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Generate impression based on findings. | Clinical question: Rule-out acute process. Signs and symptoms: Headache and blurry vision. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, sulci, ventricular system, CSF is present and gray -- white differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.Acute intracranial process.2.Unremarkable calvarium and intracranial content. |
Generate impression based on findings. | A 10-year-old female status post pectus excavatum bar removal with small pneumothoraxVIEW: Chest AP (one view) 3/18/15 at 1459 Right apical pneumothorax is unchanged. No left pneumothorax. Right chest subcutaneous emphysema is noted. Bibasilar streaky opacities likely represent atelectasis. Increased left lower lobe streaky opacity. Cardiac silhouette size is normal. | Unchanged small right pneumothorax. Increased left lower lobe atelectasis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her sister. Two standard digital views of both breasts obtained on 6 total images were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Two adjacent masses are present in the left upper outer breast. No suspicious microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications are noted. | Adjacent left breast masses for which further evaluation with spot compression and ultrasound are recommended. If it is possible to obtain the patient's prior mammograms, comparison would be potentially beneficial.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Lung cancer CHEST:LUNGS AND PLEURA: Mild interval decrease in size of a centrally necrotic right hilar mass with extension towards the midline in the paravertebrally tissues. The mass remains inseparable from the collapsed esophagus as well as the right mainstem bronchus and right lower lobe proximal airways. The lesion currently measures 4.0 x 2.4 cm (image 42 series 3) from a prior measurement of 4.3 x 2.8 cm.The left upper lobe solitary nodule is also diminished in size (image 21 series 5). Currently this nodule measures 9 x 6 mm, previously 12 x 12 mm. Scattered emphysematous changes as well as minimal dependent scarring which may be related to prior radiation therapy. Scattered pulmonary micronodules, many calcified. No significant effusionsMEDIASTINUM AND HILA: As described, this right hilar mass again invades the mediastinum. The reference right precarinal lymph node currently measures 5 mm, previously 8 mm (image 30 series 3).The cardiac and pericardium are significant for moderate coronary and annular calcifications, unchanged.CHEST WALL: Scattered degenerative changes without new suspicious lytic or lobe blastic lesions.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: Scattered bilateral left over right renal cysts, all unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large midline lower abdominal hernia | Interval improvement compatible with treatment of the known primary and metastatic lesions. Reference measurements provided |
Generate impression based on findings. | 63-year-old with suspicious right breast mass with calcifications presents for ultrasound guided biopsy. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass at the right breast 11 o'clock position with associated hyperechoic foci compatible with calcifications. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged excellent. Specimen radiograph confirmed calcifications within the specimens. All specimens sank to the bottom of the prefilled container of 10% formalin. No specimens floated. Specimen quality was judged excellent.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Increasing left breast calcifications with sonographic correlate. Ultrasound guided biopsy is requested. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a hypoechoic mass with associated calcifications immediately beneath the skin and immediately below the nipple. The lesion was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, three 14-gauge core needle (InRad) specimens were obtained of the lesion. After the third sampling, the lesion was becoming more obscured due to biopsy related changes. Specimen radiograph confirmed calcifications in one sample. Targeting was judged excellent. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen floated. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Bard wing clip was placed into the lesion in the usual manner. This clip was placed just deep to the lesion so that it would not be palpable. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the region of the retroareolar calcifications. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Schacht. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left breast lesion and clip placement. Calcifications were confirmed in one specimen. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 75 year-old returns for further work up of left breast calcifications. An ML view and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. The calcifications of interest are well seen on the spot views and have a typically benign morphology. Other calcifications within the field of view of this study are also benign appearing, at least some of which represent fibroadenomatous calcifications. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. Calcifications in the left breast have a typically benign appearance. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended in 12 months. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 19 year-old male with lupus and right shoulder painVIEWS: Right shoulder internal and external rotation (two views) 3/18/15 The humeral head is well seated at the glenoid fossa. No fracture or malalignment. No lucent or sclerotic lesion to suggest infarct. | Normal examination. |
Generate impression based on findings. | 78 years, Male. Reason: NG History: NG Ileus type gas pattern. There is a nasogastric tube with its tip projecting over the antrum of the stomach. | Nasogastric tube with its tip projecting over the antrum of the stomach. |
Generate impression based on findings. | 53-year-old female with suspicion for interstitial lung disease. LUNGS AND PLEURA: No focal consolidation, pleural effusion, or suspicious pulmonary nodules. No evidence of interstitial lung disease.MEDIASTINUM AND HILA: Heart size is normal. Mild coronary calcifications identified. No pericardial effusion. Small hiatal hernia.CHEST WALL: No suspicious focal osseous lesion. Minimal degenerative changes of the upper thoracic spine are noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Left adrenal nodule meets criteria for benign adenoma. | No evidence of interstitial lung disease. |
Generate impression based on findings. | 67-year-old female for a lung nodule follow-up CHEST:LUNGS AND PLEURA: Mild bronchial wall thickening. Right lower lobe centrilobular or nodules with thickening and bronchiectasis has progressed. Scattered tree in bud opacities in the right upper and middle lobe. Debris is noted in the right lower lobe bronchi. Focal pulmonary opacity with scarring/atelectasis in the medial lung base appears slightly increased (series 4, image 201) when compared to the prior exam. Improvement of left basilar atelectasis. No pleural effusions or pneumothorax. Few scattered parenchymal cysts are again noted. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Unchanged subcentimeter scattered mediastinal lymph nodes. Heart size is normal. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: No suspicious osseous lesions. ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver are again noted, unchanged.SPLEEN: Scattered granulomata in the spleen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slight interval increase in bronchiectasis and bronchiolitis in the right lung base. This is now suspicious for indolent atypical mycobacterial infection. Improved left lung base atelectasis. No findings to suggest malignancy. |
Generate impression based on findings. | History of right mastectomy for breast cancer. No new complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually as long as her health otherwise remains good. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 17 year old female with previously resected melanoma of left lower eyelid and left proptosis and concern for recurrence. This is a limited exam performed for the purposes of surgical localization. There is an unchanged left anterior middle cranial fossa arachnoid cyst that results in mild bowing of the posterior lateral wall of the left orbit and mild left proptosis. There is mild opacification within the left sphenoid sinus and right anterior ethmoid air cells. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. | 1.Unchanged left middle cranial fossa arachnoid cyst with mass effect upon the left orbit and mild left proptosis.2.No gross intracranial mass lesions. Refer to the concurrent brain MRI for additional details.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Malignant breast cancer. Right lumpectomy with adjuvant chemotherapy and radiation. Recurrent disease in left axilla. Assess for metastases. CHEST:LUNGS AND PLEURA: Emphysematous changes again noted. No definite pulmonary metastases identified.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Status post right lumpectomy and axillary lymph node dissection. Multiple small left axillary lymph nodes. A reference lymph node measures 1.3 x 1.0 cm (left axillary lymph node - image 40; series 4).ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense nodule in left lobe can be followed (image 94; series 4). This portion of the liver was not imaged in 2005 chest CT so it cannot be directly compared to that exam. Additional even smaller lesions are present inferiorly in the right lobe (image 113) which can also be followed.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Pessary in place.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. | Left axillary lymph nodes. Indeterminate subcentimeter hepatic lesions should be followed. |
Generate impression based on findings. | 11 year old female with head banging and history of VP shunt.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 3/18/15 A left occipital approach ventriculostomy catheter with tip near the midline is present. Shunt tubing exits the skull via a left parietal burr hole. Strata valve performance level is set at 0.5. The shunt tubing courses down the soft tissues of the left neck, anterior chest wall, crossing to the right entering the abdomen in the right upper quadrant with tip in the left hemiabdomen. The tip is in a different position than on the prior exam. Shunt catheter appears discontinuous. The first portion of the radiopaque catheter is further from the valve than on the prior study. No kinking or discontinuity of the distal radiopaque portions of the shunt catheter.Defect is present in the right parietal bone. Right orbit is small. A defect in the lateral sphenoid bone. Postoperative changes of right orbit with surgical material.Normal cardiothymic silhouette. No focal pulmonary opacities. No pleural effusion or pneumothorax.Nonobstructive bowel gas pattern. A moderate amount of feces is present. No pneumatosis, portal venous gas or free air. The urinary bladder is distended. | Discontinuity of the shunt catheter. Moderate stool burden with distended urinary bladder. |
Generate impression based on findings. | Lung cancer restaging status post chemoradiation.RADIOPHARMACEUTICAL: 16.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 180 mg/dL. Today's CT portions of the neck, abdomen, and pelvis grossly demonstrate left brain lesions with surrounding edema causing mass effect with rightward shift of the midline structures. This skull base region is incompletely evaluated on today's body PET/CT but please see dedicated brain MRI for further evaluation. Left adrenal gland nodule is present. Several left upper quadrant soft tissue implants are seen in the abdominal mesentery. A subtle sclerotic focus is seen at the left portion of the sacrum superiorly. Please see diagnostic CT report for details of the chest.Today's PET examination demonstrates a large markedly hypermetabolic lesion in the left posterior temporal parietal brain (SUV max = 24.6) consistent with a brain metastasis. In retrospect it may have been subtly present previously but has significantly progressed in size and activity. A new smaller satellite lesion medially indicates an additional brain metastasis. In the left frontal region there is an additional hypermetabolic small brain metastasis, also new from previous.In the thorax, a large markedly hypermetabolic right infrahilar mass while similar in uptake has increased significantly in size from previous (SUV max = 14.0), consistent with additional tumor progression. There has been significant interval increase in size, number, and metabolic activity of mediastinal lymph node metastases. For reference, a right paratracheal lymph node has increased significantly (SUV max = 6.2 previously, = 18.6 currently). Similarly, there has been significant interval increase in size, number, and metabolic activity of pulmonary parenchymal metastases with an increasing left upper lobe metastasis provided for reference (SUV max = 2.3 previously, = 6.5 currently).Within the abdomen, a new markedly hypermetabolic left adrenal metastasis is present (SUV max = 12.2). In addition, a hypermetabolic soft tissue density mesenteric tumor implant in the left abdomen has increased significantly in size and uptake (SUV max = 3.2 previously, = 11.3 currently).A medium-sized markedly hypermetabolic sacral lesion (SUV max = 13.1) indicates a new bone metastasis. | 1.Significant progression of tumor with multiple new and larger hypermetabolic metastases including new brain, bone, pulmonary, and adrenal metastases.2.Note the left brain metastases are causing mass effect with midline shift. Please see today's brain MRI for further details. |
Generate impression based on findings. | There is mild rightward convexity of the lumbar spine. There is 4-mm grade 1 anterolisthesis of L4 on L5, with a vacuum disk at this level. Bilateral L4 spondylolysis is noted. Trace vacuum phenomenon is also present at T12-L1. The scout lateral view and the sagittal reformatted images demonstrate the remainder of the lumbar spine to be in normal alignment, with a normal lumbar lordosis. There is moderate-severe disk space narrowing at L4-L5. The vertebral body and disk space heights are otherwise well-maintained.There is no acute fracture.At T11-T12, there is no significant disk pathology or stenosis.At T12-L1, there is a disk bulge with superimposed left foraminal and far lateral disk protrusion. There is mild ligamentum flavum thickening with overall moderate central spinal stenosis and moderate right as well as mild to moderate left foraminal narrowing.At L1-L2, there is a mild disk bulge with mild bilateral facet arthropathy and ligamentum flavum thickening. There is moderate central spinal canal stenosis and moderate left as well as mild to moderate right foraminal narrowing.At L2-L3, there is a disk bulge with a left sided prominence. There is mild bilateral facet arthropathy and ligamentum flavum thickening. There is moderate to severe central spinal stenosis as well as moderate to severe right and moderate left foraminal narrowing.At L3-L4, there is a mild disk bulge with mild bilateral facet arthropathy and ligamentum flavum thickening. There is mild central spinal canal stenosis and mild bilateral foraminal narrowing.At L4-L5, there is uncovering of the disk with moderate left and moderate to severe right foraminal narrowing. Prominent bilateral facet arthropathy is noted.At L5-S1, there is no significant disk pathology or stenosis.Limited views through the retroperitoneum demonstrate scattered aortoiliac atherosclerotic calcification. There is mild nonspecific thickening of the bladder wall especially anteriorly. There are nonobstructing left renal calculi identified measuring up to 5 x 5 mm in the lower pole. | 1. Grade 1 anterolisthesis of L4 on L5 secondary to chronic bilateral L4 spondylolysis.2. Moderate to severe central spinal canal stenosis as well as moderate to severe right and moderate left foraminal narrowing at L2-L3.3. Moderate to severe right foraminal narrowing at L4-L5.4. Nonobstructing left renal calculi. Please correlate clinically. |
Generate impression based on findings. | Reason: h/o mantle cell lymphoma now w/ lymphoma cells in the peripheral blood smear RADIOPHARMACEUTICAL: 12.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 100 mg/dL. Today's CT portion demonstrates mild pulmonary apical paraseptal emphysema and basilar atelectasis/scarring. There are mildly enlarged portacaval and retroperitoneal lymph nodes. There is marked splenic enlargement. Today's PET examination demonstrates multiple small but abnormally hypermetabolic internal mamillary lymph nodes. There are also larger more significantly FDG avid abnormal abdominal portacaval and retroperitoneal lymph nodes (SUV max 7.8), highly suspicious for tumor activity. The visualized red marrow distribution is fairly diffusely markedly hypermetabolic. Although this pattern is more commonly seen with benign marrow stimulation such as with granulocyte colony stimulating factor, the appearance in this case is more patchy and irregular and as such is very suspicious for diffuse widespread tumor involvement. Likewise, the spleen is enlarged and diffusely FDG avid, greater than liver, which can also be seen in marrow stimulation but in this setting is very suspicious for diffuse tumor involvement. | 1.Multiple hypermetabolic lymph nodes, most notably in the abdomen but also in the thorax, highly suspicious for tumor activity.Widespread marrow and diffuse splenic activity, which while it may conceivably represent benign marrow stimulation is considered more likely to represent diffuse tumor involvement (particularly if there has been no recent G-CSF administration). |
Generate impression based on findings. | Fracture A plate and screw device affixes a healing fracture of the proximal-mid humeral diaphysis in near anatomic aligned. Fracture lines are less distinct on the current study than on the prior study indicating some interval healing. I see no hardware complications. | Orthopedic fixation of healing humerus fracture. |
Generate impression based on findings. | Pain. Healing fracture of fifth metatarsal? Again seen is a comminuted but predominantly transverse fracture through the proximal tuberosity of the fifth metatarsal with slight lateral displacement of the tuberosity fracture fragment. Overall, the findings are similar to those seen on the prior study. The small density seen on the prior study lateral to the base of the 5th proximal phalanx is no longer evident, and therefore is likely artifactual. There is a bipartite lateral sesamoid bone, a normal variant. | Fracture of the fifth metatarsal base appearing similar to the prior study. |
Generate impression based on findings. | Reason: history of large squamous cancer of left cheek follow up CT, follow up lung nodule found on CT History: history of large squamous cancer of left cheek follow up CT, follow up lung nodule found on CT LUNGS AND PLEURA: Index left lower lobe, well-defined micronodule is stable in size measuring 3 mm (series 5, image 152). Additional scatter nonspecific micronodules. No new suspicious nodule or mass. No focal consolidation. No pneumothorax or pleural effusion. The central airways are patent.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Severe coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy. Moderate degenerative disease affects the thoracic spine. No suspicious osseous lesions. Median sternotomy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis without CT evidence of cholecystitis. Scarring at the superior pole of the left kidney. Moderate atherosclerotic calcification of the aorta and branch vessels.Severe atherosclerotic calcification of the renal arteries bilaterally with a small aneurysmal dilatation measuring up to 10 mm in a medial segmental branch of the right renal artery. | Unchanged 3-mm left lower lobe nodule, favoring a benign lesion such as a granuloma. Conservative follow-up CT is recommended in 4 to 6 months. Severe atherosclerotic calcification of the renal arteries bilaterally with a small aneurysmal dilatation of the right renal artery as described above. |
Generate impression based on findings. | 15-year-old female with back pain during sports.VIEWS: Thoracic spine AP, lateral, swimmers (3 views) 3/18/15 No fracture. Vertebral heights and disk spaces are maintained. There are 13 rib pairs. Mild left lumbar curve. | Mild left lumbar curve without fracture. |
Generate impression based on findings. | Reason: Restaging breast cancer, stage IV History: Restaging. CHEST:LUNGS AND PLEURA: Moderate upper lobe predominant centrilobular emphysema. Apical scarring unchanged. Scattered pulmonary nodules are redemonstrated, some of which are new or increased. A reference right lower lobe subpleural nodule measures 12 x 6 mm (series 4, image 75), previously 10 x 7 mm. Another left upper lobe nodule measures 5 x 5 mm (series 4, image 36), from previously 4 x 4 mm. MEDIASTINUM AND HILA: Trace pericardial effusion, unchanged. Normal heart size. Severe coronary calcifications. Right chest wall port IJ catheter tip at the superior cavoatrial junction. No significant mediastinal or hilar lymphadenopathy. CHEST WALL: No suspicious focal osseous lesion identified. Multiple left axillary lymph nodes are increased from the previous exam, for example a necrotic left axillary lymph node measures 25 x 22 mm (series 3, image 25), previously 14 x 12 mm. Multiple newly necrotic left axillary nodes are also noted. A single right axillary lymph node is also increased in size, now 5 mm (series 3, image 40).ABDOMEN: Absence of enteric contrast material as well as respiratory motion artifact limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The liver enhances homogeneously without focal lesion. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically. Multiple centimeter renal hypodensities, too small to further characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No definite retroperitoneal adenopathy. Moderate calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: No suspicious focal osseous lesion is identified.OTHER: No significant abnormality noted. | 1.Scattered pulmonary nodules, some of which are new or increased in size.2.Increased bilateral axillary lymphadenopathy, as above. |
Generate impression based on findings. | Tophaceous gout. Evaluate for gouty erosions. Three views of the left hand show soft tissue swelling about numerous interphalangeal joints including the second MCP joint and second, fourth, and fifth PIP joints. There are early erosions of the head of the fourth metacarpal. Three views of the right hand show significant soft tissue swelling at the second metacarpophalangeal joint in addition to swelling noted at the first metacarpophalangeal joint and several interphalangeal joints. No definite erosions are seen. Four views of the left elbow show significant soft tissue swelling about the olecranon. However, no erosive changes are noted.Four views of the right elbow show significant soft tissue swelling about the olecranon. However, no erosions are seen.Three views of the left foot show an erosion at the head of the first metatarsal along with soft tissue swelling at this joint. There is also erosive changes of the base of the fourth metatarsal.Three views of the right foot show soft tissue calcification along the medial aspect of the first digit middle phalanx. There are erosions of the base of the fourth metatarsal and the heads of the third through fifth metatarsals. | Soft tissue swelling and erosions as described above. |
Generate impression based on findings. | 68-year-old female callback from screening for posterior left breast asymmetry. Family history of breast cancer diagnosed in sister age 36 and in cousin. Full field and spot compression CC and ML 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. Previously seen asymmetry in the posterior left breast is no longer visualized in the full field of spot compression views and likely represented overlying tissue.No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 71 years old; Reason: 71M with UC now POD7 from lap assisted TAC with ileoorectal anastomosis, please evaluate for intraabdominal source of symptoms History: nausea, emesis, abdominal distention, decreased bowel function, decreased appetite ABDOMEN:LUNGS BASES: Patchy left lower lobe air space disease, suspicious for pneumonia, may be of aspiration etiology. Moderate cardiomegaly. Severe calcified coronary artery disease.LIVER, BILIARY TRACT: Patent portal veins, SMV and splenic vein.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild bilateral adrenal thickening.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Status post subtotal colectomy with ileorectal anastomosis seen. Distended fluid containing stomach with layering ingested material present. Dilated small bowel, measuring up to 3.6 cm. Status post colectomy with ileorectal anastomosis. Small bowel is dilated measuring up to 3.8 cm. Sites of relative focal/segmental narrowing seen in distal ileum (approximately 14 cm proximal to the level of the postsurgical anastomosis) and at the ileorectal anastomosis, uncertain whether appearance relates to postoperative edema in latter case. Former site of narrowing measures approximately 3 cm in length, image 81 series 3, may be due to underlying adhesive disease. Air seen distally in ileum and beyond ileorectal anastomosis in rectum, rectal air however could be related to placement of rectal tube for the retrograde instillation of contrast. Rectal tube present. Rectal contrast seen, contrast is not seen beyond or above the level of the ileorectal anastomosis, may be due in part to timing of exam. Small pneumoperitoneum, likely decreased when compared to prior 3/15/15 abdominal radiographic study. No evidence of pneumatosis. Trace lower quadrant free fluid and edema. No evidence of extraluminal enteric contrast within the limitations of the study. PELVIS:PROSTATE/SEMINAL VESICLES: Small intraprostatic calcifications.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease of spine. Grade 1 anterolisthesis of L4 on L5.OTHER: Areas of subcutaneous emphysema, likely iatrogenic. Small air in nondependent bladder, likely reflecting recent intervention. Subcentimeter focus gas in scrotum on right. Status post vasectomy. | 1. Status post subtotal colectomy with ileorectal anastomosis seen. Distended stomach and dilated small bowel with sites of focal/segmental narrowing in distal ileum and at level of ileorectal anastomosis, air seen beyond these sites, see description above. Given patient's relatively recent postoperative state, findings may reflect ileus. However, an element of partial or evolving obstruction cannot be entirely excluded and correlation with patient's clinical history and continued follow up recommended. Rectal contrast seen, contrast is not seen beyond or above the level of the ileorectal anastomosis, may be due in part to timing of exam. No evidence of extraluminal enteric contrast within the limitations of the study. Small pneumoperitoneum, likely decreased when compared to prior 3/15/15 abdominal radiographic study. Trace lower quadrant free fluid and edema. 2. Patchy left lower lobe air space disease, suspicious for pneumonia, may be of aspiration etiology.3. Areas of small subcutaneous emphysema, including in scrotum, most likely iatrogenic. Small air in nondependent bladder, likely reflecting recent intervention. Findings communicated to Ashley Suah at 3:55 p.m. on 3/18/15. |
Generate impression based on findings. | 54-year-old female with history of right foot and ankle pain. Three views of the right foot demonstrate slight plantar flexion of the talus, the head of which is slightly inferiorly subluxed with respect to the navicular. Mild osteoarthritis affects the midfoot. There is mild diffuse soft tissue swelling. Small lucencies along the bases of the third and fourth proximal phalanges as well as the distal aspect of the first and second proximal phalanges, that were not clearly evident on prior studies, may represent small erosions with sclerotic margins. However, the joint spaces do not appear narrowed. | Arthritic changes as described above, including talonavicular joint subluxation, midfoot osteoarthritis, and probable small erosions of the forefoot. The talonavicular subluxation may reflect a neuropathic arthropathy, but the small forefoot erosions suggest the possibility of an inflammatory arthritis. |
Generate impression based on findings. | Postop. Prosthetic assessment. Three views of the pelvis and two views of the right hip show a right total hip arthroplasty device situated in anatomic alignment without evidence of hardware complication. No acute fracture is evident. | Right total hip arthroplasty without evidence of hardware complication. |
Generate impression based on findings. | RFO trigger: Urgent change in planned procedure Suspected RFO location: Abdomen/Pelvis Name of suspected RFO: Instruments,sponges,needles. Attending Surgeon name/pager: Dr. Bales/ 3710 or room phone # 69410. Interval placement of a right nephroureteral stent with the distal tip terminating in the distribution the bladder. There is a surgical drain in place with the tip terminating in the midline pelvis. A Foley catheter is in place. A curvilinear metallic density at the L5-S1 level just to the right midline consistent surgical clips as confirmed by the OR housestaff. No unexpected radiopaque foreign object is identified. | No unexpected radiopaque foreign object is identified.These findings were discussed by telephone with Dr. Bales, the attending surgeon, on 3/18/2015 at time. |
Generate impression based on findings. | 21-year-old male with small lump and tenderness near inguinal canal, per patient left-sided. RIGHT TESTIS: 4.0-cm x 2.6 cm x 2.1 cm.LEFT TESTIS: 4.3 cm x 3.0-cm 0.2 cmRIGHT EPIDIDYMIS: 1.1 cm x 0.8 cm x 0.8 cmLEFT EPIDIDYMIS: 0.9 cm x 1.4 cm x 0.8 cm. OTHER: Bilateral varicoceles, left greater than right. Area of left sided palpable mass corresponds to the varicocele. | Bilateral varicoceles, left greater than right which corresponds to area of left sided palpable mass. |
Generate impression based on findings. | Shoulder fracture Three views of the right shoulder reveal a comminuted impacted surgical neck of the humerus fracture. There are degenerative changes at f the glenohumeral joint but no dislocations. | Comminuted impacted surgical neck fracture of the humerus |
Generate impression based on findings. | 57 year old female. Right flank colic-like pain x 2 days. Assess for kidney stone. Lack of intravenous and oral contrast limits evaluation for solid organ and bowel pathology.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 stones. The right ureter is not well visualized but no stones are seen along its expected course. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the aorta.BOWEL, MESENTERY: No bowel obstruction. Post-surgical findings of partial gastrectomy.BONES, SOFT TISSUES: Scoliosis of the lumbar spine with moderate degenerative changes.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No stones are seen in a collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scoliosis of the lumbar spine with moderate degenerative changes of L4-L5.OTHER: No significant abnormality noted | No renal or ureteral stones. No specific findings to explain the patient's symptoms. |
Generate impression based on findings. | 54-year-old female with history of head and neck cancer and chemoradiation therapy. CHEST:LUNGS AND PLEURA: Stable right apical scarring. No suspicious pulmonary nodules, focal consolidation, or pleural effusion.MEDIASTINUM AND HILA: Left chest wall port catheter tip in the right atrium. Heart size is normal. No pericardial effusion. No coronary calcifications detected. No mediastinal or hilar lymphadenopathy.CHEST WALL: Posterior right third rib, T5 vertebral body, L3 vertebral body, and destructive left iliac metastases are again seen. No new osseous metastases are identified. Pathologic compression deformity of L3 has increased. Please note that bone scan is more sensitive for osseous metastases.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Left hepatic lobe lesion is not significantly changed, measuring 20 x 15 mm (4, image 75), from previously 19 x 19 mm. Left hepatic cyst unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No adrenal nodularity or thickening.KIDNEYS, URETERS: The kidneys enhance symmetrically without focal lesion. No hydronephrosis or obvious renal mass.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No evidence of retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Bowel is normal in caliber without evidence of obstruction or ileus.BONES, SOFT TISSUES: Osseous metastases, as described above. Increased L3 compression deformity.OTHER: No significant abnormality noted. | 1.No significant interval change in osseous metastases. 2.Stable left hepatic lobe lesion; metastasis not excluded. |
Generate impression based on findings. | Neuroblastoma s/p autoSCT, thrombocytopenic with worsening SAH. There is no 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 18 years old; Reason: r/o appendicitis History: rlq tenderness ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodensity in the inferior left kidney is too small to adequately characterize, likely a small cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Appendix is normal. No obstruction. Colonic diverticulosis. Small pocket of free fluid in the left dependent pelvis (4:80), somewhat unusual for a male. There are colonic diverticula in the vicinity of this small pocket of fluid, and a mild diverticulitis may be the cause, although no overt CT signs are noted, and this is on the opposite side of his symptoms, as per history.BONES, SOFT TISSUES: Mild degenerative disease L5-S1.OTHER: No significant abnormality noted. | 1.No overt acute abdominal or pelvic process to account for right lower quadrant tenderness. A small pocket of free fluid is nonspecific, as described above. |
Generate impression based on findings. | Malignant uterine neoplasm. Papillary serous carcinoma. CHEST:LUNGS AND PLEURA: Previously referenced left upper lobe opacity measures 3.0 cm x 1.7 cm, equivocally smaller suggesting this represents scarring (image 31; series 5). No new mass lesions are identified. Stable postsurgical changes in the right upper lobe. MEDIASTINUM AND HILA: Reference precarinal lymph node is unchanged in size measuring 8 mm x 7 mm (image 38; series 3). No new mediastinal or hilar lymphadenopathy. Unchanged pulmonary artery dilation. Heart size is normal. No pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild left adrenal thickening is unchanged.KIDNEYS, URETERS: Previously described left renal calculus is no longer present. Hypodense lesion in the left kidney too small to characterize likely benign cyst, unchanged. RETROPERITONEUM, LYMPH NODES: Stable postoperative changes adjacent to the infrarenal IVC. Stable subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease of the thoracolumbar spine, stable.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized..BLADDER: Bladder is underdistended which makes evaluation for bladder wall thickening suboptimal. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative disease of the thoracolumbar spine, stable.OTHER: No significant abnormality noted. | No substantial interval change. Left upper lobe opacity probably represents scarring as it slightly smaller on today's examination. Stable subcentimeter mediastinal lymph node. |
Generate impression based on findings. | 54-year-old male with a history of AML, pre-allogenic stem cell transplant evaluation. LUNGS AND PLEURA: No focal consolidation, pleural effusion, or suspicious nodules.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No coronary calcifications are detected within the limitations of this non-gated study. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative changes affect the visualized spine. No suspicious focal osseous lesion.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Multiple hepatic cysts. | No evidence of infection or malignancy. |
Generate impression based on findings. | Reason: Please assess for metastatic CA History: Prior breast CA, now with C-spine contrast-positive lesions. RADIOPHARMACEUTICAL: 11.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 100 mg/dL. Today's CT portion demonstrates bilateral hip prostheses and degenerative changes throughout the lumbar facets as well as throughout the cervical spine. Surgical clips are present in the left axilla and left breast.Today's PET examination demonstrates a somewhat curvilinear region of moderate radiotracer uptake at the left C7-T1 posterior elements (SUV max 4.2), which corresponds precisely the enhancing process on recent MRI, which is nonspecific and could represent an active inflammatory process, although metastatic disease is also conceivable. A somewhat similar curvilinear region of increased activity is seen at the left L4-5 posterior elements (SUV 4.0), but correlating with clear benign degenerative changes as seen on prior CT examination. Benign expected inflammatory activity surrounds both hip prostheses, right greater than left. | 1. Small region of moderate activity in the left lower cervical spine posterior elements correlating with the area of enhancement on the recent MRI may represent benign inflammation, particularly as there is similar appearing more clearly benign degenerative activity in the lower lumbar spine. However, tumor activity in the cervical spine cannot be entirely excluded. 2. No suspicious FDG avid lesion elsewhere. |
Generate impression based on findings. | Metastatic nasopharyngeal cancer treated with TFHx on 7/19/14. There are post-treatment findings in the nasopharynx, without evidence of measurable tumor in this region. There is a newly apparent subcentimeter hyperattenuating lesion in the anterior left masseter muscle. There are also findings related to right neck dissection with persistent ill-defined soft tissues along the incision plane posterior to the right sternocleidomastoid muscle. There is interval resolution of ill-defined heterogeneity of the inferior right sternocleidomastoid muscle. There otherwise no significant change in the appearance of the cervical lymph nodes. For example, a right level 2A lymph node measures 8 mm in short axis, previously also 8 mm, and a right level 3 lymph node measures up to 3 mm in short axis, previously also 3 mm. There is a left subclavian venous catheter. The major cervical flow voids are intact. The salivary glands appear unchanged. There are patchy opacities in the lung apices. | 1. Newly apparent lesion in the left masseter muscle may represent a metastasis versus an inflammatory process or hematoma. Ultrasound or MRI may be useful for further characterization if clinically warranted. 2. Post-treatment findings in the neck with interval interval resolution of ill-defined heterogeneity of the inferior right sternocleidomastoid muscle and no evidence of tumor recurrence in the nasopharynx.3. The treated lymphadenopathy in the neck is unchanged.4. Nonspecific persistent bilateral tympanomastoid opacification. |
Generate impression based on findings. | There is significant degeneration of both temporomandibular joints, although more severe on the left. There is significant flattening of the mandibular condyles bilaterally. There is subchondral cyst formation, as well as subtle increased density suggested in the left temporomandibular joint which may represent mineralization.There is trace mucosal thickening in the anterior ethmoid air cells bilaterally. There are scattered small mucosal retention cysts within the maxillary sinuses. The ostiomeatal units are patent bilaterally, with a prominent right-sided Haller cell. There are bilateral concha bullosa. There is a large dental carie in the posterior right mandibular molar, as well as a smaller ones in ADA number 6 and 11, as well as the posterior left mandibular molar. Cervical occipital fusion construct is noted, without evidence of instrumentation complication. There is right carotid bifurcation atherosclerotic calcification. | 1. Severe left much greater than right temporomandibular joint degenerative changes with intraarticular mineralization suggested on the left, which could relate to synovitis or CPPD. MRI of the TMJs, especially the left, is recommended for further evaluation.2. Scattered dental caries. Please correlate with dental exam. |
Generate impression based on findings. | 27-year-old male with left forearm and wrist pain. Three views of the left wrist and two views of the left forearm demonstrate a nondisplaced comminuted, but predominantly transverse fracture of the distal ulnar diaphysis. No additional fractures of the forearm or wrists are identified. | Nondisplaced comminuted fracture of the distal ulnar diaphysis. No acute fracture is seen in the wrist. |
Generate impression based on findings. | Female; 71 years old. Reason: Cholangiocarcinoma please assess extent of disease and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Small right pleural effusion.MEDIASTINUM AND HILA: Mild mediastinal and bilateral hilar lymphadenopathy. For future reference, a precarinal lymph node measures 15 x 15 mm (series 4/32) and a right hilar lymph node measures 20 x 14 mm (series 4/42).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined lesion involving the gallbladder fundus with invasion into the adjacent right hepatic lobe, compatible with biopsy proven gallbladder carcinoma, measures up to 6.5 x 4.9 cm (series 4/102), previously approximately 5.5 x 3.4 cm on CT from 2/14/15 (remeasured on series 4/36). A satellite tumor nodule just superior to mass in the right lobe of the liver is new since 2/14/15 and measures up to 2.5 x 2.2 cm (series 4/85). Mild intrahepatic biliary ductal dilation, similar to prior exam. Mild perihepatic ascites.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: Extensive portacaval and gastrohepatic lymphadenopathy. Reference necrotic portacaval lymph node measures up to 3.8 x 2.4 cm (series 4/94), unchanged. Extensive retroperitoneal lymphadenopathy. For future reference, a left para-aortic lymph node measures 13 x 11 mm (series 4/17).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable small fat-containing umbilical hernia.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus is displaced to the left by the large pelvic mass described below.BLADDER: No significant abnormality noted.LYMPH NODES: Extensive pelvic lymphadenopathy. Reference left iliac node measures 2.1 x 1.7 cm (series 4/130), not significantly changed since prior study when it measured previously 1.9 x 1.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large pelvic mass with enhancing solid components is grossly stable and measures up to 13.9 x 12.9 cm (series 4/151), previously 14.4 x 13 cm. mild pelvic ascites. | 1. Increased size of gallbladder carcinoma invading adjacent right hepatic lobe with new satellite lesion in the right hepatic lobe since 2/14/15.2. Stable extensive upper abdominal, retroperitoneal, and pelvic lymphadenopathy.3. Mediastinal and bilateral hilar lymphadenopathy, suspicious for metastatic disease.4. Grossly stable large pelvic mass, which may be due to gallbladder carcinoma metastasis versus primary ovarian neoplasm. |
Generate impression based on findings. | Female, 3 years old. Swallowed penny 3/11/15 no sxs (not seen in stool)VIEW: Abdomen AP/lateral (two views) 3/18/2015, 1618 A coin is seen in the right lower quadrant, in the cecum.Nonobstructive bowel gas pattern.No pneumatosis, portal venous gas, or free air.Moderate stool burden. | Coin (penny or nickle) within the cecum without evidence of obstruction. |
Generate impression based on findings. | 55-year-old female with left foot pain. Four views of the left foot demonstrate prominent osteophytes projecting dorsally from the first tarsometatarsal joint, as well as mild osteoarthritis affecting the first metatarsophalangeal joint. Mild deformity of the fifth proximal phalanx may reflect prior trauma or surgery. | Osteoarthritis as above. |
Generate impression based on findings. | Reason: 60M with intraductal carcinoma of the prostate on biopsy, please assess for bone metastasis. Right frontal cranial activity correlates with prior craniotomy defect. A punctate area of radiotracer uptake along the left supraorbital ridge is commonly benign. There is no suspicious osseous focus to specifically suggest metastatic disease. | No evidence of bone metastasis. |
Generate impression based on findings. | 44-year-old male with history of trigger finger. Three views of the right hand demonstrate a small ossicle along the lateral aspect of the second metacarpophalangeal joint, which may represent a small intra-articular loose body. A tiny ossicle is also seen projecting lateral to the third metacarpal head. Round lucencies within the second and third metacarpal heads may represent cysts. | Small cysts in the second and third metacarpal heads with tiny ossicles in the adjacent soft tissues are of questionable clinical significance. The ring finger appears normal. |
Generate impression based on findings. | 51-year-old male with right elbow pain. Four views of the right elbow demonstrate a tiny spur projecting from the coronoid process of the ulna, otherwise unremarkable. There is no joint effusion evident; no acute fracture or malalignment. | Tiny spur projecting from the coronoid process of the ulna, otherwise normal exam. |
Generate impression based on findings. | Uterine malignancy. Solitary pulmonary nodule and enlarged large lymph nodes. CHEST:LUNGS AND PLEURA: Probable calcified granuloma in the right lower lobe. Several micronodules can be followed. Statistically, these are likely postinflammatory.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes should be followed. Fibrin sheath versus nonocclusive thrombus on the upper catheter portion of the patient's chest port which. Port terminates in the SVC.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: Left para-aortic lymph node measures 1.1 x 1.0 cm (image 127; series 3)BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: ScoliosisOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is heterogeneous and mildly enlarged although the patient's underlying, known tumor cannot definitely be visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Subcentimeter pelvic lymph nodes can be followed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Scattered small lymph nodes. Pulmonary micronodules. These findings can be followed. |
Generate impression based on findings. | Dysphagia; resistance met upon intubation of cervical esophagus with endoscope; CT neck and chest to rule out extrinsic compression. There are postoperative findings in the anterior lower neck. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The airways are patent. The salivary glands are unremarkable. The thyroid appears heterogeneous with multiple hypoattenuating areas. The major cervical vessels are patent. There is sclerosis of the left maxillary sinus with mucosal thickening and fluid. There is minimal multilevel degenerative spondylosis of the cervical spine and diffuse osteopenia. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. No evidence of an upper aerodigestive track mass.2. Findings suggestive of acute upon chronic sinusitis in the appropriate clinical setting. |
Generate impression based on findings. | Reason: Patient with history of prostate cancer s/p prostatectomy and radiation. Now with recurrence of PSA and retroperitoneal adenopathy. Has left hip pain. Evaluate for prostate metastasis. Multiple bilateral posterior and lateral rib lesions are identified with suspicious features including non-full-thickness rib involvement and extension parallel to the rib axis. Furthermore, on limited biopsy CT images there are correlative small sclerotic and lucent lesions. There is likely a right lateral scapular lesion as well. There are prominent bilateral renal pelvises and proximal-mid ureters which could represent reflux, stasis, or conceivably a degree of obstruction. | Bilateral rib lesions and right scapular lesion with some lucent and sclerotic CT correlate lesions are highly suspicious for osseous metastases or conceivably multiple myeloma given lytic CT correlates. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: The maxillary sinuses are clear. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is trace leftward nasal septal deviation. 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. | Unremarkable CT of the sinuses. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: alteration of mental status. Unenhanced head CT:Examination demonstrate no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Findings suggestive of age indeterminant small vessel ischemic strokes of mild degree are again identified.There is a focus of slightly high density likely calcific in the right sylvian fissure which appears well demarcated on reformatted images. This finding was present on prior study. Recommend follow-up with an MRI exam and MRA imaging to exclude possibility of an internal parenchymal lesion or even a mildly calcified aneurysm at the level of right MCA bifurcation.Lateral ventricles are mildly dilated similar to prior exam and with maintained midline.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Age indeterminant small vessel ischemic strokes.3.Small round focus of slightly high density in the anterior right middle cranial fossa. Differential of an aneurysm or a small mass should be considered. Follow-up with brain MRI and MRA is recommended. |
Generate impression based on findings. | Clinical question: Hemorrhage. Signs and symptoms: Weakness. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is been sensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. Questionable visualization all the previously known small left cerebellar metastatic lesion on this nonenhanced study.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Hemorrhage. Signs and symptoms: Weakness. Nonenhanced head CT:There is no detectable acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Cause of new seizure in patient with new heart transplant. Signs and symptoms: Partial seizure. Nonenhanced head CT:There is no convincing evidence of an acute intracranial process.There is paucity of cortical sulci for patient's stated age. Although this may be within normal possibility of mild generalized cerebral edema cannot be entirely excluded. Ventricular system asked to appears ascites smaller than expected for age. The gray -- white matter differentiation is preserved. Analysis cisterns remain widely patent and unremarkable.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No definitive evidence of acute intracranial process.2.Paucity of the cortical sulci and small size of supratentorial ventricular system could be within normal however possibility of subtle cerebral edema cannot be entirely excluded. |
Generate impression based on findings. | 41-year-old female for diagnostic mammogram to evaluate the right breast pain, few weeks ago for which she went to the emergency room. She was sent home with Tylenol as needed. Today, her pain has subsided, appears more cyclical. Patient does not palpate a lump. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. No suspicious abnormality in the right breast corresponding to patient's right breast pain. Right breast pain should be managed clinically. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female, 17 years old. Chest pain, elevated D Dimer. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam, without evidence of pulmonary embolism.LUNGS AND PLEURA: No focal opacities. No pleural effusions. Scattered small calcified nodules, compatible with prior granulomatous disease. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Heart size is normal, without pericardial effusion.Small calcified mediastinal and hilar lymph nodes from prior granulomatous disease. No lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. | No evidence of pulmonary embolism or other acute abnormality. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign biopsy in the past in the left breast. 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. 13-mm bilobed asymmetry in the medial right breast with a possible correlate in the inferior right breast needs further evaluation with spot compression views and possible ultrasound.Multiple stable partially circumscribed masses are present in both breasts. A percutaneously placed clip is present in the left retroareolar region. Scattered benign calcifications are unchanged in both breasts. Ectatic ducts noted bilaterally.No suspicious microcalcifications or areas of architectural distortion are present. | 13-mm bilobed asymmetry in the medial right breast with a possible correlate in the inferior right breast needs further evaluation with spot compression views and possible ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Female 40 years old; Reason: Please evaluate for intra-abdominal bleeding s/p hysterectomy History: Hgb 5 ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small focus of free intraperitoneal air in the upper abdomen consistent with recent postoperative state.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Bilateral symmetric hyperdensities in the pelvis likely relates to the vaginal cuff.BLADDER: Air within the bladder. Correlate for recent instrumentation.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic free fluid. | Status post hysterectomy. No evidence of active bleeding. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Multiple oval to round masses, few partially circumscribed, few well-circumscribed are identified in both breast. Few of the masses demonstrate internal lucencies, which would represent fat. Many of these masses appear to be close to the skin surface. There is a broad differential for these masses and hence comparison with prior mammograms is recommended to confirm stability. A small cluster of calcifications is also identified in the left upper outer quadrant. A prominent right axillary lymph node is also noted.No suspicious areas of architectural distortion are present. | 1. Multiple oval to round masses, few partially circumscribed, few well-circumscribed are identified in both breast. There is a broad differential for these masses and hence comparison with prior mammograms is recommended to confirm stability. 2. A small cluster of calcifications is also identified in the left upper outer quadrant. 3. A prominent right axillary lymph node is also noted.If patient cannot submit prior mammograms, spot compression views of both breasts to evaluate the masses, spot magnification views of the left breast calcifications and ultrasound of the right axillary region is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 67 years, Male. Reason: dht History: dht There is a Dobbhoff tube with its tip projecting over the antrum of the stomach. There is a nonobstructive bowel gas pattern. The pelvis is excluded from the field of view. Residual contrast opacifies the small bowel. Cardiomegaly. Pacemaker leads in expected position. Nonspecific focal retrocardiac opacity, follow up recommended. | Dobbhoff tube with its tip projecting over the antrum of the stomach. Nonspecific focal retrocardiac opacity, follow up recommended. |
Generate impression based on findings. | 68 years, Female. Reason: ileus/obstruction History: vomiting There is a nonobstructive bowel gas pattern. Round density projected over the left ilium likely reflects retained contrast in a diverticulum. Right upper quadrant surgical clips in place. Above average stool burden. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 68 years old Reason: thoracic mass History: dysphagia, anorexia and weight loss CHEST:LUNGS AND PLEURA: No consolidation, pleural effusion or pneumothorax. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. No pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Surgical clips status post cholecystectomy. Mildly prominent intrahepatic biliary ducts likely due to post cholecystectomy changes. No focal hepatic mass.SPLEEN: Lobulated contour of the spleen, which may be due to previous infarcts or perhaps normal variant anatomy.PANCREAS: Cystic pancreatic lesion in the body of the pancreas measuring 1.4 x 1.0 cm (image 84 series 3) most likely representing sidebranch IPMN.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal adenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged and measures 5.6 x 4.1 cm (image 185 series 3). Calcification of the seminal vesicles is noted.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 CT findings to account for patient's dysphagia.2.Cystic pancreatic lesion, which may represent sidebranch IPMN. Recommend further evaluation with MRCP or ERCP. |
Generate impression based on findings. | 53 years, Female. Reason: drive line assessment History: syncope LVAD in place. Artificial valve and pacemaker leads identified. Imaged drive line without fracture; however, drive line external patient is not well-visualized. See chest radiograph report for full evaluation of the chest.There is a nonobstructive bowel gas pattern. | Imaged drive line without fracture; however, drive line external patient is not well-visualized. |
Generate impression based on findings. | 7-month-old female with intussusception status post resection, now with abdominal distention and bloody stoolVIEWS: Abdomen AP and crosstable lateral (two views) 3/19/15 Nasogastric tube tip and proximal sidehole are within the gastric body.Staple line and surgical materials are noted in the right hemiabdomen. Diffuse gaseous distention of bowel loops is improved compared to prior exam. Mildly dilated featureless bowel loops are situated in the left hemiabdomen with air-fluid levels. Paucity of gas in the right hemiabdomen. No pneumatosis, free air, or portal venous gas. The abdomen appears distended.Triangular opacity in the left lower lobe likely represents atelectasis. | Dilated featureless bowel in the left and mid abdomen are favored to represent an ileus in the early postoperative period, however an early obstruction is also included in the differential. |
Generate impression based on findings. | Female, 14 years old. Reason: rule out fracture, patellar tendon rupture History: pain, swellingVIEWS: Right knee, AP, lateral, oblique (3 views) 3/18/2015, 1900 Patella alta. Indistinctness of the patellar tendon.Small joint effusion.No acute fracture is identified. | Patella alta and indistinctness of the patellar tendon, concerning for patellar tendon rupture. No fracture. Recommend MRI for further evaluation. |
Generate impression based on findings. | Male 24 years old; Reason: SBO? History: abdominal pain.Additional history from pathology report of 10/21/2014 indicates history of hypertension, end-stage renal disease on hemodialysis with failed kidney transplant, antiphospholipid syndrome, polymyositis. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small atrophic with a few cysts, consistent with chronic medical renal disease.RETROPERITONEUM, LYMPH NODES: Normal caliber aorta and branch vessels. No evidence of atherosclerotic disease.BOWEL, MESENTERY: There is dilatation and massive submucosal edema involving the entire jejunum and some proximal ileum. There is hyper enhancement of the mucosa of the entire jejunum and proximal ileum. There is moderate generalized ascites. No intramural air or free air. No discrete transition zone to suggest mechanical obstruction; the dilated jejunum transitions gradually to ileum. Mesenteric vessels enhance normally without evidence of visible thrombus in the mesenteric arteries or veins.Differential diagnostic considerations include ischemic or inflammatory basis and ACE inhibitor-related angioneurotic edema. Embolic phenomena in the patient with antiphospholipid syndrome is also possible although the large vessels are patent.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Moderate generalized ascites. Colon is normal. Ileal loops in the pelvis are not particularly dilated although some of the proximal ileal loops show mucosal hyperenhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Infarcted partially calcified renal allograft in the right iliac fossa. | 1.Severe submucosal edema, dilatation and wall hyperenhancement involving the entire jejunum with some hyperenhancement of the ileum associated with marked generalized ascites. Rule out ischemia, angioneurotic edema related to ACE inhibitors hypertension, small vessel embolic disease causing ischemia if the patient is hypercoagulable. I doubt that there is an element of obstruction. |
Generate impression based on findings. | 77-year-old male with shortness of breath and history of metastatic lung cancer, evaluate for pulmonary embolus PULMONARY ARTERIES: Technically adequate examination with pulmonary emboli in the left upper lobar and segmental arteries of uncertain chronicity. Main pulmonary artery measures 2.8 cm.LUNGS AND PLEURA: Saber sheath trachea. Severe centrilobular emphysema.Reticular and airspace opacities with traction bronchiectasis and low lung volume in the upper lobe and superior segment of the lower. No pneumothorax. No pleural effusion.MEDIASTINUM AND HILA: Large tracheoesophageal lymph node (series 3, image 61) measures 2.1 cm. Large subcarinal lymph node measures 2.4 cm (series 8, image 142).Additional prominent mediastinal and hilar lymph nodes are present. Severe coronary artery calcification. Heart size is top normal with no pericardial effusion. Mitral valve prosthesis.CHEST WALL: No significant axillary, retrocrural, or cardiophrenic lymphadenopathy.Likely bone island in the right scapula. Mild degenerative disease affects the thoracic spine. Median sternotomy is intact. No suspicious osseous lesions.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized, presumably pancreatic stent. | 1.Pulmonary emboli in the left upper lobar and segmental arteries of indeterminate chronicity, but potentially acute.2.Extensive reticular and air space opacities in the left upper lobe and superior segment of the lower lobe with traction bronchiectasis compatible with postradiation change. There may be a component of infection in the correct clinical context. Mediastinal and hilar lymphadenopathy, likely metastatic.3.Severe centrilobular emphysema.PULMONARY EMBOLISM: PE: Positive.Chronicity: Indeterminate.Multiplicity: Multiple.Most Proximal: Lobar.RV Strain: Negative. |
Generate impression based on findings. | 84 years, Female. Reason: r/o obstruction History: projectile vomiting There is a nonobstructive bowel gas pattern. No evidence of pneumoperitoneum. Gastrostomy tube projects over the stomach. Large rectal stool burden unchanged. There are degenerative changes of the mid spine. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | 24 years, Female. Reason: free air History: abdominal pain There is a nonobstructive bowel gas pattern. Supine radiographs are insensitive for the detection of free air and an upright chest is recommended. | There is a nonobstructive bowel gas pattern. Supine radiographs are insensitive for the detection of free air and an upright chest is recommended. |
Generate impression based on findings. | 10-year-old female with abdominal pain, nausea and vomitingVIEW: Abdomen AP (one view) 3/19/15 Large stool burden. Nonobstructive bowel gas pattern. No pneumatosis or free air. | Large stool burden. |
Generate impression based on findings. | 46 years, Female. Reason: Placement of R ureter stent History: R flank pain Right nephroureteral stent with distal tip projecting over the urinary bladder, unchanged since the 2/7/2015 exam. Surgical clips project over the right midline abdomen. There is an IVC filter in place. There is a nonobstructive bowel gas pattern. | Right nephroureteral stent position unchanged since the 2/7/2015 exam |
Generate impression based on findings. | 29 years, Male. Reason: abd fullness, constipation, eval stool burden History: abd fullness, constipation There is diffuse gaseous distention of the large bowel which may reflect colonic ileus or distal obstruction. Previously administered oral contrast opacifies portions of the ascending and descending colon. Retrocardiac opacity consistent with atelectasis/consolidation. | Diffuse gaseous distention of large bowel, which may reflect colonic ileus or distal large bowel obstruction. |
Generate impression based on findings. | 53 year old female who was recalled from screening mammogram for architectural distortion at posterior upper quadrant in the left breast . Mammogram: An ML 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Architectural distortion in the posterior upper quadrant of the left breast disperses into normal breast tissue.Ultrasound: Targeted left upper, outer quadrant breast ultrasound was performed. Normal dense glanular tissue noted. No suspicious cystic or solid mass noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 37 years, Male. Reason: abdominal pain, assess for bowel pathology, stool burden History: abdominal pain No evidence of pneumoperitoneum. There is a nonobstructive bowel gas pattern. Below average stool burden. | There is a nonobstructive bowel gas pattern. |
Generate impression based on findings. | 54 years, Male. Reason: verify NG tube placement History: s/p NG tube placement for decompression There is an NG tube in place with the tip below the diaphragm, but not identified definitively. There is extensive opacification of the right lung suggestive of pleural effusion with associated consolidation/atelectasis. There is a nonobstructive bowel gas pattern. Previously administered oral contrast opacifies portions of large bowel. Evaluation limited secondary patient body habitus. | NG tube tip below the diaphragm, but not definitely identified. |
Generate impression based on findings. | 40 year-old female with chest pain and shortness of breath. Evaluate for PE. PULMONARY ARTERIES: Technically adequate exam for evaluation of pulmonary embolism. No pulmonary embolus is identified.LUNGS AND PLEURA: Diffuse fine nodular pattern with upper lobe predominance may be mildly progressed progressed from the previous exam. No focal consolidation or pleural effusion is present.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. No coronary calcifications are detected. Marked interval decrease in bilateral hilar and mediastinal lymphadenopathy. CHEST WALL: No suspicious focal osseous lesion.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. A new 17-mm hepatic dome hypodense lesion is incompletely evaluated. | 1.No evidence of pulmonary embolism.2.Stigmata of sarcoidosis with decreased lymphadenopathy and progression of pulmonary disease.3.Incompletely evaluated new hepatic dome lesion, which may represent a granuloma given the history of sarcoidosis.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 64 years, Male. Reason: placement of R fem line History: see above Right femoral central venous catheter tip terminates in the distribution of the right common iliac vein. There is diffuse gaseous distention of the stomach. There is a gastrostomy tube in place. There is a nonobstructive bowel gas pattern. | Right femoral central venous catheter tip terminating in the distribution of the right common iliac vein. There is diffuse gaseous distention of the stomach. |
Generate impression based on findings. | Male 51 years old; Reason: hx emphysematous chole, bowel obstruction, lymphoma History: fever, open wound from chole malodorous and potential rib exposed Portions of the left abdomen are excluded from the field-of-view.CHEST:LUNGS AND PLEURA: Pleural effusion, mildly increased compared to prior with adjacent compressive atelectasis.MEDIASTINUM AND HILA: Mild coronary artery calcifications.CHEST WALL: Left-sided Port-A-Cath with tip in the distal SVC.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is collapsed. Persistent nonspecific porta hepatis lymph node enlargement.SPLEEN: Splenomegaly at 15.9 cm.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate arteriosclerosis of the abdominal aorta and branch vessels. Abdominal please.BOWEL, MESENTERY: 10.0 x 8.1 cm right lower quadrant fluid collection/mass is unchanged in size compared to prior study but there are new internal foci of gas. This raises the concern for superimposed infection. There is persistent diffuse mesenteric lymphadenopathy as well as haziness of the mesentery. Submucosal fat deposition within the wall of the large bowel is again evident, suggesting chronic inflammation.Nonspecific gastric antral thickening.BONES, SOFT TISSUES: Right abdominal wall wound/skin ulceration has increased in depth and now extends to the peritoneal surface (series 3, image 121). Left lower abdominal wall skin thickening with underlying soft tissue infiltration to the abdominal wall musculature is incompletely imaged. This appears similar to prior study.OTHER: Large-volume abdominal ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Nonspecific external iliac chain lymph node enlargement.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Large volume pelvic ascites. | 1.Stable size of right lower quadrant mass/fluid collection with new gas, raising the possibility of superimposed infection.2.Right anterior abdominal wall ulceration/wound has increased in depth compared to prior study.3.Skin and soft tissue thickening and infiltration in the left abdominal wall is incompletely imaged.4.Increasing left pleural effusion and stable large-volume abdominopelvic ascites.5.Splenomegaly the nonspecific abdominal and pelvic lymphadenopathy may relate to patient's history of follicular lymphoma. |
Generate impression based on findings. | 68-year-old female with right hip pain, left leg weakness. Two views of the right hip demonstrate minimal osteoarthritis. No fracture or malalignment is evident.Two views of the left hip demonstrate minimal osteoarthritis. No fracture or malalignment is evident.Two views of the left femur demonstrate moderate osteoarthritis of the left knee. There is no acute fracture or malalignment. | Minimal hip osteoarthritis and moderate left knee osteoarthritis. No evidence of fracture or malalignment. If pain persists, consider MRI. |
Generate impression based on findings. | Male; 54 years old with history of lung cancer. Reason: SBO History: abdominal distention, abdominal pain Lack of intravenous contrast limits sensitivity for solid organ pathology.ABDOMEN:LUNG BASES: Moderate right pleural effusion with pleural thickening, partially visualized and similar to prior study. Dense atelectasis/consolidation of the right lung base, similar to prior study. Debris is noted within the bronchus intermedius. Minimal left basilar dependent subsegmental atelectasis.LIVER, BILIARY TRACT: New scalloping of the right hepatic and caudate lobes due to increased carcinomatosis. Cholelithiasis.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: Interval increase in peritoneal and mesenteric nodularity and soft tissue thickening, consistent with peritoneal carcinomatosis, measuring up to 2.6-cm in thickness, previously 2.1-cm (series 3/86). No bowel obstruction. Prominent jejunal loops may be due to mild ileus secondary to the carcinomatosis.BONES, SOFT TISSUES: Stable scattered small nonspecific sclerotic foci within the vertebral bodies. Stable mild to moderate degenerative arthritic changes of the visualized spine.OTHER: Moderate to large abdominal ascites, increased since prior study.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Stable scattered small nonspecific sclerotic foci within the vertebral bodies. Stable mild to moderate degenerative arthritic changes of the visualized spine.OTHER: No significant abnormality noted | 1. Increased carcinomatosis and ascites.2. No bowel obstruction. Prominent jejunal loops may be due to mild ileus secondary to the carcinomatosis.3. Stable dense atelectasis/consolidation of the right lung base with moderate right pleural effusion and pleural thickening, partially visualized. Underlying infection cannot be excluded.4. Stable nonspecific scattered sclerotic foci within the vertebral bodies. |
Generate impression based on findings. | Reason: cerebellar infarct/bleed; vertebral artery dissection History: occipital headache, eye redness and blurred vision, intermittent vertigo HEAD:No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or hydrocephalus. Gray-white matter differentiation is preserved. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. CTA HEAD: Normal contrast opacification is present through anterior circulation, posterior circulation, and distal intracranial vasculature. Minimal bilateral cavernous carotid calcification with no significant narrowing. Normal contrast opacification is present through anterior communicating artery. Bilateral posterior communicating arteries are not well seen on this exam. There is no evidence of occlusive thrombus or dissection. Asymmetric enhancement of the left cavernous sinus with essentially complete lack of enhancement of the right cavernous sinus. The size of the cavernous sinuses are symmetric. The superior ophthalmic veins are symmetric in size without evidence of orbital edema.CTA NECK:Common origin of the right brachiocephalic and left common carotid arteries. Otherwise brachiocephalic, left common carotid, left subclavian, and bilateral vertebral artery origins are within normal limits. There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. Large left heterogeneous thyroid nodule measuring 2.7 by 3.6-cm (axial image 55/247), previously 2.3 x 3.4 cm on PE CT study in 2010. The left thyroid nodule is exophytic and extends down to the clavicular head. There is mass effect on the left common carotid artery without narrowing. Lung apices are clear. Scattered spondylotic changes of the cervical spine, worst at C3/4 with mild to moderate central canal stenosis. | 1.Normal-appearing intracranial and cervical vasculatures with minimal atherosclerotic changes. No evidence of vertebral artery dissection is clinically questioned.2.Asymmetric non-enhancement of the right cavernous sinus. This is likely due to variant venous drainage given lack of any associated imaging findings, but given the reported history of eye redness, please correlate clinically to exclude possibility of chronic right cavernous sinus thrombosis.3.Mild increase in the size of the large left exophytic thyroid nodule. Given the size, recommend further evaluation with thyroid ultrasound.Findings discussed with Dr. Shappell by Dr. Stephanie Jo on 3/19/2015, 10:23AM. |
Generate impression based on findings. | 3-year-old female with bright red blood per rectumVIEWS: Abdomen AP and left lateral decubitus (two views) 3/19/15, 0612 and 0615 Nonobstructive bowel gas pattern. Air-filled right colon is in normal position. No pneumatosis, free air, or portal venous gas. | Normal examination. |
Generate impression based on findings. | Please note this examination is limited by the timing of contrast.Neck CTA: The right internal carotid artery is occluded from its origin at the bifurcation. There is atherosclerotic plaque at the left carotid bifurcation without significant stenosis by NASCET criteria. There is no evidence of dissection or aneurysm of the left carotid, left vertebral, or right vertebral arteries. There is mild, scattered calcification of the aortic arch and brachiocephalic artery. The parapharyngeal soft tissues, salivary glands, and larynx appear normal. Cervical lymph nodes are not pathologically enlarged. There is pulmonary septal thickening and ground glass opacity at the right lung apex, better evaluated on concurrent CT chest, abdomen, and pelvis.Brain: There is a large area of the encephalomalacia in the right MCA territory with ex vacuo dilatation of the adjacent lateral ventricle, similar to the prior examination. The right supraclinoid internal carotid artery is very diminutive and appears to be reconstituted by the ophthalmic branch. The right MCA is smaller than the left. There is scattered atherosclerotic calcification of the cavernous and supraclinoid left internal carotid artery. There is no intracranial hemorrhage visualized. There is a right maxillary sinus mucosal retention cyst. | 1.Occlusion of the entire right ICA from its origin.2.Scattered atherosclerotic calcification but no dissection, aneurysm, or significant stenosis of the remaining cervical vasculature.3.Chronic right MCA territory infarct.4.Right lung apex opacity, better evaluated on concurrent CT chest, abdomen, and pelvis. |
Generate impression based on findings. | Shoulder pain. Question of osteoarthritis. Three views of the left shoulder show severe joint space narrowing, osteophyte formation, and degenerative changes of the humeral head; this is increased compared to the prior study. There is mild to moderate osteoarthritis of the acromioclavicular joint.Three views of the right shoulder show severe joint space narrowing, osteophyte formation, and degenerative changes of the humeral head. Mild to moderate osteoarthritis affects the acromioclavicular joint. | Severe osteoarthritis of the bilateral glenohumeral joints. |
Generate impression based on findings. | Dedicated images through the sella demonstrate a normal height of the pituitary gland. There is a small linear area of hypoenhancement along the posterior aspect of the anterior pituitary gland, adjacent to the posterior pituitary bright spot. There is additional possible corresponding T2 hypointensity on the coronal images (1001/7). The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Thin linear area of hypoenhancement just anterior to the posterior pituitary bright spot with suggestion of corresponding T2 hypointensity. This may represent an incidental pars intermedia cyst given its location and signal characteristics. |
Generate impression based on findings. | 59-year-old male with shortness of breath, evaluate for pulmonary embolism PULMONARY ARTERIES: Technically adequate examination without evidence of pulmonary embolism. Main pulmonary artery caliber is within normal limits.LUNGS AND PLEURA: Large pleural effusions with adjacent dense compressive atelectasis/consolidation not significantly changed in size since the prior exam. Patchy ground glass opacity in the right upper lobe is unchanged and may reflect scarring or atelectasis along the minor fissure. Thickened interlobular septa and bronchial wall thickening with mild bronchiectasis. MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Mild coronary artery calcification.Unchanged pretracheal lymph node using similar measurement parameters now measuring 11 mm (series 8, image 112), previously 11 mm. Additional scattered mediastinal and hilar lymph nodes. Coarse calcification within hilar and mediastinal lymph nodes suggests a prior granulomatous disease.Right chest wall port tip is at the superior cavoatrial junction.CHEST WALL: Unchanged scattered sclerotic foci throughout the osseous structures may represent metastatic lesions.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small upper abdominal ascites. | 1.No evidence of pulmonary embolism.2.Large bilateral pleural effusions, likely malignant without significant change.3.Diffuse bronchial wall thickening and thickened interlobular septa may reflect a component of edema.4.Mediastinal lymphadenopathy not significantly changed in size.5.Numerous sclerotic bone lesions compatible with metastases.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 66-year-old female with hypoxia. Evaluate for PE. PULMONARY ARTERIES: Diagnostic to the segmental level, no pulmonary embolus is identified.LUNGS AND PLEURA: Low lung volumes appeared mild basilar scarring/atelectasis. No focal consolidation, pleural effusion, or suspicious pulmonary nodules.MEDIASTINUM AND HILA: Moderate cardiomegaly. No pericardial effusion. No coronary calcifications detected. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No suspicious focal osseous lesion detected.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism or other findings to account for hypoxia. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 16-year-old male with placement of femoral port.VIEWS: Chest AP, abdomen AP (two views) 3/18/15 Chest: Median sternotomy wires are unchanged. Cervical plates and screws remain in place. Interval placement of left femoral port with tip at the IVC - right atrial junction. A single right atrial line remains in place.Cardiothymic silhouette is normal. Streaky left lower lobe opacity likely represents subsegmental atelectasis. No pneumothorax or pleural effusion.Abdomen: Interval placement of left femoral port. Disorganized bowel gas pattern. No pneumatosis, free air, or portal venous gas. | Femoral port with tip at the IVC are, right atrial junction. |
Generate impression based on findings. | Female 77 years old Reason: pt with central chest pain that spread across entire chest today, has cardiac cath at OSH yesterday History: chest pain CHEST:LUNGS AND PLEURA: No pleural effusion, consolidation or pneumothorax. No suspicious pulmonary nodules or masses. Minimal left paramediastinal atelectasis.MEDIASTINUM AND HILA: Prominent, no enlarged mediastinal and axillary lymph nodes. Dense coronary artery and aortic atherosclerotic calcification. No pericardial effusion. Small hiatal hernia.CHEST WALL: No significant abnormality notedANGIOGRAPHY: No aneurysmal dilatation of the aorta. No evidence of aortic dissection.ABDOMEN:LIVER, BILIARY TRACT: No biliary ductal dilatation. No focal hepatic mass.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal hypoattenuating lesions, some of which are too small to characterize, and some of which are cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedANGIOGRAPHY: No aneurysmal dilatation of the aorta. No evidence of aortic dissection.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes noted in the lumbar spine.ANGIOGRAPHY: No aneurysmal dilatation of the aorta. No evidence of aortic dissection.OTHER: No significant abnormality noted | 1.No evidence of aortic dissection, aortic aneurysm, or other CT findings to account for patient's chest pain. |
Generate impression based on findings. | 43-year-old female status post right lumpectomy in June, 2014 followed by radiation and hormonal therapy presents for first postlumpectomy bilateral diagnostic mammogram. Three standard views of both breasts and two spot magnification views of right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A scar marker overlies the right central slightly lateral breast with scarring, architectural distortion and few surgical clips at the lumpectomy bed. No suspicious calcifications seen on spot magnification views. Moderate right breast skin thickening noted consistent with postradiation changeNo dominant mass, suspicious microcalcifications in either breast. Scar marker noted in the right axillary region. | 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 80 years old; Reason: intra-abdominal infectious source History: abdominal pain, nausea, vomiting ABDOMEN:LUNG BASES: Streaky basilar atelectasis, unchanged compared to prior. Left basal pulmonary granuloma.LIVER, BILIARY TRACT: Cholelithiasis. Distended gallbladder.SPLEEN: Stable splenic granulomas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered hypoattenuating right renal lesions are too small to characterize. Minimal prominence of the bilateral collecting systems, reduced compared to prior study.RETROPERITONEUM, LYMPH NODES: Severe aorta and branch vessel calcific arteriosclerosis.BOWEL, MESENTERY: Unremarkable appearance of the small bowel anastomosis. See below.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Changes related to prior post cystectomy with right lower quadrant ileal conduit.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonspecific 3.1 x 3.8 cm loculated fluid collection in the pelvis (series 3, image 99). This is in the region of free fluid on prior study. This may represent simple loculated fluid however superimposed infection as well as hematoma could have a similar appearance. Apparent mural thickening of the descending colon is likely related to collapsed state. The splenic flexure is located above the left hemidiaphragm suggestive of a Bochdalek hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Chronic thrombosis the left external iliac and common femoral artery and occluded femoral-popliteal bypass graft. | 1.3.8 cm loculated fluid collection in the pelvis is nonspecific and may represent loculated simple fluid/infection/hematoma.2.Postoperative changes related to cystectomy and ileal conduit formation.3.Severe calcific arteriosclerosis of the abdominal aorta and branch vessels with chronic thrombosis of the left external iliac and common femoral artery and occluded femoral popliteal bypass graft. |
Generate impression based on findings. | 65-year-old female with right IJ/ SVC clot. R IJ tunneled permacath, neck pain with dialysis. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Multiple bilateral hypoattenuating thyroid nodules. No evidence of superior vena cava or right internal jugular vein thrombosis. Right IJ catheter tip in right atrium. Heart size is upper limits of normal. Mild coronary calcifications and aortic valve calcifications are identified.CHEST WALL: Severe degenerative changes affect the visualized spine. No suspicious focal osseous lesion detected.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. There is suggestion of intrahepatic biliary ductal dilatation, incompletely evaluated. | No evidence of SVC or right IJ thrombosis within the limitations of a CT exam; optimal evaluation is by venography.New intrahepatic biliary ductal dilatation, incompletely evaluated. |
Generate impression based on findings. | Male, 23 days old. Evaluate for NEC History: Increased abdominal extension, emesis, history of CDHVIEW: Abdomen AP (one view) 3/19/2015, 0511 ET tube below the thoracic inlet and above the carina. Enteric tube terminates in the stomach, with distal side port below the level of the GE junction. Right lower extremity central venous catheter, with tip in the infrahepatic IVC. Removal of left arm venous catheter.Persistent right-sided hydropneumothorax, similar to the prior exam. Probable right middle lobe atelectasis. Normal aeration of the left lung.Disorganized, nonspecific bowel gas pattern, slightly increased in prominence from prior. No pneumatosis, portal venous gas, or free air. | Unchanged cardiopulmonary appearance. Disorganized, nonspecific bowel gas pattern. |
Generate impression based on findings. | Left upper extremity weakness, evaluate for pathology. Per chart, patient has a history of stage IVb endometrial adenocarcinoma. There is an enhancing mass in the left anterior aspect of the superior frontal gyrus measuring 20 x 24 x 27 mm AP, transverse, and craniocaudal dimensions. There is mild intrinsic hyperintensity associated with the mass without frank hemorrhage.There is surrounding vasogenic edema with sulcal effacement and effacement of the left frontal horn and mild rightward subfalcine herniation. Mild rightward midline shift measures 4 mm. No uncal herniation. There is an additional enhancing lesion involving the left parietal lobe measuring approximately 9 mm in diameter. There is an additional enhancing mass involving the right cerebellar hemisphere measuring 17 x 19 x 21 mm. There is surrounding vasogenic edema in the right cerebellar hemisphere with minimal effacement of the fourth ventricle. No hydrocephalus. No extra-axial collections. The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | Evidence of intracranial metastatic disease with at least 3 enhancing lesions identified on postcontrast CT. The largest two lesions are in the left frontal lobe and the right cerebellar hemisphere. There is associated edema and mass-effect including mild rightward midline shift. There is minimal effacement of the fourth ventricle. No hydrocephalus. MRI with gadolinium would be more sensitive for additional lesions.Dr. Ali discussed findings with Gina Bradley (Neurosurgery) at 900 hours on 3/19/2015 |
Generate impression based on findings. | 4-month-old male with respiratory distress VIEW: Chest AP (one view) 3/19/15, 0348 Endotracheal tube tip is between the thoracic inlet and the carina. Nasogastric tube tip in proximal spinal in the gastric body. Cardiac silhouette is top normal, unchanged. Interval improvement in bibasilar atelectasis. Persistent left lower lobe atelectasis. Increasing right upper lobe opacity likely represents atelectasis. Opacity in the right costophrenic angle may represent overlying material or small pleural effusion. | Persistent but improved bibasilar atelectasis. Increased right upper lobe atelectasis. Opacity in the right costophrenic angle may represent overlying material or small pleural effusion. |
Generate impression based on findings. | 52 year-old female with wrist fracture. Cast material obscures fine bone detail. Comminuted, predominantly transverse fracture of the distal radial metaphysis, with mild impaction and dorsal and radial displacement of the distal fracture fragment. A small ossific density next to the ulnar styloid, presumably represents the stated avulsed fracture fragment. | Comminuted fracture of the distal radius as above. Probable avulsion fracture of the ulnar styloid. |
Generate impression based on findings. | Endometrial cancer with neuropathy, assess for brain metastases. There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. There is an ectopic molar tooth along the lateral wall of the right maxillary sinus. | No evidence of intracranial metastases. |
Generate impression based on findings. | Reason: stem cell transplant patient with hemoptysis History: cough. LUNGS AND PLEURA: Patchy ground glass and consolidation in the lower lobes are compatible with aspiration and/or infection. Trace right pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No coronary calcifications detected. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No suspicious focal osseous lesion detected.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Stable 11-mm right hepatic lobe hypodense lesion, compatible with simple cyst. | Bilateral lower lobe groundglass and air space opacities are compatible with aspiration or infection. Hemorrhage is also a differential consideration given the clinical history of hemoptysis. |
Generate impression based on findings. | Male 71 years old Reason: diverticulosis History: LUQ/LLQ pain. Additional information from Epic: History of CLL and prostate cancer status post prostatectomy. ABDOMEN:Lack of intravenous contrast limits evaluation of abdominal organs.LUNG BASES: Multiple pulmonary nodules are noted in the right lung base the largest measuring 9 mm (image 13 series 4). Three-month follow-up is recommended for further evaluation.LIVER, BILIARY TRACT: Within limitations of nonenhanced examination there is no focal hepatic mass or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is moderate left hydronephrosis and left perinephric stranding with the ureter coursing through large retroperitoneal soft tissue mass, presumably conglomerate lymphadenopathy. Punctate bilateral nonobstructing renal calculi. RETROPERITONEUM, LYMPH NODES: Retroperitoneal soft tissue mass measuring 10.1 x 10.0 cm in axial dimension (image 63 series 3) and 16.3 cm in craniocaudal dimension (coronal image 55) which encases the aorta, iliacs, and is contiguous with the left psoas muscle. This most likely represents conglomerate lymphadenopathy. Atherosclerotic calcification of the abdominal aorta is noted.BOWEL, MESENTERY: No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Conglomerate lymphadenopathy as described above.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Extensive retroperitoneal lymphadenopathy with conglomerate lymph node, and resulting moderate left hydronephrosis.2.9-mm right pulmonary nodule. Recommend 3 month follow up. |
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