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Generate impression based on findings. | Question of left wrist fracture and left Mallet finger of small finger. Three views of the left wrist show a transverse fracture through the ulnar styloid. There is soft tissue swelling about the ulnar aspect of the wrist.Three views of the left fifth finger show a tiny osseous fragment along the proximal and dorsal aspect of the fifth digit DIP joint which likely represents an avulsion fragment of the base of the fifth digit distal phalanx. The DIP joint is held in flexion. | 1. Ulnar styloid fracture.2. Avulsion fracture of the base of the fifth digit distal phalanx. |
Generate impression based on findings. | Female 58 years old Reason: evaluate for abscess, fluid collection to assess for drainage History: History of renal cell carcinoma, and pelvic abscess ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small amount of pneumobilia is unchanged. Peripancreatic ascites, similar to prior exam. Portal venous thrombosis, with numerous venous collaterals are again noted in the hepatic hilum and pancreas.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic atrophy, and ectatic no calcifications.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Residual air filled cavity in the left retroperitoneum with small amount of adjacent stranding is unchanged compared to prior exam. There is now air extending into the abdominal wall just superior to the left superior iliac crest with surrounding enhancement and fat stranding (image 56 series 80392).RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Persistent mid pelvic loculated fluid collection measures 4.8 x 2.2 cm (image 108 series 4) previously 4.1 x 2.2 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterine fibroids are again noted.BLADDER: Small focus of nodular enhancement in the right aspect of the bladder (image 130 series 4) unchanged.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No pelvic fluid collection, unchanged in size.2.Air fluid collection in the left nephrectomy bed, not significantly changed in size. New foci of air extending into left abdominal wall, superior to the left iliac wing, which again raises suspicion for fistulas connection. 3.Persistent ascites. |
Generate impression based on findings. | 61 year old with left breast pain. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered benign calcifications are present bilaterally. 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, 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. | Female, 11 years old. Reason: painful wrist VIEWS: Right wrist, PA, lateral, oblique (3 views) 3/19/2015, 1436 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Hypertension, backache, headache. Five views of the lumbar spine show no acute fracture. The disk spaces and vertebral body heights are maintained. Alignment is anatomic. | No acute fracture is evident. |
Generate impression based on findings. | Pain, boutonnieres deformity on the right third and fifth. Evaluate RA or gouty arthropathy. Three views of the left hand show no acute fracture or malalignment. No erosive changes are seen. A small ossicle adjacent to the third digit PIP joint is most likely related to old trauma.Three views of the right hand show no acute fracture. The third and fifth PIP and DIP joints are held in flexion and extension, respectively. There is a probable erosion of the head of the fifth metacarpal.Three views of the left wrist show no acute fracture. A small lucency within the lunate is likely a cyst. Surgical clips are noted about the distal soft tissues of the forearm. Three views of the right wrist show no acute fracture or malalignment. A small corticated ossicle dorsal to the carpals is likely related to old trauma. | Probable erosion of the right fifth metacarpal head. |
Generate impression based on findings. | Male 65 years old Reason: history of smoking, age 65 History: screen for AAA The proximal abdominal aorta measures 2.4 x 2.3 x 1.8 cm.The mid abdominal aorta measures 1.7 x 2.1 x 1.9 cm.The distal abdominal aorta measures 1.7 x 2.0 x 1.8 cm.The right iliac artery measures 0.9 x 1.1 x 1.0 cm.The left iliac artery measures 1.0 x 1.0 x 0.8 cm. | No evidence of abdominal aortic aneurysm. |
Generate impression based on findings. | Male; 46 years old. Reason: hx of gross hematuria, evaluate with delayed imaging History: see above ABDOMEN:Lack of oral contrast limits sensitivity for bowel pathology.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: Atrophic native kidneys with poor contrast enhancement and excretion, compatible with medical renal disease. There are bilateral benign-appearing renal cysts. No evidence of renal cell carcinoma. No hydroureteronephrosis. Poor excretion of contrast into the collecting systems limits evaluation of the ureters and bladder.RETROPERITONEUM, LYMPH NODES: Postsurgical changes in the right iliac fossa from transplant nephrectomy. Moderate atherosclerotic calcifications of the abdominal aorta and its branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increased density of the visualized bones, suggestive of renal osteodystrophy.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Bilateral vas deferens and seminal vesicle calcifications.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Increased density of the visualized bones, suggestive of renal osteodystrophy.OTHER: No significant abnormality noted | Atrophic kidneys with poor renal enhancement and excretion, compatible with medical renal disease. No evidence of renal cell carcinoma. Limited evaluation of the ureters and bladder on delayed phase images due to poor contrast excretion. These findings do not obviate the need for cystoscopy as clinically indicated. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is minimal mucosal thickening in the left maxillary sinus. The right maxillary sinus is clear. The ostiomeatal units are clear. There is a large right and small left sided Haller cell. There is slight narrowing of the left infundibulum.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is mild leftward nasal septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Very minimal sinus inflammatory changes. No CT evidence of acute or chronic sinusitis. |
Generate impression based on findings. | Metastatic RCC, right scalp tenderness and mass. There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of intracranial metastases or discernible scalp lesions. |
Generate impression based on findings. | Pain and swelling status post injury 4 years ago. Three views of the right ankle show no acute fracture or malalignment. No ankle joint effusion is identified. | No acute fracture is evident. |
Generate impression based on findings. | 52 year old who is called back from screening mammogram for right breast asymmetry. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. Focal asymmetry at upper outer quadrant of right breast disperses into normal glandular tissue with spot compression.Focused ultrasound did not detect any abnormalities at upper outer quadrant in the right 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. | Status post fall onto left knee on 3/2/2015. Three views of the left knee show marked medial joint space narrowing and small tricompartmental osteophyte formation. There is possibly a small joint effusion. No acute fracture is evident. | Osteoarthritis. |
Generate impression based on findings. | 32-year-old female with bilateral breast pain, greater on the left. Family history of breast cancer diagnosed in two paternal aunts. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Circular skin marker was placed over the left axilla. Intramammary lymph node in the left upper outer quadrant. Left duct ectasia. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. LEFT SONOGRAPHIC | Left 12 o'clock intraductal lesion and ductal dilatation, for which ultrasound guided biopsy is recommended. The patient also is scheduled for bilateral breast MRI the following day. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. |
Generate impression based on findings. | Pain. Question of fracture. Three views of the left ankle show no acute fracture or dislocation.Three views of the left foot show no acute fracture or malalignment. | No acute fracture is evident. |
Generate impression based on findings. | Clinical question: Patient is status post subarachnoid hemorrhage at OSH two weeks ago, now presents with worsening headaches. Signs and symptoms:Headache, nausea. Nonenhanced head CT:There is no detectable acute intracranial process. No evidence of subarachnoid hemorrhage. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Surgical cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal.Anatomical variation of partially empty sella is present. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Male; 71 years old. Reason: High calcium and PTH. No abnormal focus of activity consistent with an enlarged parathyroid gland is seen. There is a small focus of increased activity in the anterior thyroid isthmus, but this would be an atypical location for parathyroid tissue and most likely represents a small thyroid nodule. | No scintigraphic evidence for parathyroid adenoma. |
Generate impression based on findings. | Staging biopsy proven left lower lobe lung cancer. CT shows multiple lung nodules.RADIOPHARMACEUTICAL: 10.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion grossly demonstrates an approximately 2.5 cm nodule in the medial left lower lobe, not significantly changed from recent diagnostic CT tracer. Several additional nodular foci are seen elsewhere in the left lower lobe, also unchanged. Sharply demarcated hypodense hepatic lesions are likely cysts. Extensive atherosclerotic calcifications are also noted.Today's PET examination demonstrates a medium-sized markedly hypermetabolic lesion in the medial aspect of the left lower lobe (SUV max = 14.5), which corresponds with the patient's known lung cancer.At this same axial level more laterally there is a second moderately hypermetabolic lung nodule (SUV max = 4.4) which is suspicious for an additional tumor focus versus inflammation.More superiorly in the left lower lobe, a third mild to moderately hypermetabolic lung nodule (SUV max = 3.6) could represent additional tumor versus inflammation.More inferiorly in the left lower lobe at the base, a fourth mild to moderately hypermetabolic lung nodule (SUV max = 3.7) could represent additional tumor versus inflammation.A punctate but abnormally hypermetabolic focus is seen at the spinous process at T4 (SUV max = 3.4). There is no underlying lesion seen on CT and this is suspicious for a bone metastasis but is equivocal.No discrete abnormal mediastinal or hilar hypermetabolic focus is identified. No abnormal hypermetabolic focus in the contralateral right chest.No suspicious FDG avid lesion seen within the abdomen or pelvis. Two photopenic foci within the liver correspond benign appearing cysts. | 1.Four hypermetabolic nodules in the left lower lobe. The most dominant and metabolically active is seen medially and consistent with the patient's known lung cancer. The additional left lower lobe nodules seen laterally, superiorly, and inferiorly are more mildly FDG avid and could represent additional tumor foci versus inflammation.2.No FDG avid suspicious lesion in the mediastinum, hila, or contralateral right chest.3.Punctate hypermetabolic osseous focus at the T4 spinous process is of some suspicion but equivocal for a bone metastasis. Thoracic spine MR may be useful for further evaluation. |
Generate impression based on findings. | Male; 65 years old. Reason: r/o aortic injury History: hypotension, abd pain CHEST:LUNGS AND PLEURA: Minimal bibasilar dependent subsegmental atelectasis. Mild subsegmental atelectasis versus scarring is also seen in the right upper lobe. Mild posterior left pleural thickening, though a trace left hemorrhagic effusion cannot be excluded.MEDIASTINUM AND HILA: Endotracheal tube tip terminates above the carina. Enteric tube tip in the stomach. Mild cardiomegaly. No pericardial effusion. Moderate atherosclerotic calcifications of the coronary arteries. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedCT angiogram: Postsurgical changes from a thoracic aortic arch repair with surgical graft. The proximal anastomosis is just distal to the origin of the left carotid artery. The distal anastomosis is at the level of the proximal descending thoracic aorta. At the superior-most portion of the graft, there is an age-indeterminate pseudoaneurysm projecting posterolaterally towards the left measuring up to 1.7 x 1.2 cm (series 19/26). No mediastinal hemorrhage, but as above, a trace left hemorrhagic effusion cannot be excluded.No evidence of thoracic aortic dissection. Normal caliber of the ascending thoracic aorta measuring up to 3.7-cm. Atherosclerotic plaques of proximal left subclavian artery are partially visualized. Mild narrowing of the thoracic aorta at the distal anastomosis, where the lumen measures up to 1.5-cm (series 81658/40). Normal caliber of the descending thoracic aorta measuring up to 3.1-cm. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Additional subcentimeter hypoattenuating lesions are too small to characterize but likely additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedCT angiogram: No evidence of abdominal aortic dissection. Normal caliber of the suprarenal abdominal aorta measuring up to 3.2-cm. Infrarenal abdominal aortic aneurysm with eccentric mural thrombus at the level of the bifurcation measuring up to 4.4-cm (series 81656/31). Left common iliac artery aneurysm measuring up to 2.5-cm (series 81656/33). Right common iliac artery aneurysm measuring up to 2.1-cm (series 81656/34).PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter balloon and tip within the decompressed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Surgical clips in the right groin.OTHER: No significant abnormality noted | Postsurgical changes from thoracic aortic arch graft repair with age-indeterminant pseudoaneurysm at the left posterolateral aspect of the graft. Mild left pleural thickening, but a trace hemorrhagic left pleural effusion cannot be excluded. As a result, acute pseudoaneurysm with recent rupture into the left pleural space is a possibility.Findings were discussed with Dr. Gulati (emergency room physician) at 3:30 p.m. on 3/19/15 and Dr. Fleming (vascular surgery resident) at 3:45 p.m. on 3/19/15. |
Generate impression based on findings. | 58-year-old male status post C4-7 fusion. Two views of the cervical spine are provided. Postsurgical evidence of posterior fusion and laminectomy including pedicle screws and rod device affixing C4-7, without evidence of hardware complication. Surgical drain and iatrogenic gas reflects postoperative state. | Postsurgical changes of posterior fusion as detailed above. |
Generate impression based on findings. | Knee pain. Four views of the right knee show severe joint space narrowing of the lateral compartment and moderate narrowing of the medial compartment. Osteophyte formation is noted at the lateral and patellofemoral compartments. No acute fracture is evident. There is a large joint effusion. | Severe osteoarthritis. |
Generate impression based on findings. | Reason: Confirm DHT Placement History: AMS Dobhoff tube tip projects over the descending duodenum. Oral contrast noted within the large bowel. Bibasilar atelectasis. Persistent focal retrocardiac opacity. Overlying pacemaker and EKG leads. | DHT placement as above. |
Generate impression based on findings. | Left knee pain. Four views of the left knee show marked medial and lateral compartment joint space narrowing. No acute fracture is evident. No joint effusion is identified. | Marked osteoarthritis. |
Generate impression based on findings. | 58 year old female with h/o HCC please screen for mets. No abnormal osseous foci are identified to indicate metastatic disease. Inferior displacement of the left kidney due to splenomegaly is again noted. Slight abnormally superior position of the right kidney may be secondary to a cirrhotic liver and appears unchanged. | No evidence of bone metastases. |
Generate impression based on findings. | Female 64 years old Reason: breast cancer History: re-stage evaluate disease; compare to previous CT CHEST:LUNGS AND PLEURA: Right lower lobe pulmonary nodule measuring 2.7 x 2.0 cm, new from prior exam, suspicious for lung metastasis versus primary lung neoplasm.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: Soft tissue mass with osseous destruction of the sternum (image 26 series 3), new from prior exam. Changes status post right breast and axillary surgery.ABDOMEN:LIVER, BILIARY TRACT: Previously identified hyperattenuating right hepatic lesion is not identified on today's exam. No discrete hepatic lesions. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged portal caval lymph node measuring 1.8 x 1.0 cm (image 97 series 3).BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Single pulmonary nodule, favor primary lung neoplasm over metastatic breast cancer.2.Destructive osseous lesion in the sternum, highly suspicious for metastatic disease.Findings discussed with Joanna Gibbs name via phone at 4 p.m. on 3/19/15. |
Generate impression based on findings. | Female; 66 years old. Reason: primary hyperparathyroidism, would like to evaluate for abnormal glands. No abnormal focus of activity consistent with an enlarged parathyroid gland is seen. However, there is an approximately 1 to 1.5 cm focus of increased activity corresponding to soft tissue within the left lateral breast, just lateral to an area of punctate breast calcifications. Findings raise the possibility of a primary breast cancer, and are best visualized on fused transverse series 125703, frame 54/406. The right thyroid lobe appears to measure approximately 3.4 cm and the left lobe 3.2 cm in length. | 1.No scintigraphic evidence for parathyroid adenoma.2.Small focus of abnormal activity in the left lateral breast, which raises the possibility of primary breast cancer. Correlation with mammography, breast ultrasound, and/or MRI can be considered for further evaluation. The above findings were discussed with Dr. Joly Raju of the referring clinical service via telephone on 3/19/2015 at 16:45. |
Generate impression based on findings. | Hodgkin's lymphoma, restaging. There is continued decrease in size of right level IIa lymph node, previously measuring 23 x 26 mm, now 16 x 15 mm in the AP and transverse dimensions. There are additional small scattered neck lymph nodes throughout the neck which are similar to prior and not abnormal by CT criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. Right chest wall port noted. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. Small mediastinal lymph nodes are again seen. Please refer to separate report for findings in the chest. | Continued decrease in size of the right level 2 lymphadenopathy consistent with treatment response. No new cervical lymphadenopathy. |
Generate impression based on findings. | Postoperative changes are again seen within the neck relating to previous total thyroidectomy and right neck dissection. Additional postoperative changes are now seen including a partially visualized median sternotomy, with nonspecific increased soft tissue density within the right paratracheal fat. In the area of the previous right upper mediastinal lymph node that measured 9 x 14 mm, there remains suggestion of an oval soft tissue structure measuring 14 x 13 mm on 6/69. New surgical clips are seen along the left neck consistent with interval neck dissection.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: There is redemonstration of postoperative changes in the right parotid region with overlying skin thickening. There is a stable fat density lesion anterior to the right parotid gland, most likely a lipoma. The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is surgically absent, without evidence of abnormal mass or enhancement in the thyroidectomy bed.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 no pathologically enlarged cervical lymph nodes.OTHER: There is mild atherosclerotic calcification of the carotid bifurcations. Multilevel spondylotic changes are noted, most prominent at C6-C7 where there is at least moderate central spinal canal stenosis. Multilevel high-grade foraminal narrowing is also seen scattered throughout the cervical spine. There is a a small torus palatini | 1. Interval further postoperative changes from mediastinal lymph node resection and left neck dissection. Increased soft tissue density in the right paratracheal mediastinum in area of previous referenced lymph node with somewhat of an oval contour persisting as detailed above. This area of soft tissue measures greater in size than the previous lymph node measurement, although margins are somewhat obscured by postoperative changes. Please correlate with surgical report, although continued follow-up is recommended to evaluate for residual/recurrent lymphadenopathy.2. No definite abnormality involving the thyroidectomy bed. |
Generate impression based on findings. | Reason: sarcoma of breast, s/p mastectomy. Evaluate for recurrence or metastases History: none. LUNGS AND PLEURA: Multiple bilateral scattered micronodules, not significantly changed in size or number. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Mild coronary calcifications detected. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Moderate degenerative changes affect the visualized spine. No suspicious focal osseous lesion. Anterior left chest wall long, thin fluid collection approaches water density, and remains compatible with postoperative seroma. Biopsy clips within a right breast mass again noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | No evidence of metastatic disease without significant interval change. |
Generate impression based on findings. | ALTE. History: fever, congestion, cough. 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 imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage, mass, or cerebral edema. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | 52 year old female with left breast cancer; Left SNBx 3/20/15 at 7am; inject afternoon before. RADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.905 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the left axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the left axilla. |
Generate impression based on findings. | Female 65 years old Reason: Adenocarcinoma of the lung please Please provide bi-dimensional measurements per RECIST 1.1 criteria and compare to prior outside exams. History: Lung cancer ABDOMEN:LUNG BASES: Large right pneumothorax is partially visualized. Please refer to CT chest performed on the same day.LIVER, BILIARY TRACT: No focal hepatic lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Cystic lesion at the pancreas measuring 1.2 x 0.9 cm (image 50 series 10), which may represent sidebranch IPMN, stable dating back to 11/2014.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No evidence of bowel obstruction.BONES, SOFT TISSUES: Degenerative changes in lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 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.No evidence of metastatic disease in the abdomen or pelvis.2.Large right pneumothorax.3.Cystic pancreatic lesion, likely represents sidebranch IPMN, stable dating back to 11/2014.Findings discussed with Dr. Villaflor via phone at 3:38 p.m. on 3/19/15. |
Generate impression based on findings. | Male, 14 days old. Reason: ex-preemie 2wks old with NEC and RDS History: desats, increased FiO2VIEW: Chest and abdomen AP (two views) 3/19/2015, 1507 ET tube tip below the thoracic inlet and above the carina. Enteric tube with distal side port below the GE junction. Left arm PICC, tip in the SVC. Left lower quadrant drain is present.Severe soft tissue edema persists.Large lung volumes and diffuse coarse bilateral lung opacities with numerous round lucencies, compatible with PIE. No new focal pulmonary opacities.The cardiothymic silhouette is normal.No bowel gas identified. No pneumatosis, portal venous gas, or free air. | Persistent complications of surfactant deficiency. No bowel gas identified. Diffuse soft tissue edema. |
Generate impression based on findings. | 69 year-old female with left knee pain. Four views of the left knee demonstrate a small joint effusion, which has improved since the prior exam. There is severe tricompartmental osteoarthritis, with near bone-on-bone apposition, particularly in the patellofemoral compartment. No acute fracture is visible.The contralateral right knee show subtle cortical irregularity along the medial tibial cortex, which is unchanged from prior exam. | 1.No acute fracture is identified. Interval improvement of the left joint effusion.2.Cortical irregularity along the medial tibial cortex of the right knee is noted. Further dedicated right knee radiographs are suggested, if clinically warranted.3.Severe left knee osteoarthritis. |
Generate impression based on findings. | Reason: Adenocarcinoma of the lung please Please provide bi-dimensional measurements per RECIST 1.1 criteria and compare to prior outside exams. History: Lung cacner. LUNGS AND PLEURA: Interval development of a severe right-sided pneumothorax. No significant mediastinal shift. A right upper lobe mass measures 4.3 x 3.1 x 4.5 cm (series 6, image 26; coronal image 58), previously 5.3 x 5.1 x 7.0 cm. Pneumothorax limits evaluation for pulmonary nodules. No new suspicious left-sided pulmonary nodules are identified.MEDIASTINUM AND HILA: Heart size is normal. Trace pericardial effusion. Moderate to severe coronary calcifications. Left chest wall port catheter tip in the mid SVC. No mediastinal or hilar lymphadenopathy.CHEST WALL: Severe degenerative changes affect the visualized spine. Interval development of age indeterminate T7 compression deformity.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Left renal cyst. | 1.Right upper lobe mass measurements are decreased from previous exam; however, due to large pneumothorax, measurements may not be entirely reliable.2.New severe right pneumothorax without significant mediastinal shift.3.New T7 compression deformity, age indeterminate.Findings relayed via telephone by Dr. Jahangir to Dr. Villafor approximately 3:35 p.m. on 3/19/15. |
Generate impression based on findings. | 67 year-old female with right knee pain. Four views of the right knee demonstrate mild sharpening of the tibial spines and tiny osteophytes, compatible with mild osteoarthritis. There is a trace joint effusion. There is no acute fracture or malalignment. | Mild osteoarthritis, which has mildly progressed from remote exam in 2008. |
Generate impression based on findings. | 54-year-old female with left breast pain. Three standard views of both breasts and additional ML and CC spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. In the left upper inner breast, there is a new circumscribed mass with central lucency, which on spot compression demonstrated a tortuous vessel. Scattered benign calcifications are stable.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. | Male 49 years old Reason: Back Spasm on Palp Right L-Spine, Pain on Back Flexion. History: Back Spasm on Palp Right L-Spine, Pain on Back Flexion. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal hepatic lesion. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral subcentimeter renal hypoattenuating lesions which are to small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction.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 | Unremarkable study. If there is continued concern, MR of the spine should be obtained for further evaluation. |
Generate impression based on findings. | Male, 11 years old. Pain, inability to ambulate.VIEWS: Right foot, AP, lateral, oblique (3 views) 3/19/2015, 1520 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 72 years old; Reason: Hodgkin lymphoma History: reevaluation CHEST:LUNGS AND PLEURA: Stable pulmonary micronodules, for example, indeterminant right-sided 3 mm lung nodule, image 59 series 5. Bilateral calcified granuloma.MEDIASTINUM AND HILA: Trace pericardial fluid.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis. No secondary signs of acute cholecystitis. SPLEEN: Bulbous contour of the spleen laterally, image 107 series 3, appears to correspond to hemangioma questioned on earlier MRI study, unchanged. Punctate calcified granuloma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Indeterminate left adrenal nodule stable, measuring 2.2 x 2.2 cm, image 110 series 3. KIDNEYS, URETERS: Unchanged subcentimeter right intrarenal nonobstructing calculus. Unchanged bilateral renal cysts, larger on left than on right.RETROPERITONEUM, LYMPH NODES: Mildly prominent femoral lymph nodes. Stable representative left femoral lymph node, measuring 1.2 x 1 cm, image 210 series 3. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Small hiatal hernia.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Spinal degenerative disease. Visualized osseous structures without significant change, including stable T12 compression deformity and irregular sclerosis involving right acetabular posterior column. | 1. Unchanged indeterminate left adrenal nodule.2. Stable pulmonary micronodules.3. Unchanged mildly prominent femoral lymph nodes.4. Bulbous contour of the spleen laterally, appears to correspond to hemangioma questioned on earlier MRI study, unchanged. 5. Stable T12 compression deformity.6. Please refer to concomitant CT soft tissues of the neck exam from same day for additional findings. |
Generate impression based on findings. | Fall with grossly deformed right elbow. Evaluate for fracture or dislocation. Two views of the right elbow show marked deformity of the elbow from prior trauma. There is a chronic fracture of the proximal ulna with destruction of the proximal one third of the ulnar diaphysis with interposed bullet fragments. The radial head is dislocated posteriorly; this may be acute or chronic in etiology and comparison with prior radiographs would be helpful. No acute fracture is evident. | Post-traumatic changes of the right elbow with radial head dislocation and chronic ulnar fracture. No acute fracture is evident. |
Generate impression based on findings. | 46-year-old female with biopsy proven benign mass (myofibroblastoma) presents for follow-up exam. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A proven benign mass is again visualized at upper outer quadrant with a marker clip. The mass becomes larger than previous, now it measures 48 x 40 mm on CC view (previously 35 x 29 mm). No other abnormal findings are present in the right breast.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast. Mildly prominent lymph nodes are unchanged in both axillae.Right breast ultrasound visualizes the known benign mass at 12 o'clock position, 7 cm from nipple, measuring at least 40 x 14 x 35 mm (previously 28 x 11 x 26 mm). A cystic component is again present near the margin of the mass. | Proven benign mass in the right breast, which is enlarging.No mammographic evidence for malignancy in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | 16 year old female with foot pain and swellingVIEWS: Left foot: AP, oblique, lateral; left ankle: AP, oblique, and lateral (6 views) 3/18/15 Foot: No fracture or malalignment. No significant soft tissue swelling is noted.Ankle: No fracture or malalignment. The ankle mortise joint is normal in appearance. No joint effusion or significant soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 77-year-old female with signs of pulmonary fibrosis and interstitial lung disease, question of hilar mass. Deviated trachea on chest radiograph and SIADH LUNGS AND PLEURA: Increased intralobular septal thickening most pronounced in the lung apices. Mild diffuse groundglass opacities. Part solid and groundglass nodule adjacent to the major fissure in the left lung measures 1.2 x 0.6 cm (series 6, image 27). Traction bronchiectasis pronounced at the lung bases. Central airways are patent. The trachea is shifted to the right due to mass effect from a tortuous ascending aorta. Small pleural effusions with adjacent atelectasis/ scarring.MEDIASTINUM AND HILA: Prominent lymphoid tissue is noted. Heart size is normal. No pericardial effusion. Mild coronary artery calcification. CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy. No suspicious osseous lesions. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Multiple scattered hypodense lesions in the liver, the largest measuring 1.9 x 1.8 cm (series 4, image 71) likely representing a benign cyst. The subcentimeter hypodense lesions are too small to further characterize but presumably represent benign cyst. The gallbladder is distended. Small hiatal hernia. | 1.Part solid and groundglass nodule in the left upper lobe is suspicious for malignancy. PET recommended for follow-up, or tissue diagnosis if possible.2.Increased intralobular septal thickening with small pleural effusions suggestive of mild edema. |
Generate impression based on findings. | 17 year-old female with history of VDRO, evaluate hipVIEWS: Pelvis AP (one views) 3/18/15 Interval removal of blade and screw device affixing the metadiaphysis of the left femur. Left femoral head is well directed into the dysplastic acetabulum. Right coxa valga is again seen. Right femoral head is well directed into the acetabulum. No fractures identified. | Healed left femoral varus derotational osteotomy with interval removal of plate and screw device. |
Generate impression based on findings. | Male, 19 years old. Reason: Evaluate for sacroiliitis History: lower back painVIEWS: Sacroiliac joints AP, bilateral oblique (3 views) 3/19/2015, 1537 The osseous structures and joint spaces are normal.No sclerosis or other joint space abnormality at the sacroiliac joints. | No evidence of sacroiliitis. |
Generate impression based on findings. | Male, 19 years old. Reason: evaluate cause of knee pain History: knee pain with bendingVIEWS: Left knee, AP, lateral, oblique (3 views) 3/19/2015, 1532 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 52 year-old status post right mastectomy 2008 for breast cancer followed by radiation and chemotherapy presents for routine follow-up. No current breast complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in left breast. Chemo port is projected over left axillary region. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male, 47 years old.Reason: s/p right TLC placement, r/o pneumothorax History: as above Severe cardiomegaly. Support devices appear grossly unchanged. No new pulmonary opacities. Retrocardiac atelectasis and probable pleural effusion. | Limited examination. No significant interval change. |
Generate impression based on findings. | Shoulder pain. Evaluate for dislocation. Three views of the left shoulder show marked deformity of the glenoid and humeral head; this raises the question of a neuropathic joint. No acute fracture is evident. The bones are diffusely demineralized. No dislocation is identified. | Marked deformity of the right shoulder raises the question of a neuropathic joint; MRI of the cervical spine may be helpful to evaluate for a syrinx or other abnormality if clinically warranted. |
Generate impression based on findings. | Male 71 years old Reason: 71 yo M with hx of gout vs Ca hydroxyapatite crystal disease. evaluate for erosions, soft tissue calcification History: L ankle, 1st MTP pain Left foot: Bone mineralization is normal. Alignment is near-anatomic. There are extra-articular erosive changes at the base of the fourth and fifth metatarsals with cortical lucencies. No new erosive change. The erosion of the lateral aspect of the first proximal phalanx has improved.There is an Achilles' tendon insertion enthesophyte.Right foot: Bone mineralization is normal. Alignment is anatomic. Erosion in the third metatarsal head has improved from prior. No new erosive change. No acute fracture or malalignment.Mild osteoarthritis affects the first MTP joint and the midfoot.There is an Achilles' tendon insertion enthesophyte. | Combination of osteoarthritis and probable gout with improvement in the erosive change. |
Generate impression based on findings. | Occipital/neck pain and history of metastatic renal cell carcinoma. Head: 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. There is mucosal thickening within the right sphenoid sinus. The skull and scalp soft tissues are unremarkable. Neck: There is a diffusely enlarged and heterogeneous thyroid gland with minimal narrowing of the trachea. There is otherwise no definite evidence of cervical lymphadenopathy. There is a punctate calcification within the left submandibular gland that likely represents a calculus. There is multilevel degenerative cervical spondylosis. There are vascular calcifications at the carotid bifurcations. The imaged portions of the lungs are clear. | 1. No evidence of intracranial hemorrhage or mass, although assessment for metastatic disease is limited without intravenous contrast.2. A diffusely enlarged and heterogeneous thyroid gland with minimal narrowing of the trachea is compatible with multinodular goiter. 3. Multilevel degenerative cervical spondylosis. |
Generate impression based on findings. | Evaluation for heart transplant. Question of signs of infection or malignancy, loose or cracked teeth. Panorex radiograph of the mandible shows no osseous destruction or fracture. Multiple dental fillings are noted. No periapical lucency is seen. | No acute fracture is evident. |
Generate impression based on findings. | 51-year-old female with history of left upper lobectomy (2010) for follow-up LUNGS AND PLEURA: Central airways are patent. Moderate centrilobular emphysema. No pneumothorax or pleural effusion. Postsurgical changes are noted in the left hilum. Focal consolidation in the superior segment of the left lower lobe with air bronchograms. MEDIASTINUM AND HILA: Left thyroid lobe nodule is unchanged. Common origin of the common carotid artery and right brachiocephalic artery. right chest port tip is at the superior cavoatrial junction. No visible coronary artery calcification. The heart size is normal. No pericardial effusion. No mediastinal or hilar lymphadenopathy. Small hiatal hernia. CHEST WALL: No suspicious osseous lesions. No significant axillary, retrocrural, or cardiophrenic lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No suspicious liver lesions. Status post cholecystectomy. Probable splenule. Diverticulosis without evidence of diverticulitis. | Focal consolidation in the superior segment of the left lower lobe with air bronchograms adjacent to the prior surgical site likely reflects atelectasis, unchanged. |
Generate impression based on findings. | Reason: neutropenic fever History: neutropenic fever. LUNGS AND PLEURA: Few areas of tree in but opacities in the right middle lobe, right upper lobe, and left lower lobe may represent sequela of aspiration. Scattered calcified granulomata. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Right PICC tip in the SVC. Calcified mediastinal and right hilar lymphadenopathy. Heart size normal. No pericardial effusion. Moderate coronary calcifications.CHEST WALL: Moderate degenerative changes affect the visualized spine. Orthopedic fixation hardware in the lower cervical spine is also noted. A small hiatal hernia.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Scattered tree in bud opacities may represent bronchiolitis, either from aspiration or infectious, though not characteristic of fungal infection. |
Generate impression based on findings. | Male 71 years old Reason: 71 yo M with hx of gout vs Ca hydroxyapatite crystal disease. evaluate for erosions, soft tissue calcification History: L ankle, 1st MTP pain Left foot: Bone mineralization is normal. Alignment is near-anatomic. There are extra-articular erosive changes at the base of the fourth and fifth metatarsals with cortical lucencies. No new erosive change. The erosion of the lateral aspect of the first proximal phalanx has improved.There is an Achilles' tendon insertion enthesophyte.Right foot: Bone mineralization is normal. Alignment is anatomic. Erosion in the third metatarsal head has improved from prior. No new erosive change. No acute fracture or malalignment.Mild osteoarthritis affects the first MTP joint and the midfoot.There is an Achilles' tendon insertion enthesophyte. | Combination of osteoarthritis and probable gout with improvement in the erosive change. |
Generate impression based on findings. | Male 71 years old Reason: 71 yo M with hx of gout vs Ca hydroxyapatite crystal disease. evaluate for erosions, soft tissue calcification History: L shoulder pain Bone mineralization is normal. Alignment is anatomic. Mild osteoarthritis affects the left shoulder joint with tiny osteophytes. There are enthesopathic changes at the supraspinatus footprint.Mild osteoarthritis affects the left AC joint. No acute fracture or malalignment. | Mild left shoulder osteoarthritis. |
Generate impression based on findings. | Pain Six views of the cervical spine show no acute fracture. There is reversal of normal cervical lordosis. Vertebral body and disk space heights are preserved. No prevertebral soft tissue swelling. | Mild reversal of the normal cervical lordosis may be secondary to spasm or positioning. |
Generate impression based on findings. | Male 61 years old Reason: S/p Left TKA History: S/p Left TKA Components of a total left knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication.The medial infarctions in the left distal femur are unchanged.Soft tissue gas and joint drain are present. | Total left knee arthroplasty as detailed above. |
Generate impression based on findings. | Spontaneous otorrhea and cerebrospinal fluid leak at the middle cranial fossawith encephalocele status post recent repair. There are interval postoperative findings related to right mastoidectomy and skull base repair with reconstruction of the right tegmen and a small amount of pneumocephalus, as well as trace extra-axial fluid deep to the craniotomy. There is non-specific opacification of the remaining right mastoid air cells and middle ear. There is also left otomastoid opacification. 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. There is mild scattered paranasal sinus opacification. There is a small skin excrescence along the left nasal ala. | Interval postoperative findings related to right mastoidectomy and skull base repair with bilateral nonspecific tympanomastoid opacification, but no evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Female; 58 years old. Reason: eval for progression History: metastatic RCC, on sunitinib CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules consistent with metastases, which overall have mildly decreased in size, including the right hilar metastasis which was previously obstructing the right upper lobe bronchus. Improved aeration of the right upper lobe, though some mild subsegmental atelectasis persists medially. No definite new nodules. Mild scattered patchy ground glass opacities, particularly at the posterior costophrenic angles, most likely due to subsegmental atelectasis.Reference left upper lobe nodule measures 1.6 x 1.3 cm, previously 2 x 1.9 cm, mildly decreased (series 6/21). New small left pleural effusion.MEDIASTINUM AND HILA: Heart size within normal limits with no significant pericardial effusion. Small mediastinal and hilar lymph nodes are stable. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable small inferior right hepatic lobe hypoattenuating focus, too small to characterize and likely a cyst.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Postoperative findings of left nephrectomy, with surgical clips in the nephrectomy bed. Right kidney is normal in appearance, with stable small hypoattenuating foci consistent with benign cysts.RETROPERITONEUM, LYMPH NODES: Mildly enlarged subdiaphragmatic para-aortic lymph nodes have decreased in size. Reference left para-aortic lymph node measures approximately 1.5 x 0.7 cm, previously 2.1 x 1.6 cm (series 4/100).BOWEL, MESENTERY: Left buttock injection granulomas, unchanged.BONES, SOFT TISSUES: Left posterior sixth rib expansile lytic lesion at the costovertebral junction has increased in size (series 4/34). OTHER: Small amount of low attenuation material in the left nephrectomy bed is stable and likely postoperative in nature. New mild abdominal ascites, particularly in both paracolic gutters.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: New mild pelvic ascites. | 1.Interval decreased size of pulmonary metastases.2.Interval decreased size of retroperitoneal lymphadenopathy.3.Interval increased size of posterior T6 lytic rib lesion.4.New mild right pleural effusion and abdominopelvic ascites. |
Generate impression based on findings. | Reason: 37yoF asthma exac with hypoxemia, rule out PE and infection History: as above PULMONARY ARTERIES: Technically adequate examination without evidence of pulmonary embolism.LUNGS AND PLEURA: Minimal basilar atelectasis/scarring. No focal consolidation. The pulmonary artery measures 3.6 cm, enlarged and suggestive of pulmonary hypertension. No suspicious nodule or mass. No pleural effusion or pneumothorax.Bronchial thickening suggestive of reactive airway disease.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No visible coronary calcifications are detected within the limitations of this non-gated study. The trachea and mainstem bronchi are patent. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative change affects the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1.No evidence of pulmonary embolism.2.Bronchial thickening suggestive of reactive airway disease.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 13-year-old male with injury to left arm, concern for fractureVIEWS: Left wrist: PA, oblique, lateral; left elbow: Oblique, lateral, AP; left forearm: AP, lateral (8 views) 3/19/15 No fracture or malalignment of the wrist, elbow, or forearm. Mild soft tissue swelling is present within the wrist and forearm. No elbow joint effusion. | Mild soft tissue swelling without evidence of fracture. |
Generate impression based on findings. | 47-year-old female with highly suspicious left breast mass and enlarged left axillary lymph node present for ultrasound guided biopsy of both areas. Left ultrasound re-identified the target lesions for biopsy. The first lesion to be targeted is an enlarged left axillary lymph node measuring 2.1 cm in a sub-pectoral location, with increased vascularity. The lesion was readily visible. The second lesion to be targeted is a lobulated, hypoechoic mass measuring 2.8 cm at the two o'clock position of the left breast, 6 cm from the nipple, with increased vascularity. The lesion was readily visible. PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left axilla was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferolateral to superomedial approach, two 14-gauge core needle (Inrad) specimens were obtained of the lesion. Targeting was judged excellent. Both specimens sank to the bottom of the prefilled container of 10% formalin. No specimens were fragmented. Specimen quality was judged excellent.Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Subsequently, the left breast lesion was targeted. The left breast was cleansed with chlorhexidine over the target area. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, five 9-gauge core needle (Suros) specimens were obtained of the lesion. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. All specimens were fragmented. Specimen quality was judged excellent.Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. All specimens were sent to Pathology with an accompanying history sheet. Post-procedure digital left CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the lesion. No evidence of hematoma or other complication. Concurrent right postprocedural mammogram was performed, demonstrating the right-sided clip to be at the site of biopsy within the right breast. These findings are further described on the dedicated right breast ultrasound and biopsy report.Pressure dressings were positioned over the biopsy sites and ice packs positioned over the pressure dressings. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedures well with no evident complications and left the Breast Imaging Department in stable condition.The procedure was performed by Dr. Happ. Dr. Kulkarni was present during the procedure at all times. | Successful ultrasound-guided core biopsy of the left axillary and breast masses and clip placements. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Metastatic endometrial cancer with right shoulder pain. Question of lytic lesion/dislocation. Three views of the right shoulder show marked destruction of the right acromion process of the scapula, which appears new from a chest radiograph from 1/2015. No acute fracture or shoulder dislocation is evident. A right chest port is noted. | Marked destruction of the acromion process compatible with a lytic metastasis given provided history of malignancy. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are right digital mammographic images (2/18/15), ultrasound images of right breast (2/18/15), images from ultrasound guided biopsy of right breast and post procedural right mammographic images (2/27/15) performed at Rush University Medical Center. For comparison, digital mammographic images (5/28/13 and priors) are available. RIGHT DIGITAL MAMMOGRAPHIC IMAGES (2/18/15):The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A triangular marker is placed at anterior 12 o'clock position of right breast, denoting the area of palpable lump. There is an ill-defined mass measuring 14 x 9 mm, posterior to the triangular marker. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast. ULTRASOUND IMAGES OF RIGHT BREAST (2/18/15):A microlobulated hypoechoic mass measuring 15 x 11 mm at 12 o'clock position in the right breast, corresponding to the mass seen on the mammogram. Increased blood flow is detected with color Doppler study.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST AND POST PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (2/27/15):Ultrasound guided needle biopsy was performed for the right breast mass, with appropriate needle placement.Per outside pathology report, the biopsy results was malignant; invasive ductal carcinoma, grade 2. | 1. Biopsy proven invasive carcinoma in the right breast.2. Images of left breast are not submitted.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male 61 years old Reason: History of lymphoma, please restage History: back pain CHEST:LUNGS AND PLEURA: Scattered ground glass and solid pulmonary micronodules appear similar to prior exam. Reference right pulmonary nodule measures 4 mm (image 56 years 5) unchanged. Scarring in the anteromedial lungs is again noted, likely due to radiation treatment. Upper lobe predominant centrilobular emphysema is again noted. No consolidation or pleural effusion.MEDIASTINUM AND HILA: Right chest port catheter tip at the cavoatrial junction. No mediastinal or hilar lymphadenopathy. Small retrocrural lymph nodes are unchanged. Coronary artery calcifications are again noted.CHEST WALL: Reference right axillary mass measures 1.8 x 1.1 cm (image 22 series 3) previously 2.1 x 1.7 cm. VP shunt catheter is again noted in the anterior right chest wall. T8 and T12 vertebral body compression fractures are unchanged compared to prior examination.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypoattenuating hepatic lesions, with nodular liver contour consistent with metastatic disease. Perihepatic ascites is again noted. Reference segment 8/4a lesion measures 1.6 x 1.3 cm (image 85 series 3) previously 2.0 x 1.8 cm. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: Calcifications in the pancreatic head/uncinate process, similar to prior exam, most likely due to chronic pancreatitis.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC filter is again noted in place. Atherosclerotic calcifications in the aorta and its branches. Small gastrohepatic lymph nodes are again noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Compression fractures of L2, L4, and L5 appear similar to prior exam, with vertebroplasty material again noted in the L5 vertebral body. New compression fracture of L1 vertebral body. VP shunt catheter, with its tip in the right lower quadrant.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted | 1.No significant change in size and number of pulmonary nodules.2.Stable to slight decrease in size of hepatic metastases.3.Slight interval decrease in size of right axillary mass.4.New L1 vertebral body compression fracture. |
Generate impression based on findings. | Female, 17 years old. Reason: R/o Fracture. 17 year old female w/ bruise on hand History: Point tenderness over rt distal 4/5 metacarpalsVIEWS: Right hand, AP, lateral, oblique (3 views) 3/19/2015, 1616 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 42 year old female with enlarged right clavicle. Two views of the right clavicle are unremarkable. There is no evidence of fracture or malalignment. No significant soft tissue swelling. Bone mineralization is within normal limits. | No evidence of fracture or malalignment. |
Generate impression based on findings. | Restaging cervical cancer following chemoradiation.RADIOPHARMACEUTICAL: 11.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 116 mg/dL. Today's CT portion grossly demonstrates right chest Port-A-Cath with tip in the right atrium. Numerous calcified mediastinal lymph nodes are present. Punctate calcification is seen in the inferior gallbladder. Lobular enlargement of the uterus is again noted.Today's PET examination demonstrates altered biodistribution with increased diffuse skeletal muscle activity suggesting hyperinsulinemia such as from recent meal and has the potential to limit the exam. There has been complete interval resolution of previous hypermetabolic tumor activity involving the cervical/uterine mass.There has been complete interval resolution of previous hypermetabolic left axillary lymph nodes which may reflect resolved metastatic tumor or inflammatory activity.There is currently no suspicious FDG avid lesion to indicate tumor activity.Mild to moderate increased activity along the gallbladder wall diffusely (SUV max = 3.2), is not significantly changed and may represent chronic cholecystitis or gallbladder adenomyomatosis among other possibilities. | 1.Complete interval resolution of previous hypermetabolic tumor activity with no suspicious FDG avid lesion currently.2.Stable mild to moderately hypermetabolic gallbladder wall activity may reflect chronic cholecystitis or adenomyomatosis and could be further evaluated with gallbladder ultrasound as clinically warranted. |
Generate impression based on findings. | Female; 62 years old. Reason: evaluate for acute intraabdominal process History: abdominal pain, onset of vomiting ABDOMEN:LUNG BASES: Small left lower lobe calcified granuloma and calcified mediastinal and bilateral hilar lymph nodes, likely from prior granulomatous process.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Exophytic fatty lesion arising from the left kidney midpole measuring up to 4.8 x 6.5 cm, compatible with angiomyolipoma.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix identified. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is markedly enlarged by multiple fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No acute abdominopelvic abnormality.2. Large left renal angiomyolipoma, for which urologic consultation is recommended for potential treatment.3. Fibroid uterus. |
Generate impression based on findings. | 6-month-old male with pulmonary hypertension, trach dependent with feverVIEW: Chest and Abdomen AP (two view) 3/19/15 The tracheostomy tube is in the above level of the thoracic inlet. Feeding to tip and proximal sidehole in the gastric body. Peripheral catheter in the right femoral vein. Bilateral diffuse coarse lung opacities with round lucencies unchanged. The cardiothymic silhouette is normal. Disorganized, nonobstructive bowel gas pattern. Left inguinal hernia. | Malpositioned tracheostomy tube. Bilateral diffuse coarse lung opacities represent chronic lung disease unchanged. |
Generate impression based on findings. | Male; 69 years old. Reason: Evaluate for bone mets History: HCC No abnormal osseous foci are identified to indicate metastatic disease. Faint increased linear activity along the periosteum of the left distal tibia may represent shin splints or a site of remote fracture. | No evidence of bone metastases. |
Generate impression based on findings. | Male; 55 years old. Reason: 55 y/o h/o AML, fatty liver (per US), s/p 3 cycles of chemo and lap appendectomy still w/ vague b/l UQ pain. Please eval for any type of obstruction, malignancy, ileus, abnormality History: vague b/l UQ abd pain, pain worse in evening, no pain with palpation. s/p lap appendectomy; h/o FLD per US. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. No visible coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Mild to moderate splenomegaly, similar to prior studies dating back to CT chest on 10/15/14.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable postsurgical changes from appendectomy.BONES, SOFT TISSUES: Stable right iliac sclerotic lesion, likely benign bone island.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Stable postsurgical changes from appendectomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No definite findings to account for the patient's symptoms. The splenomegaly may be symptomatic, and clinical correlation for such is recommended. |
Generate impression based on findings. | 62 year old female with breast cancer; surgery on 3/20/2015 (bilateral SNBx and bilateral mastectomy; please inject both left and right sides. RADIOPHARMACEUTICAL: The left and right breasts were prepared in a sterile manner. A total of 1.01 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections in the left breast. A total of 1.03 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections in the right breast. Foci of increased activity are noted in the bilateral axillae, representing the respective sentinel nodes. These regions were marked with an indelible marker. | Sentinel nodes identified in the bilateral axillae. |
Generate impression based on findings. | Male; 84 years old. Reason: evaluate for pulmonary embolism History: acute onset SOB. The comparison chest radiograph performed on 3/19/2015 demonstrates globular cardiomegaly and a probable small right pleural effusion but no focal pulmonary opacities. The ventilation portion demonstrates diffusely decreased activity throughout the left lung on single-breath images, which subsequently equilibrates during wash-in. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a small defect in the left apex and several medium sized defects in the anterior basal segment of the left lung, all of which are matched to the decreased activity throughout the left lung on single-breath ventilation images. | Low probability for pulmonary embolism. |
Generate impression based on findings. | Reason: eval for PE History: CP, tachycardia PULMONARY ARTERIES: The quality of this examination is limited secondary to the timing of the contrast bolus. No pulmonary embolus is noted to the lobar level. The segmental and subsegmental branches are poorly opacified. If there is high clinical suspicion for pulmonary embolism, recommend repeat PE CT with contrast when clinically appropriate.LUNGS AND PLEURA: Subsegmental atelectasis of bilateral lower lobes. This may be related to aspiration.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion.No mediastinal or hilar lymphadenopathy. Minimal calcification is noted within the mid LAD.CHEST WALL: Soft tissue induration in the left axilla with associated lymphadenopathy, partially included in this field of view. This can be further evaluated with dedicated shoulder or upper extremity imaging..UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Limited evaluation for pulmonary embolism due to timing of contrast bolus. No central pulmonary embolus to the lobar level is detected.Soft tissue induration and lymphadenopathy within the left axilla, partially included in the field of view. Further evaluation with dedicated left upper extremity and axillary imaging may be performed.PULMONARY EMBOLISM: PE: None to the lobar level.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable Reason: eval for PE History: CP, tachycardia |
Generate impression based on findings. | Female; 24 years old. Reason: Evaluate for source of abd pain (appy, renal stones, intraabdominal mass) - Attn to T/L spine as well for compression fx History: abdominal pain, metastatic breast cancer, new back pain ABDOMEN:LUNG BASES: Stable chronic fracture deformity of the left ninth rib.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Stable small hypoattenuating lesion, too small to characterize but likely a benign cystic lesion.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Greater than average colonic stool burden.BONES, SOFT TISSUES: Stable appearance of the spine with T10 compression fracture with corpectomy and left lateral fusion hardware and L2 compression fracture status post kyphoplasty. Multiple lytic lesions in the visualized spine and iliac bones, compatible with metastases and not significantly changed.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Greater than average colonic stool burden.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Greater than average stool burden, suggestive of constipation.2. Stable widespread bony metastatic disease. |
Generate impression based on findings. | Reason: r/o pulmonary embolus History: dyspnea, tachycardia, possible malignancy (renal cell) PULMONARY ARTERIES: The quality of this examination is good for the evaluation of pulmonary embolism. No pulmonary embolus is present.LUNGS AND PLEURA: Within the posterior basal segment of the left lower lobe (9/218), there is a predominantly solid nodule measuring 1.5 x 1.8 cm. Several small bronchioles are noted within it. There is minimal surrounding ground glass and reticulation. Associated bronchial wall thickening. While this may represent a focus of inflammation related to aspiration, a primary adenocarcinoma cannot be excluded. This is atypical for a metastasis. Therefore, short interval follow-up in 8 weeks is recommended.Severe centrilobular and paraseptal emphysema.Nodular fissural density (10/79) suspicious for intrapulmonary lymph node.Right Bochdalek hernia.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. AICD electrode terminates at the right ventricular apex. An atrial appendage electrode is also present. There is enlargement of the left thyroid gland it extends into the superior mediastinum to the level of the sternal manubrial junction. Mildly enlarged lower left paratracheal lymph node. No axillary lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. At the inferior field of view, there is diastases of the rectus muscles with minimal herniation of intraperitoneal fat. Nodularity of the left adrenal gland demonstrating low density, statistically an adenoma but follow-up and further imaging is warranted. Pancreatic atrophy. | No pulmonary embolism.Predominantly solid nodule measuring 1.5 x 1.8 cm posterior basal segment left lower lobe. Minimal surrounding ground glass and reticulation. Associated bronchial wall thickening. While this may represent a focus of inflammation related to aspiration, a primary adenocarcinoma cannot be excluded. This is atypical for a metastasis. Therefore, short interval follow-up in 8 weeks is recommended.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: tachy, SOB, anxious, O2 requirement, h/o DVT 1/2015 -- r/o PE History: tachy, SOB, anxious, O2 requirement, h/o DVT 1/2015 off Lovenox POD#0 -- r/o PE, previously reported history of tumor in right hepatic lobe, outside surgical pathology report of moderately differentiated rectal adenocarcinoma 2/20/15 PULMONARY ARTERIES: The quality of this examination is adequate for the evaluation of pulmonary embolism. No pulmonary embolus is present.LUNGS AND PLEURA: Small right pleural effusion. Bilateral lower lobe subsegmental atelectasis.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There is motion artifact but a small amount of coronary artery and aortic valvular calcification is present.CHEST WALL: Right port catheter terminates in the central superior vena cava.Degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is a drain draped over the dome of the liver that is partially included in this field of view. Moderate pneumoperitoneum in this postoperative state. Postsurgical changes of the liver suggestive of left hepatic lobe resection with heterogeneous density within the hepatic parenchyma. Two foci of subcapsular gas and focal low density (8/224, 273) are of uncertain etiology. These may represent postoperative fluid collections or hematomas, possibly the site of focal wedge resections. Continued observation with dedicated abdominal imaging is recommended. Mild induration of the superior mesenteric fat favors postoperative fluid. No frank ascites. | No pulmonary embolism.Postoperative changes from recent partial hepatectomy. Heterogeneous hepatic parenchyma with two foci of subcapsular gas and low density for which continued imaging with abdominal CT is recommended. Postoperative pneumoperitoneum. Minimal stranding of mesenteric fat likely postoperative fluid without frank ascites.PULMONARY EMBOLISM: PE: NoneChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: Evaluate for intracranial hemorrhage History: RUE weakness and HA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Periventricular and subcortical white matter hypodensities of a mild degree are present.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Patient with two episodes of hemoptysis and oral pharyngeal bleeding. Right carotid pseuodaneurysm noted on CT angiographyFLUOROSCOPY TIME: 29.7 minutes; Frontal Air Karma: 415.27 mGyLateral Air Karma: 238.5 mGyOPERATORS: Greg Christoforidis Right common carotid artery: There is a pseudo aneurysm at the origin of the distal common carotid artery. There are areas of narrowing and dilation along the right common carotid arteries.There is collateral reconstitution of left external carotid artery branches.There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. Left subclavian artery: There is no evidence for arteriovenous fistula. The vertebral artery does not originate from this vessel and likely has aortic arch origin. There is collateral reconstitution of left external carotid artery branches predominantly from the left descending cervical and the left dorsal cervical arteries. No pseudoaneurysm or other signs suggestive of bleeding source are identified.Left thyrocervical trunk: There is collateral reconstitution of left external carotid artery . No pseudoaneurysm or other signs suggestive of bleeding source are identified.Left ascending cervical artery: There is collateral reconstitution of left external carotid artery . No pseudoaneurysm or other signs suggestive of bleeding source are identified.Left common carotid artery: There is no evidence for evidence for carotid stenosis on the basis of NASCET criteria. No evidence for carotid dissection. The origin of the left ECA is obstructed by a covered stent. No pseudoaneurysm or other signs suggestive of bleeding source are identified.Right subclavian artery: There is no evidence for evidence for vertebral dissection. There is no stenosis at the origin of the right vertebral artery. No pseudoaneurysm or other signs suggestive of bleeding source are identified.Right thyrocervical trunk: There is no pseudoaneurysm or other signs suggestive of bleeding source are identified.Right vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. The posterior communicating arteries did not opacify. Venous and parenchymal phases were within normal limits. There is no pseudoaneurysm or other signs suggestive of bleeding source are identified.Left vertebral artery: The left vertebral artery is the non-dominant vertebral artery. There is opacification of the basilar artery and both posterior cerebral arteries. The right p1 segment is smaller than the right posterior communicating artery but not hypoplastic. Venous and parenchymal phases were within normal limits. The posterior meningeal artery originates from this vessel. There is no pseudoaneurysm or other signs suggestive of bleeding source are identified. There is collateral reconstitution of left external carotid artery branches.Intraprocedural images:These images demonstrate the stent extending from the mid cervical right internal carotid artery across the carotid bifurcation and into the midportion of the right common carotid artery. It completely covers the prior stent as well as the pseudoaneurysm.Right common carotid artery post carotid stentThe angiogram demonstrated no anterograde flow at the right external carotid artery origin. There is reverse reconstitution of the right external carotid artery branches via the right opthalmic artery and the petrous and possibly the cavernous segments of the right internal carotid artery. The patient's pseudoaneurysm no longer opacifies .Intracranially there is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no evidence for a cerebrovascular event. There is transient opacification of a medium sized right posterior communicating artery appearedRight common iliac artery: No contraindications to closure device. | 1.Pseudoaneurysm at the distal right common carotid artery.2.Deployment of 8mmx10cm covered VIABAHN ENDOPROSTHESIS (MR Conditional up to 3T) from RICA to RCCA across the pseudoaneurysm with successful obstruction of the pseudoaneurysm and cessation of antegrade right ECA flow. There was reverse reconstitution of the RECA via opthalmic artery and intracranial internal carotid artery collaterals at the end of the procedure. The pseudoaneurysms did not opacify at the end of the procedure.3.Findings were discussed with the referring service at the end of the procedure. The patient was started on plavix and aspirin. The patient will be mildly anticoagulated for 24 hours. The patient was be placed on prophylactic antibiotics following the procedure -Ampicillin/Sulbactam (unasyn).MRI Safety and Compatibility MR Conditional Non-clinical testing has demonstrated that the GORE® VIABAHN® Endoprosthesis is MR Conditional. It can be scanned safely under the following conditions: • Static magnetic field of 1.5 or 3.0 Tesla • Spatial gradient field of =720 Gauss/cm • Maximum scanner displayed whole-body-averaged specific absorption rate (SAR) of 3.0W/kg for 15 minutes of scanning. 3.0 Tesla Temperature Rise: In non-clinical testing, the GORE® VIABAHN® Endoprosthesis produced a temperature rise of 2.5ºC at an MR system reported maximum whole bodied averaged specific absorption rate (SAR) of 3.0W/kg for 15 minutes of MR scanning in a 3.0 Tesla, Excite, General Electric active-shield, horizontal field MR scanner using G3.0-052B Software and placed in a worst-case location in a phantom designed to simulate human tissue. The SAR calculated using calorimetry was 2.8 W/kg.1.1.5 Tesla Temperature Rise: In non-clinical testing, the GORE® VIABAHN® Endoprosthesis produced a temperature rise of 2.4ºC at an MR system reported maximum whole bodied averaged specific absorption rate (SAR) of 2.8W/kg for 15 minutes of MR scanning in a 1.5 Tesla, Magnetom, Siemens Medical Solutions, active-shield, horizontal field MR scanner using Numaris/4 Software and placed in a worst-case location in a phantom designed to simulate human tissue. The SAR calculated using calorimetry was 1.5 W/kg. |
Generate impression based on findings. | CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. Neck CTA: The patient is status post bilateral carotid stent placement and proximal embolic coil occlusion of the left superior thyroidal artery and embolic coil occlusion of the left inferior thyroidal artery. Since the prior exam a small pseudoaneurysm has developed at the right common carotid artery immediately superior to the covered stent. The right common carotid artery has mildly narrowed at the level of the pseudoaneurysm and appears mildly elongated. The right common carotid artery is mildly prolapsed into the hypopharynx. There are luminal filling defects within the right common carotid artery stent.The left ECA is occluded by a covered stent but fills via collaterals.The patient is status post tracheostomy, laryngectomy, voice prosthesis, partial thyroidectomy and right neck dissection. There is irregularity of the neopharynx, but no definite evidence of discrete mass lesions or significant cervical lymphadenopathy. The salivary glands and residual left thyroid lobe are unchanged. There is an irregular airfilled sinus tract between the voice prosthesis and the esophagus. This was present on the prior exam as well.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.The neck is in a flexed position.There is interstitial thickening at the lung apices likely related to scar formation.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. Medial right posterior communicating artery is small to medium sized. The left posterior communicating artery is small. The anterior communicating artery is small.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a posterior fossa subdural effusion present which likely represents atrophy. It is stable compared to the prior CT from 11/2/14.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate right maxillary sinus mucous retention cyst as well as scattered opacities elsewhere. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.New pseudoaneurysm is present along the right common carotid artery immediately superior to the stent.2.There are filling defects within the right common carotid stent. It is possible that this represent endothelial reaction or mural thrombus.3.No evidence for cervicocerebral occlusive disease.4.Findings were discussed with the Emergency room physician and the ENT resident on call at the time of the exam. |
Generate impression based on findings. | Reason: r/o mass History: headache with scalp tenderness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Reason: r/o acute intracranial hemorrhage History: HA, dizziness, mild vertigo, 9hrs s/p head injury with LOC The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening in the visualized portions of the maxillary sinuses left more than right, the posterior ethmoid air cells and the right sphenoid sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Paranasal sinus opacities are present. Sinusitis cannot be excluded. Please correlate with clinical symptoms. |
Generate impression based on findings. | Reason: assess mass History: mass, sob LUNGS AND PLEURA: Left upper lobe mass measures 5.2 x 6.1 cm (4/22). This is new since the prior CT. Associated foci of central necrosis with internal bronchograms. This does invade the left superior mediastinum, invading fat. There is a fat plane demonstrated between the left lateral esophageal wall and the medial extent of this tumor. Surrounding ground glass within the left upper lobe which abuts but does not traverse the left major fissure.There is associated narrowing of the central left upper lobe bronchus. No gross rib invasion is identified. No pleural effusion.Right upper pulmonary micronodule measures 3 mm (6/11). Subsegmental atelectasis involving the right middle and left upper lobes. MEDIASTINUM AND HILA: Aortopulmonary window lymphadenopathy. Representative lymph node measures 9 mm (4/29). Right hilar adenopathy with representative lymph node measuring 14 mm (4/34). Left hilar lymphadenopathy is contiguous with this left upper lobe mass. No subcarinal lymphadenopathy. The ostium of the right main stem bronchus is narrowed as the azygous vein passes across its lateral aspect, similar to multiple prior studies. Right hilar adenopathy does not appear to invade the right mainstem bronchus at this time.Small hiatal hernia.CHEST WALL: Small bilateral axillary lymph nodes.Degenerative changes of the lower thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Left upper lobe suprahilar mass 5.2 x 6.1 cm. associated central necrosis, invasion into the superior left mediastinum and surrounding ground glass within the left upper lobe. This is compatible with malignancy. Associated bilateral hilar and aortopulmonary lymphadenopathy. |
Generate impression based on findings. | Female 57 years old; Reason: 57yo h/o renal txp 2011 with worsening renal fxn, morbidly obese with anasarca. now on IV diuresis. Txp team requesting CT wo eval for massive ascites or abdominal hernia History: volume overload Portions of the superficial abdominal wall are excluded from the field-of-view. The absence of intravenous and oral contrast limits evaluation of the solid organs and of the bowels. Given these limitations, the following observations were made:ABDOMEN:LUNG BASES: Bilateral small effusions; left greater than right, with compressive atelectasis. Moderate coronary artery calcifications.LIVER, BILIARY TRACT: Pericholecystic inflammatory changes. No gallstones are identified however CT is less sensitive than ultrasound for their detection.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The native kidneys are severely atrophic. Transplant graft in the right iliac fossa. There is no hydronephrosis or significant perinephric fluid. Subcentimeter hyperattenuating lesion at the of the transplant kidney is too small to characterize but may represent a hemorrhagic cyst.RETROPERITONEUM, LYMPH NODES: Moderate aortic and branch vessel arteriostenosis. Metallic stent within the left common iliac vein.BOWEL, MESENTERY: No bowel obstruction. Diverticular disease without CT evidence of diverticulitis.BONES, SOFT TISSUES: The bones are diffusely osteopenic. There are degenerative changes throughout the spine. Nonspecific lucency within the T8 vertebral body, stable compared to prior study 2012.OTHER: Nonspecific mesenteric stranding in the upper abdomen. Dystrophic calcifications are again noted in the bilateral breast tissues. Multiple collateral vessels are noted in the chest and abdominal walls. Edema throughout the subcutaneous soft tissues. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction. Diverticular disease without CT evidence of diverticulitis.BONES, SOFT TISSUES: Edema throughout the subcutaneous soft tissues. OTHER: No significant abnormality noted. | 1.No intra-abdominal ascites or abdominal wall hernia as clinically questioned.2.Small bilateral pleural effusions, left greater than right.3.Pericholecystic inflammatory changes. No gallstones are identified however CT is less sensitive than ultrasound in the detection of same. Consider right upper quadrant ultrasound if clinical concern for acute cholecystitis. |
Generate impression based on findings. | Altered mental status.VIEWS: Chest and abdomen AP (two views) 03/19/15, 1700 Endotracheal tube tip is below thoracic inlet. Feeding tube tip is in distal gastric body. Lower extremity PICC tip is at junction of IVC and right atrium. A urinary bladder catheter is present.Left lower lobe remains atelectatic. The rest of the left lung is normally aerated. No right sided opacities are present. Cardiothymic silhouette is normal in size. The aortic arch, cardiac apex, and stomach are left-sided.Only a small amount of bowel gas is seen. | Reexpansion of the left upper lobe after repositioning of endotracheal tube. Small amount of bowel gas. |
Generate impression based on findings. | 78 year old with history of right lumpectomy in 1992 for breast cancer. Benign left breast surgery. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable postsurgical changes are present in the upper outer right breast, including increased density, architectural distortion, and extensive dystrophic calcifications. Additional benign calcifications are seen bilaterally. 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 unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female; 39 years old. Reason: change in size of pancreatic pseudocyst or communication with pleural space? s/p cystgastrostomy w persistent pain, po intolerance and SIRS History: as above CHEST:LUNGS AND PLEURA: Moderate left pleural effusion, similar to prior. Moderate adjacent left lower lobe atelectasis/consolidation, similar to prior. Chronic-appearing interstitial opacities and projects is in the right lung are stable. No new air space opacities.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No visible coronary artery calcifications. Stable prominent mediastinal lymph nodes, which are not pathologically enlarged by CT size criteria.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions. No biliary ductal dilation. The main portal vein and its branches are patent.SPLEEN: No significant abnormality notedPANCREAS: Stable cystogastrostomy tube. Largest peripancreatic fluid collection with foci of air has slightly decreased in size and measures up to 6.4 x 4 cm (series 4/89), previously 7.9 x 4.8 cm. Additional smaller fluid collections extending into the left upper quadrant are also mildly decreased in size. For future reference, a collection medial to the spleen measures 3.2 x 1.9 cm (series 4/73). No new peripancreatic fluid collections. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Native kidneys are not visualized. Left iliac fossa transplant kidney with new mild gas density within the collecting system, most likely due to Foley catheter being in place. No peri-transplant kidney fatty stranding.RETROPERITONEUM, LYMPH NODES: Nonenlarged retroperitoneal lymph nodes are nonspecific but stable.BOWEL, MESENTERY: Enteric tube tip in jejunum. Broad-based ventral abdominal wall hernia noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Bulky uterus, likely due to underlying fibroids.BLADDER: Decompressed bladder with a small amount of air, likely due to Foley catheter being in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Enteric tube tip in jejunum. Broad-based ventral abdominal wall hernia noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Mild interval decrease in peripancreatic fluid collections.2. New mild gas density within the left iliac fossa transplant kidney collecting system is most likely due to Foley catheter being in place. Recommend correlation with urinalysis for possibility of infection. |
Generate impression based on findings. | 82 years, Female. Reason: advanced stage uterine cancer with SBO, please check NG tube placement History: nausea/vomiting There is a nasogastric tube with its tip projecting over the body of the stomach. There is a nonobstructive bowel gas pattern. Bibasilar opacities suggest atelectasis. Surgical clips project over the right upper quadrant.Sclerotic changes in the right femoral head. Nonspecific sclerotic changes in the sacrum. | Nasogastric tube with its tip projecting over the body of the stomach. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 9-year-old female experiencing altered mental status, with history of anoxic brain injury. Redemonstrated is marked enlargement of the lateral and third ventricles with mild enlargement of the fourth ventricle. Although there has been increase in size of the greatest transverse extent of lateral ventricles, the calvarium has also increased with greater age and skull growth. Thus, ventricle enlargement may be commensurate.As before, white matter volume is decreased with areas of low attenuation and overall volume loss. Encephalomalacia is again noted involving the occipital lobes bilaterally left greater than right. No evidence of acute intracranial hemorrhage. No significant midline shift or mass effect. Mucosal thickening can be found throughout the paranasal sinuses, however without superimposed air-fluid level. The mastoid air cells and middle ear cavities are clear. | Redemonstrated is marked enlargement of the lateral and third ventricles with mild enlargement of the fourth ventricle. Although there has been increase in size of the greatest transverse extent of lateral ventricles, the calvarium has also increased with greater age and skull growth. Thus, ventricle enlargement may be commensurate. |
Generate impression based on findings. | RFO trigger: BMI over 40 Suspected RFO location: na Name of suspected RFO: na Attending Surgeon name/pager: Tenney Body Mass Index (BMI): 42.14 NG tube tip terminates in the distal esophagus. Surgical drain with tip terminating in the right hemipelvis. Surgical clips are present within the pelvis. No unexpected radiopaque foreign object identified. | No unexpected radiopaque foreign object identified.These findings were discussed by telephone with Dr. Tenney, the attending surgeon, on 3/20/2015 at 18:49.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are screening mammogram (2/9/15), diagnostic left mammogram and ultrasound (2/23/15), and images from stereotactic left breast biopsy and post procedural mammogram (3/3/15) performed at St. James Hospital in Olympia Fields, IL. No studies are available for comparison. SCREENING MAMMOGRAM (2/9/2015): Two standard views of both breasts were obtained. The breast parenchyma iscomposed of scattered fibroglandular elements ,distributes fairly symmetrically in both breasts. A 0.6 cm focal asymmetry is present within the central slightly inner left breast, with associated architectural distortion. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in the right breast. Benign appearing lymph nodes are projected over the right axillae. DIAGNOSTIC LEFT MAMMOGRAM (2/23/2015): The previously visualized focal asymmetry within the central, slightly inner left breast persists on spot compression imaging.LEFT BREAST ULTRASOUND (2/23/2015): Multiple sonographic images were submitted labeled "Left breast 8:00, 3 cm fn", demonstrating a 0.4 x 0.2 x 0.4 cm circumscribed hypoechoic mass, which is not felt to correspond to the findings on mammogram. No additional findings are present on the submitted images.IMAGES FROM LEFT STEREOTACTIC BIOPSY AND POST PROCEDURAL MAMMOGRAM (3/3/2015): Images from stereotactic biopsy of the left breast asymmetry were submitted for review. Targeting appears appropriate. A twist-shaped clip was deployed at the biopsy site.Post procedural left breast mammogram reveals a twist-shaped clip within the central, slightly inner left breast. A small hematoma is present at the biopsy site.PATHOLOGY: Invasive ductal carcinoma, grade 1, ER/PR positive, HER2 negative. | Left breast focal asymmetry status post stereotactic biopsy revealing invasive ductal carcinoma. Continued surgical management is advised. BIRADS:6 - Known cancer. RECOMMENDATION:T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Low Apgar scores. Perinatal acidosis.VIEWS: Chest and abdomen AP (two views) 03/19/15, 2007 Endotracheal tube tip is at thoracic inlet. Feeding tube tip is at GE junction. Esophageal temperature probe tip is in lower esophagus. Umbilical venous line has its tip in right atrium. Umbilical arterial line is coiled upon itself between T9 and T12.Cardiothymic silhouette is normal. No focal lung opacities are present.Gas is seen in the stomach and in no other bowel loops. | No focal lung opacity. Almost gasless abdomen. |
Generate impression based on findings. | 59 years, Male. Reason: Eval for obstruction History: Constipation Dilated loops of small bowel with gas present in the colon, suggestive of ileus. Sclerotic bone metastases better evaluated on the prior CT examination. Surgical clips project over the pelvis. There are bilateral pleural effusions with associated atelectasis left greater than right. No evidence of pneumoperitoneum.Extensive sclerotic bony metastases. | Mild ileus-type gas pattern.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male, 12 years old. Evaluate for fracture History: wrist trauma, swelling, bony tendernessVIEWS: Right wrist PA, lateral, oblique (3 views) 3/19/2015, 1732 The posterior aspect of the radial physis is minimally widened. No other osseous abnormalities noted.Soft tissue swelling about the wrist. The pronator quadratus is bowed anteriorly. | Small joint effusion. Slightly widened posterior radial physis. If point tenderness is over the posterior distal radius, this may represent a Salter Harris 1 fracture. |
Generate impression based on findings. | Scrotal pain RIGHT TESTIS: No significant abnormalities noted. The right testis is located in the inguinal canal. Mild hydrocele is identified. The testis is 1.56 X 1.99 X 1.56 cms in 3 dimensions. LEFT TESTIS: No significant abnormalities noted. The testis is located in the scrotum. Hydrocele is noted as well. The testis is 2.08 X 1.17 X 2.31 cms in 3 dimensions.RIGHT EPIDIDYMIS: Multiple punctate calcifications noted.LEFT EPIDIDYMIS: Multiple punctate calcifications noted.OTHER: No significant abnormalities noted.DOPPLER | Extensive bilateral , punctate calcifications of the epididymis, diagnostic considerations are either chronic calcifications due to recurring epididymitis or meconium epididymitis. |
Generate impression based on findings. | Pole multiple female with tracheoesophageal fistula post repairVIEW: Chest AP (one view) 3/19/15 at 2230 Gastrostomy tube is present in expected position. Cardiac silhouette is normal. Lucency along the upper right mediastinum represents air-filled dilated esophagus. No focal pulmonary opacities. No pleural effusion or pneumothorax. | Dilated air-filled esophagus along the upper right mediastinum. No pleural effusion or pneumothorax. |
Generate impression based on findings. | 60 year-old male status post esophageal stent (3/18/15), now with severe upper esophageal pain CHEST:LUNGS AND PLEURA: New moderate bilateral pleural effusions with adjacent atelectasis.MEDIASTINUM AND HILA: Right chest port tip is in the SVC. No extraluminal air is evident. Concentric esophageal thickening within the distal esophagus likely reflects the patient's known primary malignancy. No significant mediastinal or hilar lymphadenopathy. Heart size is normal. Small pericardial effusion. Mild coronary artery calcification. No pneumopericardium.CHEST WALL: No axillary, retrocrural, or cardiophrenic lymphadenopathy. Unchanged sclerotic lesion in the right second rib. ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Unchanged bilateral renal hypodensities are unchanged, likely cyst. Focal 8mm hyperdense focus in the right kidney is slightly increased since prior exam.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference gastrohepatic nodal mass now measures approximately 3.8 x 3.4 cm in series 3, image 92), previously 3.5 x 3.0 cm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Small pneumoperitoneum likely due to recent gastrostomy tube insertion. Gastrostomy tube is in place. Small amount of surrounding soft tissue density likely represents hematoma.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New moderate pleural effusions with adjacent atelectasis. New small pericardial effusion. No pneumomediastinum or pericardium. Small pneumoperitoneum likely due to recent gastrostomy tube insertion. Findings were discussed with Dr. Waxman by Dr. Montner on 3/19/15. |
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