basilar joint and moderate osteoarthritis affects the trapezioscaphoid articulation. Ovoid lucencies in the scaphoid and distal radius likely represent small cysts. Arterial calcifications are also noted in the soft tissues.Three views of the right hand are provided. The soft tissues appear slightly edematous. Mild osteoarthritis affects the interphalangeal joints. There is chondrocalcinosis of the second and third metacarpophalangeal joints with mild associated degenerative changes. Severe osteoarthritis affects the basilar joint and mild osteoarthritis affects the trapezioscaphoid articulation. There is also chondrocalcinosis of the wrist. Arterial calcifications are noted in the soft tissues of the wrist. | Arthritic changes as described above compatible with a combination of osteoarthritis and CPPD arthropathy. Overall the degree of arthritis appears to have progressed slightly since 2005. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign morphology mass compatible with a normal-sized intramammary lymph node in the right upper outer breast. | 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. | 59 year old female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Clinical question: Altered mental status. Signs and symptoms: Altered mental status. Nonenhanced head CT:No detectable acute intracranial process. CT however is sensitive for early detection of acute nonhemorrhagic ischemic strokes.Diffuse prevertebral subcortical low attenuation of white matter highly suspected of age indeterminate small vessel ischemic strokes considering the patient's stated age of 75. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces otherwise. Very minimal large vessel intracranial vascular calcification is noted. Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits with the exception of expected postoperative changes. Paranasal sinuses and mastoid air cells remain well pneumatized.. | 1.No acute intracranial process.2.Extensive age indeterminate small vessel ischemic strokes |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history breast cancer in her mother at age 64. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications and areas of asymmetry are unchanged. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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. New focal asymmetry in the posterior depth of the right lower outer breast. Other bilateral areas of asymmetry are stable, as are bilateral benign calcifications. No suspicious microcalcifications or areas of architectural distortion are present. | New right breast focal asymmetry for which further evaluation with spot compression and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Pneumomediastinum. Chest pain, had and neck and throat pain yesterday. LUNGS AND PLEURA: No pneumothorax, minimal extrapleural air extension from the pneumomediastinum at the thoracic inlet level and posterior to the right hilum. Very mild pulmonary interstitial emphysema extending along the proximal airways at the level of the right hilum. No focal air space opacities, subpleural cysts or emphysema. The lungs are very well inflated which may be secondary to good inspiratory effort.MEDIASTINUM AND HILA: Extensive pneumomediastinum bilaterally, extending into all compartments.No periesophageal fluid collections, hematoma or pericardial fluid. Scattered subcentimeter mediastinal lymph nodes. 11-mm low density right hilar lymph node. Anterior mediastinal soft tissue likely reflects residual thymus given the patient's age. Normal heart size. No visible coronary artery calcifications.No radiopaque foreign bodies are appreciated.No areas of discontinuity of the tracheal or esophageal wall or of the mainstem bronchi are identified, though very small tears may not be visible by this technique.CHEST WALL: Subcutaneous emphysema in the anterior chest wall.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Minimal extension of pneumomediastinum into the extraperitoneal and extrapleural reflection anteriorly. | Extensive pneumomediastinum without visible source. |
Generate impression based on findings. | Neuroblastoma s/p autoSCT, thrombocytopenic with worsening SAH. There is significant change in the scattered foci of subarachnoid hemorrhage. The grey-white matter differentiation appears to be intact. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There is new fluid within the right maxillary sinus in addition to fluid elsewhere in the paranasal sinuses likely related to intubation. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No significant change in the scattered foci of subarachnoid hemorrhage. |
Generate impression based on findings. | Male, 54 years old, reportedly correct counts. Right-sided pelvic drainage catheter. Additional left approach drainage catheter seen with tip coiled in pelvis. Adjacent to tip of this catheter is rounded heterogeneous radiodensity measuring 1.1 cm, of uncertain etiology but may be a colonic diverticulum containing inspissated contrast, patient had multiple colonic diverticula on prior CT imaging. Subcentimeter bilateral radiodensities in mid abdomen, may be postoperative in etiology. Capsule shaped radiodensity in right upper quadrant, presumably ingested by patient earlier. Surgical clips overlying right femur and medial to left femoral head and overlying lower lung fields bilaterally. Another upper abdominal surgical clip. Dual lumen central venous catheter with tips in right atrium. Enteric tube seen with side-port located in gastric fundus. Nonobstructive bowel gas pattern. Amorphous radiolucency seen in superior abdominal/inferior thoracic area, nonspecific but could reflect postoperative pneumoperitoneum. | Right-sided pelvic drainage catheter. Additional left approach drainage catheter seen with tip coiled in pelvis. Adjacent to tip of this catheter is rounded heterogeneous radiodensity measuring 1.1 cm, of uncertain etiology but may be a colonic diverticulum containing inspissated contrast, patient had multiple colonic diverticula on prior CT imaging. No unexpected repeat foreign body otherwise. Findings discussed with resident Dr. Poli at 12:55 p.m. and with surgical attending Dr. Witkowski at 1:05 p.m. on March 18, 2015. |
Generate impression based on findings. | Evaluate status post right TKA with infection Evaluation is slightly limited due to inability to optimally position the patient. I see no hardware, although there is a cement spacer device. Alignment is near-anatomic. I see no specific radiographic features of active osteomyelitis. | Cement spacer. |
Generate impression based on findings. | There is slight interval increase in mild prominence of the ventricles and sulci, consistent with mild age-related volume loss. There is no midline shift or mass effect. There is no acute 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. There is no extraaxial fluid collection. There are atherosclerotic calcifications of the cavernous portions of the bilateral internal carotid arteries. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. Partially imaged is a chronic blowout fracture of the left orbital floor with herniation of fat into the maxillary sinus. There is a 6 mm soft tissue nodule in the vertex, likely representing a sebaceous cyst or other benign subcutaneous lesion. This can be correlated with physical exam. | 1. No acute intracranial hemorrhage. 2. Slight interval increase in mild age-related volume loss. Stable mild chronic small vessel ischemic changes. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and there are no contraindications, MRI of the brain is recommended. |
Generate impression based on findings. | Status post ORIF left proximal humerus A plate and screw device affixes a fracture of the proximal humerus in near-anatomic alignment. I see no hardware complications. There is slight inferior subluxation of the humeral head with respect to the glenoid, perhaps representing an overlying joint effusion. | Orthopedic fixation of proximal humerus fracture. |
Generate impression based on findings. | Relapsed mantle cell lymphoma now on Ibrutinib. For restaging.RADIOPHARMACEUTICAL: 11.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 82 mg/dL. Today's CT portion grossly demonstrates bilateral maxillary chronic appearing sinusitis. Mild bilateral upper lobe emphysematous changes are noted. Multiple borderline enlarged right axillary, paratracheal, and hilar lymph nodes are seen. Surgical material involving right abdominal bowel is present.Today's PET examination demonstrates complete interval resolution of previous multifocal hypermetabolic tumor activity within the abdomen and pelvis.Within the chest, there has been partial decrease in size, number, and metabolic activity of previous suspicious right axillary lymph nodes. A single decreased but persistent hypermetabolic right axillary lymph node could represent residual tumor metabolism or inflammation (SUV max = 4.8 previously, = 3.6 currently). Elsewhere in the thorax, there is mild to moderate fairly symmetric bilateral hilar and paratracheal lymph node activity which is similar to previous and considered more likely granulomatous inflammation than tumor activity.In the neck, there has been some interval decrease in metabolic activity involving bilateral lymph nodes. Some residual lymph node activity most notably on the right (SUV max = 5.9 previously, = 3.8 currently) could reflect persistent tumor metabolism versus inflammation.No new suspicious FDG avid is identified. | 1.Complete interval resolution of previous hypermetabolic tumor foci within the abdomen and pelvis.2.At least partial improvement in the neck and thorax. Decreased but residual lymph node activity in the right axilla and neck may reflect inflammation or some residual tumor metabolism. Stable hypermetabolic hilar and mediastinal lymph node activity considered more likely inflammatory.3.No new suspicious FDG avid lesion. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and 2 repeat left MLO views 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. Asymmetry in the left medial breast is stable compared to multiple prior exams. | 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. | Right hip pain. Rule out fracture. Mild osteoarthritis affects the hip. I see no fracture. There are mild enthesopathic changes along the visualized portions of the iliac crest. | Mild osteoarthritis without fracture evident. If there is strong clinical concern for fracture, CT or MRI may be considered. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is an asymmetry in the posterior depth of the left upper breast on MLO view and tomosynthesis. Bilateral benign calcifications are noted. No suspicious microcalcifications or areas of architectural distortion are present. | Asymmetry in the posterior depth of the left breast for which further evaluation with laterally exaggerated CC view, spot compression and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Right foot pain. Evaluate base of metatarsal fractures Again seen are fractures through the bases of the third and fourth metatarsals with adjacent periosteal new bone formation indicating an attempt at healing. When compared to prior study, there appears to be a slight increase in callus along the base of the third metatarsal. I suspect that there is also a healing fracture of the distal articular surface of the cuboid bone, and there may also be a fracture through the lateral aspect of the base of the second metatarsal, but this is equivocal. There is lateral subluxation of the proximal phalanx of the second toe relative to the second metatarsal head, associated with a fracture through the medial aspect of the base of the proximal phalanx that appears similar to the prior study accounting for slight positional differences. Deformity of the proximal phalanx of the fourth toe represents an old healed fracture. There is soft tissue swelling, as well as arterial calcifications in the soft tissues. | Multiple fractures as described above with slight progression of callus formation along the base of the third metatarsal. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications are noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
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