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Generate impression based on findings. | Male; 65 years old. Reason: dissection History: back pain Lack of oral contrast limits sensitivity for bowel pathology. The patient's arms were positioned by his side, causing streak artifact which mildly limits evaluation.CHEST:LUNGS AND PLEURA: Respiratory motion limits evaluation of the lung parenchyma. Within this limitation, there is questionable mild groundglass opacity at the right lung apex, which may be due to infection. Mild bibasilar streaky opacities, most likely due to subsegmental atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size. No pericardial effusion. Severe coronary artery calcifications. Mild calcified atherosclerosis of the thoracic aorta. Minimal dilation of the ascending aorta measuring up to 4.1-cm (6/41). Small hiatal hernia.CHEST WALL: Small metallic bullet fragments are seen just posterior to the left scapula.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No perinephric stranding. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Vascular postsurgical changes including right iliac artery stent and femoral-femoral bypass graft. | No definite acute abnormality. Questionable mild right apical ground glass opacity, which may be due infection. |
Generate impression based on findings. | 37-year-old male with ESRD on hemodialysis, HCPA/RSV+, continued hypoxia and SOB, evaluate for pulmonary embolism. PULMONARY ARTERIES: Main pulmonary artery is enlarged measuring 4.2 cm and thickened right ventricular wall is suggestive of pulmonary artery hypertension. LUNGS AND PLEURA: Thickened interlobular septa with patchy ground glass opacity suggestive of pulmonary edema. Focal airspace opacities in the right and left lower lobes. Right middle lobe atelectasis. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Moderate cardiomegaly with thickened right ventricular wall and enlarged right atrium.No pericardial effusion.Multiple prominent mediastinal and hilar lymph nodes.For reference, a prevascular lymph node measures 7 mm (series 9, image 99).CHEST WALL: Renal osteodystrophy. No suspicious osseous lesions. No axillary, cardiophrenic, or retrocrural lymphadenopathy. Diffuse body wall edema. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small amount of upper abdominal ascites is noted. | 1.No evidence of pulmonary embolism.2.Dependent atelectasis and consolidation in the posterior lobes may be related to aspirated secretions. Extensive mediastinal lymphadenopathy, likely reactive. 3.Mild pulmonary edema.4.Findings compatible with pulmonary artery hypertension.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 45 year old male with metastatic lung cancer. There is no evidence of abnormal enhancement. There is no mass effect or herniation. The ventricles and basal cisterns are normal in size and configuration. The imaged mastoid air cells are clear. There is mild mucosal thickening and retention cysts within the maxillary sinuses. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial metastases. |
Generate impression based on findings. | 45-year-old male with palpable lump in the right breast for one year. It is not increasing in size. No family history of breast cancer. Mammogram: Three standard views of both breasts and spot compression views of right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. Triangle marker denoting palpable abnormality identified in the right breast 8 to 9 o'clock position posterior depth. On spot compression views a circumscribed partially visualized encapsulated 3.5-cm lucent fat-containing lesion is identified, which could represent a lipoma. Few benign calcifications seen in the right breast.No suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.Ultrasound: Targeted right breast ultrasound was performed. On physical examination, is soft and mobile 3-cm mass is identified at 8 o'clock position. Ultrasound demonstrates parallel oriented circumscribed encapsulated hyperechoic mass that measures 4.5 x 1.6 cm without peripheral blood flow most consistent with a lipoma. No suspicious solid or cystic mass noted. | Palpable abnormality in the right breast 8 to 9 o'clock position corresponds to a benign lipoma on mammogram and ultrasound. Findings and recommendations were discussed with the patient. Clinical correlation is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | 52 year old male POD #1 status post craniotomy for resection of a left parietal metastasis. There are postoperative findings related to recent left parietal craniotomy for resection of a subjacent mass. There is pneumocephalus and high attenuation blood products within the surgical bed. There is extensive surrounding low attenuation within the left frontal and parietal white matter most compatible with edema and unchanged mass effect upon the left lateral ventricle. There is no midline shift or herniation. There are also postoperative findings related to prior right temporal craniotomy for resection of a subjacent metastasis. There is punctate pneumocephalus and low-attenuation presumed edema or gliosis within the surgical bed. There is mild atherosclerotic calcification of the distal internal carotid and vertebral arteries. The imaged paranasal sinuses and mastoid air cells are clear. | 1.Expected postoperative findings related to recent left parietal craniotomy for resection of a subjacent mass without evidence of midline shift or herniation.2.Unchanged postoperative findings related to prior right temporal craniotomy for resection of a subjacent mass. |
Generate impression based on findings. | Male 45 years old Reason: Metastatic lung cancer, bones mets, s/p vertebroplasty and lung wedge resection. Please compare with previous outside studies to evaluate disease status. Please provide bi-dimensional measurement to all lesions. History: lung cancer ABDOMEN:LUNG BASES: Bibasilar scarring. Postsurgical changes in the right lung base. Bilateral pulmonary nodules largest measuring 6 mm in the right lung base (image 9 series 7) previously 5 mm.LIVER, BILIARY TRACT: Right hepatic lobe subcapsular hypoattenuating lesion measuring 1.9 x 1.4 cm (image 36 series 8) previously 1.2 x 0.8 cm, most likely representing metastasis. Additional scattered subcentimeter hypoattenuating foci which are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter right renal hypoattenuating lesion which is too small to characterize but most likely represents a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Vertebroplasty changes in L4 vertebral body. Interval pathologic compression fracture of L2 vertebral body with multiple lytic lesions. Mixed lytic and sclerotic lesions throughout the visualized spine and pelvis increased from prior exam.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Lytic and sclerotic lesions throughout the spine and pelvis as described above.OTHER: Cystic area adjacent to the right testicle, most likely representing epididymal cyst, similar to prior exam. | 1.Interval increase in size of right hepatic metastasis.2.Interval pathologic compression fracture L2 vertebral body.3.Interval increase in number of lytic and sclerotic metastatic lesions in the spine and pelvis. |
Generate impression based on findings. | Status post fracture.VIEWS: Right great toe AP, lateral and oblique 3/18/15 (3 view/s) There is no evidence of acute or healing fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | PHARYNX/LARYNX: There is mild enlargement of the left palatine tonsil without evidence of heterogeneous enhancement. There is no focal fluid collection or abscess. Minimal if any inflammatory changes are seen within the adjacent parapharyngeal fat. There is slight thickening of the left aryepiglottic fold. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland demonstrates areas of hypoenhancement within the right lobe which are nonspecific. The largest measures 1.8 x 1.9 cm. In addition, there is posterior mediastinal and caudal extension of thyroid tissue as seen on 80337/45, to the T1-T2 level.ORAL CAVITY: The oral tongue and floor of mouth are unremarkable, within the limitations of this exam as there is artifact from dental amalgam.CERVICAL SOFT TISSUES: There are mildly enlarged left level 1a and bilateral level IIa lymph nodes, measuring up to 2.2-cm on the right. There is also a left level 5 lymph node measuring 1.4-cm. There is a 1.2 cm left supraclavicular lymph node. These are nonspecific and may be reactive. There are a few prominent preauricular lymph nodes noted.OTHER: Lobulated enhancing soft tissue is seen of the left auricle, for which correlation with physical exam is recommended for skin lesions. There is an impacted right mandibular molar. | 1. Asymmetric left palatine tonsillar enlargement suggestive of tonsillitis, without evidence of associated abscess. No retropharyngeal fluid collection.2. Cervical lymphadenopathy, which is nonspecific but most likely reactive.3. Thyroid lesions measuring up to 1.8 x 1 .9 cm, with additional exophytic nodule possible extending posteriorly and inferiorly into mediastinum. Correlation with thyroid function tests and thyroid ultrasound are recommended.4. Soft tissue nodules exophytic off left auricle. Please correlate with physical exam. |
Generate impression based on findings. | Female; 23 years old. Reason: Evaluate for appendicitis History: Acute abdominal pain LLQ ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: A subcentimeter hypoattenuating foci in the right hepatic lobe measuring 3 Hounsfield units, too small to accurately characterize but most likely a benign cyst (series 3/31). Small, coarse calcification in the right hepatic lobe, likely due to prior granulomatous process. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate predominately lower abdominal ascites.PELVIS:UTERUS, ADNEXA: Large, multi-loculated cystic pelvic mass with thin, enhancing wall measuring up to approximately 11 x 7.5 x 10.3 cm (transverse by AP by craniocaudal, series 3/113 and series 80 224/41). No mural nodularity or solid enhancing components evident. No macroscopic fat or calcifications. The mass is predominantly left-sided with slight deviation of the uterus to the right. Both ovaries are not visualized. Overall, findings are most suspicious for left ovarian serous or mucinous cystadenoma or cystadenocarcinoma. Small amount of endometrial fluid, likely physiologic.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate predominately lower abdominal ascites. | Large cystic pelvic mass as detailed above, suspicious for left ovarian serous or mucinous cystadenoma or cystadenocarcinoma. The patient's acute left lower quadrant pain may be due to left ovarian torsion, which cannot be excluded on this examination. Pelvic ultrasound can be obtained for further characterization. |
Generate impression based on findings. | 39-year-old female with recurrent sinusitis, history of nasal polyps status post biopsy ES There is near complete opacification of the bilateral maxillary sinuses and moderate opacification of the bilateral anterior and posterior ethmoid air cells. High-density within the sinuses may represent inspissated secretions and/or chronic fungal colonization. No evidence of aggressive sinonasal process. Thickening of the sinus walls consistent with chronic sinusitis. Mucosal thickening of the sphenoid sinuses. The left frontal sinus is hypoplastic. The frontoethmoidal and sphenoethmoidal recesses are opacified. Bilateral osteomeatal units are opacified. There is evidence of prior endoscopic sinonasal surgery. There is polypoid soft tissue involving right middle meatus and nasal cavity. The cribriform plate, lateral lamellae, fovea ethmoidalis and lamina papyracea appear normal. The orbits and limited view of the brain parenchyma are unremarkable. A superficial nasal implant is noted. | Extensive paranasal sinus opacification and polypoid opacification in the nasal cavity. Findings are compatible with chronic sinusitis and sinonasal polyposis. Hyperdense secretions within the paranasal sinuses may be related to inspissated secretions and/or chronic fungal colonization. |
Generate impression based on findings. | No acute intracranial hemorrhage is identified. Generalized cerebral volume loss with ex vacuo dilatation of the ventricles. No evidence of intracranial mass, mass-effect, or hydrocephalus. No extra-axial fluid collections. Gray-white matter differentiation is preserved. There is atherosclerotic calcification of the cavernous carotids. There is bilateral maxillary sinus aerated air-fluid levels and scattered bilateral ethmoid air cell opacification. There is also air-fluid level in the right frontal sinus. The imaged mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. | 1.No evidence of acute intracranial abnormality. CT is not sensitive for detection of acute nonhemorrhagic ischemia. If high clinical suspicion of acute ischemia, consider MRI.2.Sinus air-fluid levels suggestive of active sinusitis. Please correlate clinically. |
Generate impression based on findings. | 79-year-old male with leg pain and swelling status post fall. Two views of the right lower leg demonstrate chronic deformity of the distal tibia and fibula with syndesmotic osseous fusion. There is diffuse soft tissue swelling, without underlying acute fracture identified. Multiple small ovoid densities in the anterior soft tissues of the leg likely represent vascular calcifications.Three views of the right ankle demonstrate the aforementioned diffuse soft tissue swelling. Findings suggestive of hypertrophic tendinosis of the Achilles' tendon. No fracture or malalignment is evident.Three views of the right foot reveal significant soft tissue swelling particularly along the dorsum of the foot. A plantar heel spur is present. | 1.Diffuse soft tissue swelling without underlying acute fracture or malalignment. 2.Hypertrophic tendinosis Achilles' tendon.3.Chronic deformity of the distal tibia/fibula. |
Generate impression based on findings. | 32-year-old female with chest pain, evaluate for pulmonary embolism PULMONARY ARTERIES: Technically adequate examination without evidence of pulmonary embolism. The main pulmonary artery measures 2.8 cm.LUNGS AND PLEURA: No focal consolidation. No pleural effusion or pneumothorax. No suspicious nodules or masses. Mild bronchial wall thickening suggestive of reactive airways disease.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. The heart size is normal. No pericardial effusion. No visible coronary artery calcification.CHEST WALL: The osseous structures are within normal limits. No suspicious osseous lesions.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism. Mild bronchial wall thickening suggestive of reactive airways disease.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign biopsy left breast in 1975 Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Study is limited by significant motion artifact. There is extensive diffusion restriction of left ACA territory with extension into the genu of the corpus callosum on the left side, with additional punctate foci in the left caudate nucleus, and peripherally in the left parietal lobe cortex consistent with acute ischemia. No evidence of hemorrhagic transformation. Flow voids are grossly present in the major vessels, but evaluation is limited by motion artifact.There is mild scattered FLAIR hyperintensity of the periventricular and subcortical white matter compatible with chronic small vessel ischemic disease. There is likely patchy hyperintensity in the pons, but evaluation is limited by motion artifact. No evidence of mass or hydrocephalus. | Diffusion restriction of the left ACA territory extending into the genu of the corpus callosum, with additional punctate foci in the left caudate nucleus and peripheral left parietal lobe cortex, compatible with acute ischemia. No evidence of hemorrhagic transformation. Suspect embolic etiology.Other underlying chronic small vessel ischemic changes. |
Generate impression based on findings. | TIA with receptive aphasia and history of metastatic NSCLC s/p 6 cycles of chemotherapy now on maintenance therapy. Many of the images are degraded by patient motion.Head CT: There is no evidence of acute intracranial hemorrhage or mass. 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 mastoid air cells are clear. Thre is mild scattered paranasal sinus mucosal thickening. The skull and scalp soft tissues are unremarkable. There are bilateral lens implants.Head CTA: There are mild calcifications in the carotid siphons and a punctate calcification along the left intradural vertebral artery. There is no evidence of significant steno-occlusive lesions or cerebral aneurysms.Neck CTA: There are mild calcifications in the region of the carotid bulbs. There is no evidence of significant steno-occlusive lesions. There is mild pannus formation at the dens. There is extensive emphysema in the partially-imaged lungs. | 1. No evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, CT is insensitive for the detection of non-hemorrhagic acute infarct.2. No evidence of significant steno-occlusive lesions in the head and neck arteries.3. Extensive emphysema in the partially-imaged lungs. |
Generate impression based on findings. | Male 72 years old Reason: eval for evidence of fracture or evidence of crystalline arthropathy History: L foot pain Bones are demineralized suggesting osteopenia/osteoporosis. There is a moderate hallux valgus deformity. Moderate osteoarthritis affects the midfoot with osteophytes and joint space narrowing. Moderate osteoarthritis affects the first MTP joint. There is a calcaneal heel spur. Calcific arteriosclerotic disease affects the vessels. No acute fracture or dislocation. | Degenerative changes without evident fracture. |
Generate impression based on findings. | Female 79 years old Reason: r/o extrinsic compression of small bowel. on endoscopy duodenum appeared tortuous with possible compression ABDOMEN:LUNG BASES: Small Bochdalek hernia is noted. 4 mm right pulmonary nodule is noted.LIVER, BILIARY TRACT: Gallstones and gallbladder wall calcification consistent with porcelain gallbladder. No biliary ductal dilatation. No focal hepatic mass.SPLEEN: Subcentimeter hypoattenuating splenic lesion, too small to characterize.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Heavy atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Focal dilatation of the duodenum measuring 3.9 cm, with the aorto-SMA angle of 21 degrees and aorto-SMA distance of 5 mm, consistent with SMA syndrome, correlate with recent weight loss. Residual barium is noted from recent esophagram.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. Residual barium is noted from recent esophagram.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine.OTHER: No significant abnormality noted | 1.Focal dilatation of the duodenum, with findings consistent with SMA syndrome. Correlate with recent weight loss.2.Porcelain gallbladder.3.4-mm pulmonary nodule. Recommend follow up exam in 12 months in low-risk patient, or 6 months in high-risk patient. |
Generate impression based on findings. | 57 year-old female with right breast pain for past 3 months and self palpated mass noted. No family history of breast cancer. Mammogram: Three standard views of both breasts and two spot compression views of right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Triangular marker denoting area of concern identified in the right upper outer quadrant anterior to mid depth. No definite underlying mass identified. A partially circumscribed, oval mass in the right upper, outer quadrant posterior depth is better appreciated in 2014. Multiple punctate, round, benign morphology, stable calcifications in both breasts, left more than right.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae.Ultrasound: Targeted right upper, outer quadrant Ultrasound was performed. On physical examination, no discrete palpable mass identified in the right upper, outer quadrant. Patient could not definitely identify a site of palpable mass. She complains of pain in right upper outer quadrant. Ultrasound demonstrates normal glandular tissue corresponding to the area of pain in the right breast 10 o'clock position 2 cm from the nipple. There is an oval hypoechoic mass, parallel oriented with microlobulated indistinct margins at 10 o'clock position 5 cm from the nipple that measures 1.1 x 1 x 0.6 cm with peripheral blood flow that needs further evaluation with ultrasound guided biopsy. This most likely corresponds to the mammographic abnormality in the right upper outer quadrant posterior depth which was better appreciated in 2014. | Right breast 10 o'clock position, 5 cm from the nipple hypoechoic mass with mammographic correlate has indistinct margins and needs further evaluation with ultrasound guided core biopsy.Patient's area of concern in the right breast 10 o'clock position 2 cm from the nipple, demonstrates normal glandular tissue.Findings and recommendations were discussed with the patient in detail.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Clinical question: Mass? Infection? Signs and symptoms: History of seizures, recurrent seizures. Nonenhanced head CT: There is no evidence of an acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable surgical 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. | Bilateral scrotal swelling for 2 to 3 years RIGHT TESTIS: Measures 5.5 by 3.3 x 2.3 cm. No focal parenchymal lesion. Symmetric parenchymal flow.LEFT TESTIS: Measures 5.1 by 3.5 x 2.7 cm. Subcentimeter parenchymal calcification, may reflect a site of prior infection/inflammation, no associated focal parenchymal lesion delineated. Symmetric parenchymal flow.RIGHT EPIDIDYMIS: Rounded cystic structures in expected region of epididymal head and extending into inguinal canal, most likely epididymal cysts, largest dominant structure measures approximately 4.5 x 3.7 x 2.2 cm.LEFT EPIDIDYMIS: Similar to right side, cystic structures in expected region of epididymal head with largest measuring approximately 4.8 x 3.6 x 2.5 cm and containing septation (versus two structures alongside each other) and containing layering debris, likely a complex epididymal cyst or spermatocele.OTHER: No significant abnormalities noted. | Bilateral epididymal cystic foci as above, likely accounting for patient's reported scrotal swelling. |
Generate impression based on findings. | There is diffuse striking low attenuation of the cerebral cortex with comparative hyperdensity of the white matter. Gray-white matter differentiation is delineated but not optimally. Basal ganglia are not well delineated. There is also questionable hyperdensity in the dural venous sinuses, slightly more conspicuous in the superior sagittal sinus, which may be due to hemoconcentration from low fluid status. There is no acute intracranial hemorrhage or extra-axial collection. The cerebellum demonstrates diffuse relative hyperdensity, within normal limits.There is patchy bilateral middle ear and left mastoid air cell opacification. No acute intracranial hemorrhage is identified. No evidence of fracture. No extra-axial fluid collections. Paranasal sinuses demonstrate patchy opacification. | 1.Striking diffuse low attenuation of the cerebral cortex with comparative hyperdensity of the white matter. Poor delineation of the gray-white differentiation as well as poor visualization of the basal ganglia. This may represent diffuse cerebral edema, of uncertain etiology, including encephalitis. MRI is recommended for further evaluation.2.Questionable hyperdensity of the dural venous sinuses, more conspicuous in the superior sagittal sinus, which may be due to hemoconcentration from low fluid status as well as accentuation by the abnormal appearing cerebrum. If high clinical concern, MRV can be obtained to exclude the possibility of venous thrombosis.3.No evidence of acute intracranial hemorrhage or fracture.Findings discussed with Dr. Tracy Koogler by Dr. Stephanie Jo on 3/19/2015 at 10:46am. |
Generate impression based on findings. | Female 50 years old Reason: pain with exercise History: pain with exercise Bone mineralization is normal for age. Alignment is anatomic. No acute fracture or malalignment. There is abnormal offset of the right femoral head neck junction compatible with a small CAM Type deformity which may cause impingement and possibly groin pain. There is mild medial joint space narrowing. | Abnormal offset of the right femoral head neck junction compatible with a CAM Type deformity which may be the cause of the patient's pain. |
Generate impression based on findings. | Female 76 years old Reason: evaluate for metastatic disease History: new parotid/facial mass CHEST:LUNGS AND PLEURA: Multiple scattered pulmonary nodules, some of which are calcified. For reference right apical nodule measures 5 mm (image 20 series 6). No pleural effusion.MEDIASTINUM AND HILA: Partial intrathoracic stomach is noted. Calcified left thyroid nodule is noted. No mediastinal or hilar lymphadenopathy.CHEST WALL: No axillary adenopathy.ABDOMEN:LIVER, BILIARY TRACT: Nonspecific subcentimeter hypoattenuating hepatic lesion (image 76 series 4). Punctate calcified gallstones are present.SPLEEN: Punctate calcifications likely due to prior granulomatous disease. Small accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal hypoattenuating lesion, consistent with cyst. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta. No retroperitoneal adenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine.OTHER: No free fluid.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in lumbar spine.OTHER: No significant abnormality noted. | Nonspecific pulmonary nodules, the largest measuring 5 mm. Otherwise no definite evidence of metastatic disease in the chest, abdomen or pelvis. |
Generate impression based on findings. | 37 year-old female with history of left knee pain after fall. Four views of the left knee demonstrate a small joint effusion. No underlying fracture or malalignment is evident. | Small joint effusion without underlying fracture or malalignment. |
Generate impression based on findings. | Male; 48 years old. Reason: appy? chole? History: RLQ>RUQ pain, diarrhea, ++tender 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: Bilateral renal simple cysts. Right lower pole hypoattenuating lesion is too small to characterize but is likely an additional cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Normal appendix identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted. Normal appendix identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No acute abdominopelvic abnormality. |
Generate impression based on findings. | There is a tiny focus of T1 hypointensity along the lateral margin of the mid body of the left lateral ventricle which is isointense to gray matter. There is slight mass effect upon the ventricular margin as seen on 605/46 and 801/10. There is corresponding T2 hyperintensity which corresponds to gray matter signal as well, and this may represent a very tiny focus of subependymal gray matter heterotopia. There is also visualized on coronal T2 image 17.The ventricles and sulci are within normal limits. There is an incidental cavum vellum interpositum with slight convex margins especially on the right, with the possibility of an associated cyst not entirely excluded. The basal cisterns remain patent. There is no midline shift. There is minimal ill-defined FLAIR hyperintensity within the periatrial white matter in the expected location of the terminal zones of myelination likely representing areas of minimal incomplete myelination. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is a severely enlarged right node of Rouviere measuring at least 1.8-cm. There also is significant enlargement of Waldeyer's ring structures which may represent reactive lymphoid tissue in a patient of this age although there is associated moderate narrowing of the nasopharyngeal and oropharyngeal airway. | 1. Small focus of apparent gray matter signal along the lateral margin of the body of the left lateral ventricle suggestive of focal subependymal gray matter heterotopia.2. Incidental cavum vellum interpositum with slight right convex margin which may indicate an associated cyst.3. Significantly enlarged right node of Rouviere with also significant enlargement of Waldeyer's ring. Findings may represent reactive lymphoid tissue in a patient of this age, although clinical correlation is recommended. |
Generate impression based on findings. | 62 year-old female with bilateral hip pain. Single view of the right hip demonstrate interval removal of surgical drain and skin staples. Hardware components of a right hip hemiarthroplasty device in near anatomic alignment is unchanged. No fracture or radiographic evidence of osteomyelitis.Single view of the left hip demonstrates minimal osteoarthritis without underlying fracture or malalignment. There is no specific radiographic evidence of osteomyelitis. | Right hip hemiarthroplasty as above. Minimal left osteoarthritis. No specific radiographic evidence of osteomyelitis. |
Generate impression based on findings. | 62-year-old status post left lumpectomy and sentinel node biopsy in March 2012 for IDC, status post radiation therapy and on aromatase inhibitor. Three standard views of both breasts and two spot magnification views of 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. Post surgical scar with multiple clips is redemonstrated at 6 o'clock position in the left breast, unchanged. No suspicious calcifications seen on spot magnification views.No dominant mass, suspicious microcalcifications or new areas of architectural distortion in either breast. Multiple surgical clips in the left 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. | Male 32 years old Reason: BL knee pain History: BL knee pain Right knee: Bone mineralization is normal. Alignment is anatomic. The joint space is normal. No acute fracture or malalignment.Left knee: Bone mineralization is normal. Alignment is anatomic. Postsurgical changes from an ACL graft repair. The tibial tunnel measures 15 mm. There are proximal interference screw and distal staples. There are mild degenerative changes in the left knee with tiny osteophytes and small notch osteophytes. There is mild extensor compartment joint space narrowing. Possible trace joint effusion | Postsurgical changes from a left knee ACL graft repair with findings of early osteoarthritis. |
Generate impression based on findings. | 50 year-old female with right ankle pain. Three views of the right ankle demonstrate diffuse soft tissue swelling. No underlying acute fracture is identified. A plantar heel spur is present. | Moderate diffuse soft tissue swelling without underlying acute fracture or malalignment. |
Generate impression based on findings. | Female 54 years old Reason: Bilateral hip pain no hx trauma History: 719.45 Right hip: Bone mineralization is normal. Alignment is anatomic mild osteoarthritis affects the right hip joint osteophytes and joint space narrowing.No acute fracture malalignment.Left hip: Bone mineralization is normal. Alignment is anatomic mild osteoarthritis affects the left hip joint osteophytes and joint space narrowing.No acute fracture malalignment. | Mild bilateral hip osteoarthritis. |
Generate impression based on findings. | Male; 28 years old. Reason: evaluate for appy vs chole History: abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Acute appendicitis with enlarged appendix measuring up to 9 mm with wall thickening and minimal periappendiceal fatty stranding. Small appendicolith is seen within the base of the appendix. No evidence of perforation or periappendiceal abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Scattered, small sclerotic foci in both iliac bones, most likely due to bone islands.OTHER: Trace pelvic free fluid, likely reactive to the appendicitis. | Acute appendicitis as detailed above. No evidence of perforation or periappendiceal abscess. |
Generate impression based on findings. | Clinical question: Hydrocephalus. Signs and symptoms: Hydrocephalus. Unenhanced head CT:There is interval decreased subarachnoid and intraventricular hemorrhage since prior exam.Shunted supratentorial ventricles demonstrate 3 subtle interval increased size since prior study. The transverse diameter of the third ventricle measures at 12.4 the prior study measurement of 11.8. The left frontal horn of the lateral ventricle measures at 18.2mm compare to prior study measurement of 16.6mm.There is interval decreased density and size of right frontal hematoma since prior exam. Subtle residual edema at this site still present and the minimal effacement of adjacent cortical sulci. Visualization of metallic density at the level of right cavernous sinus consistent with coiled aneurysm. | 1.Subtle interval increased size of supratentorial shunted ventricular system and stable shunt position in the left frontal horn.2.Interval decreased density and size of right frontal hematoma.3.Interval decreased subarachnoid and intraventricular hemorrhage. |
Generate impression based on findings. | 72-year-old with history of right mastectomy for breast cancer presents for left unilateral follow-up. Mammogram: Three standard views of the left breast and two spot compression views of 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. 5-mm round mass in the left upper outer quadrant mid depth persist on spot compression views. Few benign skin calcifications seen in the left breast. A benign intramammary lymph node identified in the left upper outer quadrant, posterior depth.No suspicious microcalcifications or areas of architectural distortion in the left breast. Benign appearing lymph nodes are projected over the left axilla.Ultrasound: Targeted left upper outer quadrant Ultrasound was performed. A hypoechoic suspicious irregular mass with indistinct margins, measuring 6 x 4 mm without peripheral blood flow is identified at 2:30 o'clock position of the left breast that needs further evaluation with ultrasound guided core biopsy. | New 6-mm mass left breast 2:30 o'clock position needs further evaluation with ultrasound guided core biopsy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Female 65 years old Reason: gerd History: gerd. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Note is made of right upper quadrant surgical clips compatible with cholecystectomy.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed a small hiatal hernia without morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, spontaneous gastroesophageal reflux was observed to above the level of the thoracic inlet. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 5:44 minutes. | Small hiatal hernia and spontaneous gastroesophageal reflux to above the level of the thoracic inlet. |
Generate impression based on findings. | 19-year-old female with right shoulder pain. Single view of the right shoulder demonstrates right shoulder arthroplasty device in near-anatomic alignment. There is no evidence of fracture or dislocation. | Right shoulder arthroplasty device in near-anatomic alignment. |
Generate impression based on findings. | 77 years, Female. Reason: diarrhea likely 2/2 heavy stool burden, eval for improvement History: diarrhea, abdominal pain Below average stool burden, decreased from the prior exam. There is a nonobstructive bowel gas pattern. There are marked degenerative changes of the lower lumbar spine. There are severe degenerative changes of the bilateral hips, right greater than left. | Below average stool burden, decreased from the prior exam. |
Generate impression based on findings. | Female 55 years old Reason: right knee pain History: right knee pain Bone mineralization is normal. Alignment is near-anatomic. There is moderate extensor compartment osteoarthritis with bone on bone apposition of the lateral trochlea and the the patella.There are tricompartmental osteophytes. There is a moderate joint effusion.No acute fracture or malalignment. | Osteoarthritis and joint effusion. |
Generate impression based on findings. | -year-old male with abdominal pain.VIEW: Abdomen upright AP (one view) 3/19/15 Disorganized, nonobstructive bowel gas pattern. No pneumatosis, free air, or portal venous gas. Moderate stool burden. | Disorganized, nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male, 19 days old. Evaluate bowel gas pattern. Abdominal distentionVIEW: Abdomen AP (one view) 3/19/2015, 0457 Enteric tube terminates in the stomach, with distal side port below the level of the GE junction.Disorganized, nonspecific bowel gas pattern.No pneumatosis, portal venous gas, or free air. | Disorganized, nonspecific bowel gas pattern. |
Generate impression based on findings. | 19-year-old female with right shoulder pain. Single view of the right shoulder demonstrates right shoulder arthroplasty device in near-anatomic alignment. There is no evidence of fracture or dislocation. | Right shoulder arthroplasty device in near-anatomic alignment. |
Generate impression based on findings. | Chronic dizziness and unusual sounds in ears. Right: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. | No evidence of gross temporal bone abnormalities. |
Generate impression based on findings. | Male; 56 years old. Reason: SBO History: abdominal pain The lack of intravenous contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Stable postsurgical changes from right thoracotomy with multiple right-sided rib fractures, some of which demonstrate nonunion. Severe coronary artery calcifications.LIVER, BILIARY TRACT: Cholelithiasis without acute cholecystitis or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Redemonstrated is severe fatty infiltration of the right lower quadrant transplant pancreas, which is partially located within the right body wall hernia. No adjacent fluid collection or CT evidence of pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys with stable thickening at the left lower pole. Left iliac fossa renal transplant without hydronephrosis or perinephric fluid collection. Stable small hyperdense lesion in the midpole of the transplant kidney (series 80294/115).RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: New moderate mesenteric free fluid and fatty stranding centered in the midabdomen at the level of the transplant pancreas and its enteric limb, with fluid extending to the left paracolic gutter. Mild wall thickening of the enteric limb noted, which remains closely apposed to the anterior peritoneum, suspicious for adhesive disease. No significant mechanical bowel obstruction.BONES, SOFT TISSUES: Large abdominal wall hernia containing bowel, a portion of transplant pancreas, and bladder. Smaller superior left abdominal wall hernia containing a portion of the transverse colon. Healed fractures of the seventh and eighth posterior ribs.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New moderate mesenteric free fluid and fatty stranding at the level of the transplant pancreas and its enteric limb extending into the left hemiabdomen, most suspicious for transplant pancreatitis, particularly given the patient's elevated lipase. No evidence of bowel obstruction. |
Generate impression based on findings. | Female 70 years old; Reason: pt with a history of renal cell cancer, please assess for disease progression History: renal cell cancer CHEST:LUNGS AND PLEURA: Decrease size of multiple right-sided lung nodules. Right lower lobe lung nodule now measures 7 x 6 mm on image 60 series 4, previously measured 12 x 9 mm. Interval decrease in size of right apical lung nodule, measuring 7 x 5 mm, image 17 series 4, previously measured 12 x 10 mm. Another right upper lung nodule, located just anterior to major fissure, also smaller. Punctate right middle lobe and left-sided calcified granulomata. No pleural effusion.MEDIASTINUM AND HILA: Increased size of mild mediastinal lymphadenopathy. Pretracheal lymph node submitted for reference, measuring 1.9 x 1.1 cm on image 31 series 3, previously measured 1.2 x 08 cm. Moderate to severe coronary artery and thoracic aorta calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. Appearance of unenhanced liver parenchyma without significant change.SPLEEN: Again seen is small perisplenic fluid.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Mild interval decreased size of left adrenal nodule, measuring 1.9 x 1 cm, image 95 series 3, previously measured 2 x 1.2 cm.KIDNEYS, URETERS: Status post left nephrectomy, no soft tissue attenuation seen in left renal bed to suggest tumor recurrence. Stable subcentimeter exophytic focus extending from right kidney, image 150 series 3, may be a tiny cyst but too small to characterize. RETROPERITONEUM, LYMPH NODES: Decreased size of soft tissue focus behind abdominal aorta, measuring 1.5 x 0.9 cm on image 123 series 3, previously measured 2.1 x 1 cm, again may be a small seroma or lymphocele but nonspecific. Subcentimeter upper abdominal/periportal lymph nodes. Reference node measures 1.4 x 1 cm, without significant change accounting for differences in technique. Aortobiiliac atherosclerotic disease. BOWEL, MESENTERY: Mild degenerative disease. Small bowel and fat containing ventral abdominal hernia without associated bowel obstruction, defect measures 3.7 cm, hernia sac measures 5.5 cm. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures without significant change. Spinal and hip degenerative disease. | 1. Interval decrease in size of pulmonary nodules.2. Mild increase in mediastinal adenopathy, nonspecific. 3. Decreased size of left adrenal lesion.4. Small bowel containing ventral abdominal hernia, no associated bowel obstruction. |
Generate impression based on findings. | 65-year-old female with dysphagia and resistance upon intubation of cervical esophagus with endoscope. LUNGS AND PLEURA: No pneumothorax or pleural effusion. No suspicious nodule or masses. No focal consolidation.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No coronary pulmonary calcifications are detected within the limitations of this non-gated study. Caliber of the great vessels is normal. The left vertebral artery arises from the aortic arch. The trachea and mainstem bronchi are patent. No significant mediastinal or hilar lymphadenopathy. Probable calcified lymph node adjacent to the azygos vein. No mass lesion or cause of compression is evident in the upper mediastinum.Mild soft tissue edema or distal esophageal thickening at the GE junction.CHEST WALL: No suspicious osseous lesions. No axillary, cardiophrenic, or retrocrural lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Bariatric laparoscopic band is noted in place. Hypodense lesions in the left kidney are too small to further characterize but are presumably of benign etiology. | 1.No findings to account for resistance upon intubation of cervical esophagus with endoscope.2.Mild soft tissue edema or distal esophageal thickening at the GE junction.3.Low density lesions in the left kidney are too small to further characterize but are presumably of benign etiology. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in mother and aunt. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the left medial breast, mid depth, is not significantly changed. Scattered benign calcifications in both breasts are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, additional right CC view, and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A few scattered benign calcifications are present, including minimal arterial calcification.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 49 years old Reason: Evaluate for progression History: metastatic RCC CHEST:LUNGS AND PLEURA: Moderate right and small to moderate left pleural effusions with right basilar compressive atelectasis, increased from prior exam. Left lower lobe pulmonary nodule measuring 5 mm (image 82 series 5) unchanged. Left lower lobe subpleural nodular densities also unchanged.MEDIASTINUM AND HILA: Reference left supraclavicular lymph node measures 1.4 x 1.1 cm (image 5 series 3) previously 1.3 x 1.1 cm. Calcified left hilar lymph node is unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis is again noted. Periportal edema appears similar to prior exam.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal gland is not well visualized.KIDNEYS, URETERS: Status post right nephrectomy. No focal left renal mass.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal adenopathy is again noted. Reference left periaortic lymph node measures 5.3 x 4.6 cm (image 122 series 3) previously 5.2 x 4.6 cm. Reference portacaval lymph node measures 5.2 x 4.0 cm (image 105 series 3) previously 5.0 x 3.6 cm. Adenopathy encases the left renal vein, IVC and main portal vein. The IVC is highly attenuated, appearing similar to prior exam.BOWEL, MESENTERY: Small to moderate ascites, slightly increased from prior exam.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Orthopedic fixation of lower lumbar spine is again noted.OTHER: Body wall anasarca. | 1.Slight increase in size of reference portacaval lymph node, remaining reference lymph nodes are stable.2.Bilateral pleural effusions, increased.3.Ascites and anasarca, slightly increased from prior exam. |
Generate impression based on findings. | 39-year-old female with bilateral benign biopsies 10 years ago and recent right breast mass seen on CT scan underwent excisional biopsy of the right breast mass in October 2014, now presents for bilateral diagnostic mammogram . Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Scar markers overlie bilateral upper outer quadrants. The previously described right upper outer quadrant mass was recently excised in October 2014. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | The ventricles and sulci are within normal limits for age. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is right parietal vertex subgaleal thickening and overlying mild fat stranding consistent with soft tissue edema. There is no underlying fracture. | No acute intracranial hemorrhage. High right parietal subgaleal and scalp swelling without fracture. |
Generate impression based on findings. | New right parotid mass concerning for malignancy, right lateral rectus palsy. Head CT: There is an infiltrative mass involving the right parotid space, where there is necrotic lymphadenopathy, with extension into the masticator and carotid spaces, sphenoid sinuses, and into the middle cranial fossa through skull base defects. In particular, there is tumor within the right cavernous sinus, Meckel cave, and prepontine cistern, which abuts the pons. There is also diffuse thickening of the dura along the floor of the right middle cranial fossa and slight protrusion of tumor in to the right aspect of the sella. There is irregularity of the right mandible diffusely, likely due to tumor infiltration. Although not significantly enlarged by size criteria, a right level 1B lymph node that measures 7 mm in short axis displays a rather globular morphology. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. There are multiple skin excrescences in the face. There are bilateral lens implants.Head CTA: There is mild diffuse narrowing of the lacerum and cavernous portions of the right internal carotid artery due to encasement by the mass. The tumor also abuts the basilar artery without narrowing of that vessel. There is mild calcification of the carotid siphons. There is no evidence of cerebral aneurysms. Neck CTA: There is no evidence of significant steno-occlusive arterial lesions. There appears to be mild narrowing of the superior portion of the right internal jugular vein. The thyroid gland is heterogeneous with multiple subcentimeter hypoattenuating and partly calcified nodules. There are subcentimeter calcified nodules in the imaged portions of the left lung and calcified left hilar lymph nodes that likely represent sequela of prior granulomatous disease. However, there are also multiple subcentimeter non-calcified nodules in the partially-imaged lungs. | 1. Extensive tumor burden involving the right parotid space, where there is necrotic lymphadenopathy, as well as in the masticator and carotid spaces, sphenoid sinuses, and into the middle cranial fossa through extensive skull base defects. In particular, tumor involves the right cavernous sinus, Meckel cave, with extension into the prepontine cistern, abutting the pons. 2. Mild diffuse narrowing of the lacerum and cavernous portions of the right internal carotid artery due to encasement by tumor.3. Nonspecific heterogeneous thyroid gland with multiple subcentimeter hypoattenuating and partly calcified nodules. A thyroid ultrasound may be useful for further characterization.4. Multiple subcentimeter nodules in the partially-imaged lungs are non-specific, but may represent metastatic disease. A dedicated chest CT is recommended for further evaluation.5. Although not significantly enlarged by size criteria, a right level 1B lymph node that measures 7 mm in short axis displays a rather globular morphology that may indicate metastatic tumor involvement. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in maternal grandmother. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male; 79 years old. Reason: evaluate for malignancy History: malignancy CHEST:LUNGS AND PLEURA: Stable bibasilar emphysematous/cystic changes, left greater than right. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Prominent right hilar lymph node measuring up to 9 mm in short axis (series 3/48). No mediastinal or hilar lymphadenopathy by CT size criteria. Normal heart size. Minimal pericardial fluid. No visible coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy. Mild pectus excavatum deformity.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Mild, scattered areas of focal cortical thinning in the right kidney, similar to prior study and most suggestive of scarring from prior infection or infarct.RETROPERITONEUM, LYMPH NODES: Moderate aortoiliac atherosclerotic calcifications.BOWEL, MESENTERY: Large colonic stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:Large amount of streak artifact from right hip arthroplasty hardware limits evaluation of the pelvis.PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large colonic stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of malignancy. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of skin cancer. Family history of breast cancer diagnosed in mother and maternal second cousins. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Gradual increase in a small cluster of calcifications in a linear orientation in the right lower inner quadrant, mid depth. A few additional scattered benign calcifications are present.No suspicious masses or areas of architectural distortion are present. | Gradual increase in a small cluster of calcifications in a linear orientation in the right lower inner quadrant, mid depth, for which additional views including spot magnification views are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 45-year-old male with metastatic lung cancer LUNGS AND PLEURA: Severe apex predominant centrilobular emphysema. Mild debris in the trachea may reflect secretions or aspirated material. Postsurgical and postradiation changes in the right upper and lower lobe. Consolidation adjacent to the right upper lobe suture material likely reflects scarring and atelectasis. Soft tissue, well marginated, solid nodule in the right lower lobe adjacent to surgical suture material measures 1.9 x 1.0 cm (series 6, image 154) and may be postsurgical or local recurrence. Numerous new scattered nodules are noted bilaterally suspicious for metastatic lesions. For reference, there is adjacent left upper lobe nodule measuring 11 x 8 mm (series 6, image 61), previously 7 x 5 mm.Reticular opacities adjacent to the vertebral column bilaterally with mild bronchiectasis likely represents scarring. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Scattered subcentimeter mediastinal lymph nodes. No significant hilar lymphadenopathy. The heart size is normal without pericardial effusion. Mild coronary artery calcification. Enteric contrast is noted in the esophagus suggestive of reflux. CHEST WALL: No significant hilar, cardiophrenic, or retrocrural lymphadenopathy. Surgical resection of the lateral right sixth rib. Mottled sclerotic and lytic appearance of the bodies suggestive of metastases.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Multiple hypodense lesions in the liver, the largest measuring 19 x 17 cm (series 4, image 26) in segment 8 of the liver, increased in size compared to the prior exam, previously measuring 10 x 7 mm. | 1.Postsurgical and postradiation changes in the right upper and lower lobes as described above.2.Multiple new pulmonary nodules bilaterally are suspicious for metastatic lesions. Reference measurements provided above. Skeletal changes compatible with metastatic lesions.3.Indeterminant liver lesions may reflect metastatic disease, increased in size since prior exam. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional left MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. A few scattered bilateral benign calcifications.No microcalcifications or areas of architectural distortion are present. | 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: NSA - Screening Mammogram. |
Generate impression based on findings. | Joint pain, elevated inflammatory markers. Evaluate for erosive disease, tophi. Three views of the left hand show no acute fracture. The bones appear diffusely demineralized. There is chondrocalcinosis of the triangular fibrocartilage. There is osteoarthritis of basilar joint. No definite erosions are seen.Three views of the right hand show no acute fracture. The bones appear diffusely demineralized. There is osteoarthritis of the basilar joint. No definite erosions are seen.Three views of the left foot show a hallux valgus deformity. No definite erosions are seen.Three views of the right foot show a hallux valgus deformity. No definite erosions are seen. The Lisfranc joint is not well seen on this examination which is most likely secondary to position. | Degenerative changes as above without definite erosions. |
Generate impression based on findings. | 47-year-old female with Langerhans cell histiocytosis. Shortness of breath. LUNGS AND PLEURA: Severe upper lobe predominant paraseptal bullous emphysema. Interval left upper lobe wedge resection. Right upper lobe nodules have resolved.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Moderate coronary calcifications. 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. Status post cholecystectomy. | 1.Interval resection of left upper lobe nodule and resolution of right upper lobe nodules.2.Severe paraseptal bullous emphysema. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left benign breast biopsy. Patient reports some left breast tenderness. 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. Scattered benign calcifications in both breasts, including mild arterial calcifications, are stableNo suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Recent history of bilateral breast reduction/lift in 2014. Known breast cysts. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density changed in pattern and distribution, given the recent history of bilateral breast reduction No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional CC and MLO views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered bilateral calcifications are stable. Small probable intramammary lymph nodes in the left medial breast are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 45-year-old male with left knee pain status post fall. Four views of the left knee demonstrate a small joint effusion without underlying fracture or malalignment. Mild osteophytosis is indicative of minimal left knee osteoarthritis. | Small joint effusion without underlying acute fracture or malalignment. |
Generate impression based on findings. | 73 year-old female with bilateral knee pain. Four views of the left knee demonstrate evidence of previous medial cruciate ligament injury. There is mild sharpening of the tibial spines and osteophytosis, consistent with moderate osteoarthritis. There is chondrocalcinosis of the articular cartilage. No evidence of acute fracture or malalignment. Arterial calcifications are present in the leg.Four views of the right knee demonstrate chondrocalcinosis of the articular cartilage. There is no joint effusion, fracture, or evidence of malalignment. There is evidence of previous medial cruciate ligament injury. Joint space narrowing and osteophytosis in particular of the lateral tibiofemoral compartment is indicative of mild osteoarthritis. Arterial classifications present in length. | Bilateral chondrocalcinosis. Moderate left and mild right osteoarthritis. |
Generate impression based on findings. | Male 55 years old Reason: 55 y/o M with DLBCL on therapy needs interim staging please CHEST:LUNGS AND PLEURA: Interval decrease in right upper lobe pulmonary nodules, with small scarlike opacities remaining. There is no measurable lesion at site of previously reference nodule. Right middle lobe scarring is noted. No new pulmonary nodules or masses. No pleural effusion.MEDIASTINUM AND HILA: Right chest port tip at the cavoatrial junction. Marked interval decrease in size of mediastinal adenopathy. Reference prevascular lymphadenopathy measures 2.3 x 0.9 cm (image 32 series 3) previously 6.8 x 5.4 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No focal hepatic mass. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal thickening is unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes in the lumbar spine.OTHER: Subcutaneous injections are noted in the anterior abdominal wall.PELVIS:PROSTATE, SEMINAL VESICLES: Calcifications noted in the prostate.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 | Marked interval decrease in mediastinal adenopathy. Interval decrease in size of pulmonary nodules. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications bilaterally are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 71 year old with history of benign biopsy in the right retroareolar region in July 2011. No current breast complaints. Three standard views of both breasts with a spot compression view of left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There is a stable percutaneously placed wing clip in the right retroareolar region. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: 58 yo with HCC please screen for mets History: none. LUNGS AND PLEURA: Scattered bilateral micronodules are unchanged in size and number. No new suspicious pulmonary nodules. Stable right lower lobe bronchocele. No focal consolidation or 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.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Redemonstrated cirrhotic liver morphology, findings related to prior TACE, and splenomegaly. | No evidence of metastatic disease. |
Generate impression based on findings. | 60 year-old female with right breast pain. The patient states that there is a throbbing pain in the upper part of the right breast. Focused ultrasound was performed for the upper part of the right breast. The study did not detect any abnormalities, including edema, fluid collection, or masses, at the area of pain. | No sonographic evidence of abnormality in the right breast BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | 15-year-old female with history of left hip pain concern for ASIS avulsion. Single view of the pelvis demonstrates normal anatomic alignment without evidence of acute avulsion fracture or malalignment. | No evidence of avulsion fractures as clinically queried. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts for a total of 10 images were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Bilateral benign calcifications, including a popcorn calcification in a hyalinized fibroadenoma in the right medial breast, are unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 48 years, Female. Reason: eval stool burden History: constipation, abd pain Column bile duct stent and pancreatic duct stent in place with the tips terminating in the duodenum. Cholecystectomy clips project over the right upper quadrant. There is a small amount of contrast in Morison pouch. There is a nonobstructive bowel gas pattern. Moderate to large stool burden distributed throughout the colon. Bridging osteophyte at the L5-S1 left posterior elements. | Moderate to large stool burden distributed throughout the colon. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are ultrasound images of left breast (3/8/15) performed at Mercy Hospital. Ultrasound images labeled as "12 o'clock Trans" are submitted. There is a hypo-/anechoic branching tubular structure at the superficial area in the left breast, likely mildly dilated duct. Because of the image quality, it is hard to judge if there is intraductal solid component or not. No gross abnormalities are seen in the submitted images. | Mildly dilated duct in the left breast. Repeat ultrasound is suggested due to the image quality.BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in mother, sister, and maternal great aunt. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. A few scattered benign calcifications are present in both breasts.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 69-year-old male with shortness of breath, scleroderma ILD, possible pulmonary hypertension. LUNGS AND PLEURA: No significant interval change in basilar predominant subpleural reticulation, traction bronchiectasis, and honeycombing, compatible with UIP pattern. No suspicious pulmonary nodules, focal consolidation, or pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Low-density cardiac blood pool is typical of anemia. Severe coronary calcifications. The pulmonary artery measures 3.2 cm in diameter, mildly enlarged, and suggestive of pulmonary hypertension.CHEST WALL: No suspicious focal osseous lesion is identified. Severe degenerative changes affect the visualized spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Severe calcifications affect the visualized abdominal aorta. A high density, exophytic right renal cyst is stable. | 1.Moderate to severe UIP pattern, unchanged.2.Findings suggestive of pulmonary arterial hypertension. |
Generate impression based on findings. | Female, 5 months old. Reason: position of ETT History: intubationVIEW: Chest AP (one view) 3/19/2015, 1044 The endotracheal tube tip is within the right mainstem bronchus.The aortic arch, cardiac apex, and stomach are left-sided.Complete opacification of the left hemithorax, with decreased volume, compatible with complete atelectasis. The cardiothymic silhouette cannot be evaluated due to left hemithorax opacification.No focal right lung opacities. | Right mainstem bronchus intubation, with associated complete collapse of the left lung. |
Generate impression based on findings. | 59-year-old female with shortness of breath status post LVAD LUNGS AND PLEURA: Interval improvement of diffuse ground glass and reticular opacities associated with intralobular septal thickening. Bronchiectasis is unchanged. No pleural effusion. No pneumothorax. Central airways are patent.MEDIASTINUM AND HILA: Left chest wall ICD with leads unchanged. Severe cardiomegaly without pericardial effusion. LVAD device is noted and the aortic component appears to cross a hematoma/seroma that has been present since the first abdominal CT following placement in 06/2014, unchanged. Mitral valve prosthesis. Severe coronary artery calcification. Nonfused median sternotomy is unchanged. No significant mediastinal or hilar lymphadenopathy. The main pulmonary artery measures 3.8 cm, suggestive of pulmonary artery hypertension. Debris is noted within the esophagus. CHEST WALL: Left chest wall ICD as described above. No significant axillary or retrocrural lymphadenopathy. Prominent right cardiophrenic lymph node. Small, midline wide neck ventral hernia with hyperdense material that may reflect fat necrosis is unchanged.Moderate degenerative disease affects the thoracic spine. Sclerotic lesion in the T2 vertebral body likely represents a benign bone island.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Severe atherosclerotic calcification of the aorta and its branches. | 1.Improving diffuse ground glass and reticular opacities with associated intralobular septal thickening compatible with improving pulmonary hemorrhage or drug reaction. In the absence of pleural effusion, edema is still considered less likely. Infection may be considered in the correct clinical context.2.LVAD device is noted and the aortic component appears to cross a hematoma/seroma that has been present since the first abdominal CT following placement in 06/2014, unchanged. Findings paged to Dr. Kagan at 1201 on 3/19/15. |
Generate impression based on findings. | Male; 74 years old. Reason: 6.5 CM right CIA aneurysm History: NONE CT ANGIOGRAM: Extensive atherosclerotic calcifications of the abdominal aorta and its branches. The celiac artery and SMA origins are widely patent. There is narrowing of the origin of the IMA with runoff preserved. Widely patent single left renal artery. Patent right renal arteries with a small inferior accessory right renal artery supplying the right kidney lower pole. Narrowing of the proximal bilateral superficial femoral arteries, which remain patent.Stable 3-cm aneurysmal is dilatation of the infrarenal abdominal aorta (series 9/96). Stable 6.5 cm right common iliac aneurysm (series 9/156 and series 80728/58). Stable 2.7-cm aneurysmal dilatation of the left common iliac artery (series 80728/60).ABDOMEN:LUNG BASES: Moderate calcifications of the coronary arteries.LIVER, BILIARY TRACT: Hepatic steatosis. No focal hepatic lesions. Cholelithiasis without evidence of cholecystitis. No biliary ductal dilation. Main portal vein and its branches are patent.SPLEEN: Scattered calcified granulomas.PANCREAS: No significant abnormality noted. Splenic vein is patent. No splenic artery pseudoaneurysm.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing right renal stone and multiple bilateral renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval resolution of previously seen perigastric fluid collection with previously seen stent now entirely within the stomach.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Stable abdominal aortic and bilateral iliac aneurysms.2.Interval resolution of perigastric fluid collection. |
Generate impression based on findings. | Hip pain AP view of the pelvis and two views of the bilateral hips show mild osteophyte formation and medial joint space narrowing of the bilateral hips compatible with moderate osteoarthritis. No acute fracture is evident. There are marked degenerative changes of the lower lumbar spine. | Moderate osteoarthritis of the bilateral hips. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.The ventricles and sulci are within normal limits for age. The cisterns remain patent. There is no midline shift or mass effect. There are few nonspecific punctate T2/FLAIR hyperintense foci within the bifrontal subcortical white matter. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is an incidental empty sella. The remainder of the midline structures and craniocervical junction are within normal limits. There is minimal right anterior ethmoid opacification.CERVICAL SPINE | 1. Essentially unremarkable MRI brain and IACs, without evidence of intracranial schwannomas or meningiomas. A few nonspecific non-enhancing foci of T2/FLAIR hyperintensity within the bifrontal white matter.2. Multilevel predominantly thoracolumbar and sacral foraminal peripherally enhancing T2 hyperintense masses some of which are expanding the foramina, with less conspicuous findings of the cervical spine. The largest of the lesions demonstrate mild heterogeneity with suggestion of central lower signal. These most likely represent multilevel schwannomas. The largest is located at in the left L1-L2 foramen.3. Additionally partially visualized left infraclavicular large heterogeneous mass, also likely representing a schwannoma. This may may be adjacent to or involve a portion of the distal brachial plexus.4. Mild scattered spondylotic changes, with minimal grade 1 anterolisthesis of L3 on L4.5. No intrinsic cord abnormality or mass. |
Generate impression based on findings. | Patient undergoing heart transplant workup. Question of dental disease. Single view of the mandible shows no severe dental caries or periapical lucency. No acute fracture is evident. A left lower mandibular molar is absent. | No severe dental caries. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (2/9/15), ultrasound images of left breast (2/9/15), images from ultrasound guided biopsy of left breast and post procedural left mammographic images (2/23/15) performed at St. Joseph Hospital. DIGITAL MAMMOGRAPHIC IMAGES (2/9/15):The breast parenchyma is composed of scattered fibroglandular elements. Extensive arterial calcifications are noted in both breasts.There is an irregularly-shaped mass is spiculations and architectural distortions at retroareolar region in the left breast measuring approximately 29 x 23 mm. Nipple retraction and skin thickening at the periareolar region is present. Spiculations at anterior part of the mass extends to the nipple.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. ULTRASOUND IMAGES OF LEFT BREAST (2/9/15):An irregularly-shaped hypoechoic mass with angular margins, measuring 30 x 21 mm, is visualized at 12 o'clock position in the left breast, corresponding to the mass seen on the mammogram. A vague hypoechoic band-like area extends towards the skin from the mass.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POST PROCEDURAL LEFT MAMMOGRAPHIC IMAGES (2/23/15):Ultrasound guided needle biopsy was performed for the mass in the left breast with appropriate needle placement. A marker clip is placed at inferior medial aspect of the mass, confirmed on the post procedural mammographic images.Per outside pathology report, the biopsy result was malignant; infiltrating mammary carcinoma, fabor infiltrating lobular carcinoma, grade 3. | Biopsy proven invasive cancer in the left retroareolar region, likely extending to the nipple.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Postop longstem. AP view of the pelvis, femur, and right hip show a long femoral stem bipolar hemiarthroplasty device in anatomic alignment. There are diaphyseal cerclage wires and a cable and claw device about the greater trochanter. No acute fracture is evident. A surgical drain is noted within the soft tissues along with surgical skin staples.Severe osteoarthritis affects the right knee. An IVC filter is partially imaged. | Right long femoral stem bipolar hemiarthroplasty as above. |
Generate impression based on findings. | 56 years, Male. Reason: 56M s/p kidney transplant now with concern for Sbo History: abd pain, chronic partial obstruction There is diffuse gaseous distention of the stomach, but otherwise there is a generalized paucity of bowel gas. Central venous catheter tip terminates in the high right atrium. Bibasilar streaky opacities suggest atelectasis. Right posterior deformities consistent with prior fractures. Degenerative changes of the lower lumbar spine. Nonspecific lucent lesion in the left pubic symphysis. | Gaseous distention the stomach, but otherwise a generalized paucity of bowel gas. |
Generate impression based on findings. | 11-year-old male with a ketogenic diet, concern for kidney stones Evaluation of right kidney is suboptimal due to contracted posture of patient.BLADDER Wall Thickness: Normal Contents: Distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 7.4 cm. Due to contractures, length measurement may not be accurate. Left: 8.7 cm Mean for age: 9.2 cm Range for age: 8.0 - 10.5 cmADDITIONAL OBSERVATIONS: No shadowing calculus. | Normal examination. No evidence of hydronephrosis or shadowing calculus although evaluation of right kidney is suboptimal due to contracted posture of patient.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | Male 22 years old Reason: r/o fx History: pain and swelling to lateral hand s/p pain There is a transverse fracture through the base of the fifth metacarpal with minimal displacement. No evidence of intra-articular extension.There is adjacent soft tissue swelling.The joint spaces are appropriate for age. Bone mineralization is normal. | Fracture through the base of the fifth metacarpal. |
Generate impression based on findings. | There is nonenhancing low density anterior right submandibular space unilocular oval structure measuring 2.1 x 3.5 cm (series 6 image 48) in greatest axial dimensions, adjacent to the angle of the right mandible with a very small component extending into the posterior sublingual region. This measures 27 HU, slightly greater than simple fluid density. The cystic lesion is deep to the platysma. This lesion has smooth borders and does not invade surrounding structures. There are no surrounding inflammatory changes and no perceptible wall identified. There is moderate mass effect on the right submandibular gland. There are no associated osseous changes.Left submandibular, bilateral parotid, and thyroid glands are unremarkable. The airway is patent. There is no cervical lymphadenopathy by CT size criteria. Limited view of the intracranial structures are unremarkable. The imaged mastoid air cells and paranasal sinuses are clear. The imaged orbits are unremarkable. Major cervical vasculature are grossly patent. The lung apices are clear. Osseous structures are unremarkable. | Nonenhancing right anterior submandibular space cystic lesion with small posterior sublingual component. Mild localized mass effect. Differential diagnosis includes benign entities such as ranula versus lymphatic malformation, as well as epidermoid. |
Generate impression based on findings. | 2-year-old male with fever and cough, concern for pneumonia.VIEWS: Chest AP/lateral (two views) 3/19/15 The cardiac apex, aortic arch, and stomach are left-sided. No focal opacities to suggest pneumonia. Mild peribronchial thickening consistent with bronchiolitis/active airway disease. Streaky left lower lobe opacity likely represents atelectasis. | Left lower lobe subsegmental atelectasis on a background of mild bronchiolitis/reactive airway disease pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Patient was previously evaluated for bilateral palpable lumps and pain, shown to represent Mondor's disease. History of breast cancer in sister diagnosed at the age of 55. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 66 years old Reason: Evaluate known pancreatic mass for interval changes (last study 2/16/14) History: known pancreatic mass ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis with cholecystectomy tube in place. Common bile duct stent with expected pneumobilia. There is a potential area of narrowing just superior to the stent on coronal image 47, similar to prior exam. Persistent intrahepatic biliary ductal dilatation. Multiple arterially enhancing peripheral, wedge-shaped regions throughout the liver, with no washout on venous phase most likely representing transient hepatic attenuation differences. No definite hepatic mass.SPLEEN: No significant abnormality notedPANCREAS: Mass in the head of the pancreas measures 2.7 x 2.1 cm (image 53 series 9) previously 2.7 x 2.0 cm. The tumor encases the GDA, similar to prior exam. Tumor abuts the replaced right hepatic artery, less than 180 degrees, unchanged. Proximal celiac and SMA are uninvolved.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nephrolithiasis. Bilateral renal cortical scarring.RETROPERITONEUM, LYMPH NODES: Enlarged periportal lymph node measures 1.4 x 1.0 cm (image 14 series 9) previously 1.5 x 1.0 cm. Atherosclerotic calcification of abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Pancreatic head mass which abuts the replaced right hepatic artery and portal vein, and encases the GDA, is not significantly changed in size. Mildly enlarged retroperitoneal lymph nodes are unchanged.2.Persistent biliary ductal dilatation, with possible area of narrowing just superior to common bile duct stent, which appear similar to prior exam.Findings discussed with Barb Gordon in Dr. Posner's office via phone at 11:50 AM on 3/19/15. |
Generate impression based on findings. | Right ankle follow-up. Status post right ankle ORIF. Three views of the right ankle show a side plate with multiple screws affixing the distal fibula with two syndesmotic screws in anatomic alignment. The fibular fracture line is less distinct suggestive of healing. The posterior distal tibial fracture line is still seen. | Orthopedic fixation of distal fibular and posterior tibial fractures as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in paternal aunt. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign calcifications, including arterial calcifications, have progressed in a benign fashion.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Hard palate cancer status post treatment. There are post-treatment findings in the right hard palate region. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria, although the lack of intravenous contrast and presence of dental amalgam artifacts limit assessment. There appears to be herniation of the sublingual glands into the submandibular spaces bilaterally through mylohyoid defects. The thyroid and major salivary glands are otherwise unremarkable. The airways are patent. The imaged paranasal sinuses and mastoid air cells are clear. There appears to be a partially-empty sella. The imaged portions of the lungs are clear. | Post-treatment findings in the right hard palate region without evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria, although the lack of intravenous contrast and presence of dental amalgam artifacts limit assessment. |
Generate impression based on findings. | 5-year-old male with history of neuroblastoma status post transplant now with worsening abdominal pain and emesisVIEW: Abdomen AP (one view) 3/19/15 A central line is in the right atrium. Surgical clips are noted in the left hemiabdomen. Disorganized nonobstructive bowel gas pattern. No pneumatosis, free air, or portal venous gas. | Disorganized nonobstructive bowel gas pattern. |
Generate impression based on findings. | 53-year-old male with desaturations and groundglass opacities LUNGS AND PLEURA: Slight interval increase in size of small bilateral pleural effusions. Moderate centrilobular emphysema. Diffuse and symmetric groundglass opacities and intralobular opacities most pronounced in the lower lobes is not significantly changed since the prior exam. Calcified granuloma in the left lower lobe. No suspicious nodules or masses. MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. Low attenuation of the blood pool relative to the cardiac muscle is suggestive of anemia.No visible coronary calcifications are detected within the limitations of this non-gated study. The trachea and mainstem bronchi are patent. No significant change in scattered subcentimeter mediastinal and hilar lymph nodes.Left PICC tip is at the superior cavoatrial junction.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Diffuse symmetric groundglass opacities and intralobular opacities with mild interval increase in small bilateral pleural effusions, overall not significantly changed from the prior exam. Findings are compatible with unchanged pulmonary edema.2.Moderate centrilobular emphysema. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer diagnosed in mother at age 56 and sister at age 40. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 73 years old Reason: Hx of radiation related obstruction, hx of "barium perforation" per pt, must use alternative for barium. Hx of obstruction and cervical cancer. History: evaluation for ileostomy reversal The scout film showed extensive barium staining of the peritoneum, particularly of the right upper quadrant as well as multiple scybala in the distribution of the distal colon. There are degenerative changes of the hips and spine. A scoliosis of the thoracolumbar spine. There are severe atherosclerotic calcifications of the abdominal aorta and its branches.Following insertion of a 10-French transanal Foley catheter, approximately 50 cc of barium was administered retrograde into the rectum. Flow was limited by the desiccated stool in the rectum as well as the small caliber the catheter. Larger bore catheters were attempted, but not tolerated. No definite fixed narrowings were evident; however, the examination was limited as detailed above. At the end of the examination approximately 20 cc of barium was able to be extracted, and the patient was asked to evacuate her bowels.Subsequently, a small bowel follow-through was performed. Transit time to the ileostomy was 60 minutes. The small bowel is diffusely mildly dilated, but no areas of fixed narrowing or evident. The bowel loops within the pelvis were difficult to mobilize, likely reflecting some degree of adhesive disease, and the adjacent opacified stool in the colon further limited evaluation of the pelvic small bowel loops. | 1.Limited single contrast barium enema, without evidence of fixed narrowing or stenosis in the distal sigmoid colon and rectum.2.Small bowel follow-through demonstrating diffusely mildly dilated small bowel loops suggestion of adhesive disease, but without evidence of stenosis.3.Desiccated opacified stool balls within the rectum and staining of the peritoneum with barium, present prior to the examination. |
Generate impression based on findings. | Left elbow contracture from brachial plexus palsy. Assess for bony change. Four views of the left wrist show a dysmorphic distal ulna. Many of the carpal bones appear to be fused. There is marked extension at the carpometacarpal joints with marked flexion at the MCP, PIP and DIP joints.Four views of the left elbow show the radial head to be dislocated anteriorly. No acute fracture is evident. | 1. Deformity of the left wrist as described above.2. Anteriorly dislocated radial head. |
Generate impression based on findings. | 49 years, Female. Reason: eval for cause of diarrhea, distention, pain History: diarrhea, distention, pain, post OLT There are mildly more prominent dilated loops of small bowel which appear to be more centralized and measure up to 3.7 cm in diameter; these may represent an early small bowel obstruction. Multiple foci of air in the right upper quadrant may represent postprocedural air in the subcutaneous tissues or air within the right hemicolon.Multiple midline abdominal and pelvic surgical clips are noted. There is a retrievable IVC filter in place. There is a nasojejunal tube with its tip overlying the jejunum. A partially visualized tip in the right atrium is compatible with previously seen left IJ line. Partially visualized atelectasis in the lung bases. | 1. Mildly dilated loops of centralized small bowel measuring up to 3.7 cm in diameter may represent an early small bowel obstruction. 2. Multiple foci of air in the right upper quadrant may represent postprocedural air in the subcutaneous tissues or air within the right hemicolon. Please correlate clinically. |
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