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Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Benign calcifications in both breasts are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 56 years, Male. Reason: assess NGT position History: s/p NGT There is a nasogastric tube with its tip projecting over the body of the stomach. There is nonspecific gaseous distention of the stomach. | NG tube with tip projecting over the body of the stomach. Nonspecific gaseous distention of the stomach. |
Generate impression based on findings. | 62 years, Male. Reason: Abdominal distension, evaluate for ileus History: abdominal distension There is diffuse gaseous distention of both large and small bowel with gas seen in the rectum, most consistent with ileus although obstruction at the level of the of anal canal cannot be excluded. Moderate degenerative changes of the lower lumbar spine. | Diffuse gaseous distention of both large and small bowel most consistent with ileus, although distal obstruction not excluded. |
Generate impression based on findings. | Male 60 years old; Reason: evaluate for sternal dehiscence, evaluate sternal wires, plates, fluid collection History: s/p CABG, known sternal drainage, unstable sternum LUNGS AND PLEURA: Moderate left pleural effusion with underlying left lower lobe segmental atelectasis. No specific evidence of pneumonia or interstitial pulmonary edema.MEDIASTINUM AND HILA: Status post CABG. There is stranding of the anterior mediastinal fat with a minimal pericardial effusion. Small foci of gas are noted anteriorly along the sternotomy margin, as described below. No mediastinal lymphadenopathy by CT size criteria. CHEST WALL: Status post sternotomy with sternal wires and plates with screws. There is no specific evidence of hardware complication. Superiorly, the sternotomy fragments are well-approximated. At the inferior margin of the sternotomy, there is approximately 5 mm of diastasis of the sternotomy fragments, with associated attenuation in the surrounding soft tissues. Foci of gas are noted in the subcutaneous soft tissues along the sternotomy and also less so in the adjacent anterior mediastinum. No drainable chest wall fluid collection is present to suggest abscess. Nondisplaced left first rib fracture. Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Status post CABG with sternotomy. Attenuation and foci of gas in the surrounding subcutaneous and anterior mediastinal soft tissues may represent, in part, post-surgical changes such as hematoma or seroma. However, given the persistence of these findings 10 days after surgery, a developing cellulitis remains on the differential diagnosis, and short term interval follow up is recommended to assess for resolution of the above findings. 2. No drainable chest wall fluid collection is present to suggest abscess. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Patient reports weight loss since last mammogram. Two standard digital views of both breasts, additional left MLO view, and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Round circumscribed mass in the left upper inner quadrant is better visualized on the CC view compared to prior, unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Desaturations and intubated. Hyperthermia protocol.VIEWS: Chest and abdomen AP (two views) 03/20/15, 0655 Endotracheal tube tip is at thoracic inlet. Feeding tube tip is in proximal stomach. Esophageal temperature probe tip is in mid esophagus. Umbilical venous line tip is at level of left hepatic vein or ductus venosus. Umbilical arterial line has its tip at L5.Soft tissue edema is a new finding.Cardiothymic silhouette is normal. Streaky opacities are present in the lung bases.Almost no bowel gas is present. | Development of soft tissue edema. Streaky opacities in lung bases may be subsegmental atelectasis. |
Generate impression based on findings. | 56-year-old male with two week history of back pain. Two views of the thoracic spine demonstrate multilevel mild degenerative disease of the thoracic and lower cervical spine, including mild disk space narrowing. The body heights are grossly preserved. Alignment is anatomic.Four views of the lumbar spine demonstrate mild multilevel degenerative disease, particularly at L3-4, with mild disk space narrowing. There is sclerosis of the lumbar facet joints, suggestive of osteoarthritis. The SI joints appear mildly sclerotic. Vertebral heights are preserved. Alignment is anatomic. No evidence of acute fracture. However, details of the lumber spine are obscured by overlying gas and stool. | Scattered multilevel degenerative disease of the spine as above. No evidence of acute fracture or malalignment. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional right MLO and CC views were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered benign calcifications bilaterally are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 62 year old female with history of left breast cysts. No current breast complaints. No family history of breast cancer. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable subcentimeter asymmetries are present within the lower central and upper inner left breast, previously shown on ultrasound to represent cysts. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | Stable left breast asymmetries. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Supracondylar fracture.VIEWS: Left elbow AP/lateral/oblique (3 views) 03/20/15 K wires have been removed. Callus formation around the distal humeral fracture is again seen. Alignment is near-anatomic. | Healing supracondylar fracture. Removal of K wires. |
Generate impression based on findings. | Left thumb injury. Needs surgery.VIEWS: Left hand PA left thumb PA/lateral (3 views) 03/20/15 The soft tissues of the lateral aspect of the index finger at the level of the proximal phalanx and proximal interphalangeal joint, and the soft tissues surrounding the thumb, especially posteriorly at the level of the phalanges, are thickened and lobulated. The bones at these levels have abnormal scalloped contours. Additionally, the size of the proximal and middle phalanges of the index finger and the proximal and distal phalanges of the thumb is enlarged. Increased density is noted within the enlarged soft tissues of the thumb. Scalloping of the medial aspect of the radial metaphysis is also seen. | Abnormal soft tissues, abnormal bone contours raise the possibility of vascular malformation, lymphangioma, Proteus syndrome, and others. |
Generate impression based on findings. | Ataxia. Tremors. There is mild parenchymal volume loss. There is no evidence of acute intracranial hemorrhage or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is a partially empty sella. The venous sinus is prominent at the confluence. There is extension of the cerebellar tonsils below the level of the foramen magnum, measuring approximately 6-7 mm. There is an unfused posterior arch of C1, which is a normal anatomic variant. The skull and extracranial soft tissues are otherwise unremarkable. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Findings of Chiari one malformation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Circular skin markers were placed over both axillae. Partially obscured mass in the right medial central breast, mid depth.No suspicious calcifications or areas of architectural distortion are present. | Partially obscured mass in the right medial central breast, mid depth for which additional views including spot compression views and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Male 74 years old; Reason: Eval for obstruction History: Vomiting There is gaseous distention of the small bowel compatible with an ileus. Scattered gas is noted within the colon. There is some enteric contrast in the left upper abdomen likely within the stomach.Degenerative changes affects the hips and lumbar spine. | 1.Ileus |
Generate impression based on findings. | Female 67 years old; Reason: Evaluate for distension, bowel wall abnormalities, free air History: Pain, unable to verbalize site; diarrhea, NG feedings Bilateral double nephroureteral stents. These originates in the region of the renal pelvis and terminate in the region of the urinary bladder.The descending colon has a mottled appearance up to the level of the rectum small bowel gas pattern is nonobstructive. No free air noted within the lateral view. | 1.Abnormal radiograph for the mottled appearance of the descending colon differential considerations include a colitis or colonic pneumatosis. Follow up CT scan is recommended.Findings discussed with Dr.ARDELT at the time of dictation |
Generate impression based on findings. | Female; 56 years old. Reason: Pt with h/o peripancreatic edema possible pseudocyst. Last scan was December 2014. Needs to be revaluated in March, 2015. History: Left sided abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Focal fatty sparing along the falciform ligament. Interval cholecystectomy. No biliary ductal dilation.SPLEEN: No significant abnormality notedPANCREAS: Peripancreatic fluid collections are mildly decreased since prior study. Reference collection anterior to the pancreatic body measures up to 4.9 x 2.8 cm (3/31), previously 6.8 x 3.5 cm. Additional smaller collections about the pancreatic tail have also decreased. No central gas or thick rim enhancement. No new fluid collections. No pancreatic ductal dilation.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable 6-mm nonobstructing left renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable postoperative changes of the lumbar spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable postoperative changes of the lumbar spine.OTHER: Trace pelvic ascites. | Decreased peripancreatic fluid collections. |
Generate impression based on findings. | 63-year-old male with renal failure. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures approximately 15 cm in length. There is severe hydronephrosis with marked parenchymal loss involving the right kidney with dilatation of the visualized proximal ureterLEFT KIDNEY: The left kidney measures approximately 16.4 cm in length. There is severe hydronephrosis with almost complete parenchymal atrophy involving the left kidney with dilatation of the visualized proximal ureter.OTHER: Urinary bladder is severely distended with a pre-void volume of 4000 cc and a postvoid volume of 2400 cc. There is debris within the urinary bladder. | Bladder outlet obstruction with severe, bilateral hydronephrosis and parenchymal loss involving the kidneys.Debris within urinary bladder.No evidence for renal artery stenosis.Discussed with Dr. Toback, Gerber and the Emergency Room. Patient to be admitted to the emergency room with Foley catheter placement and electrolyte correction |
Generate impression based on findings. | ESRD patient with stent, sudden worsening of vision. Evaluate for hemorrhage or large hypodensity. There is no evidence of intracranial hemorrhage or mass effect. There are bilateral patchy areas of white matter hypoattenuation including the frontal periventricular white matter, right internal capsule, and coronaradiata. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are scattered intracranial vascular calcifications. There is near complete opacification of the right maxillary sinus with hyperdense material, likely inspissated secretions. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There are bilateral lens replacements. | 1.No evidence of acute intracranial hemorrhage or mass effect. Patchy white matter hypoattenuation, which is compatible with chronic small vessel ischemic disease. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and no contraindications, MRI of the brain is recommended. |
Generate impression based on findings. | Female 48 years old; Reason: evaluate for abnormal lung parenchyma History: hypoxia at rest. LUNGS AND PLEURA: Minimal basilar scarring/subsegmental atelectasis. No specific evidence of infection or edema. No pleural effusions. MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal-sized heart without pericardial effusion. No appreciable coronary artery calcifications on this non-gated study.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Partially visualized surgical clips and calcifications noted about the pancreas. Otherwise, no significant abnormality noted. | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Prior surgical biopsy right axilla 2006 with benign findings. Family history of breast cancer in two maternal aunts. Two standard digital views of both breasts on a total of 10 images were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Linear scar marker was placed over the right axilla. Right postbiopsy architectural distortion is stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 15-year-old female suspect right fifth metacarpal fracture.VIEWS: Right hand PA, oblique, lateral (3 views) 3/20/15 Overlying cast material obscures fine bone detail. No fracture or sclerotic line to suggest a healing fracture is identified. | No fracture or healing fractures identified. |
Generate impression based on findings. | Hodgkin lymphoma status post chemotherapy and radiation. There are postoperative findings related to excisional biopsy in the right supraclavicular region. There is extensive bilateral cervical, supraclavicular, and partially imaged mediastinal lymphadenopathy. The suprahyoid lymph nodes appear to be slightly larger, which the other lymph node appear to be stable to slightly smaller. For example, a left level 2A lymph node measures 10 mm in short axis, previously 7 mm, while a right level 4 lymph node measures 10 mm in short axis, previously 10 mm as well. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. The major cervical vessels are patent. The osseous structures are unremarkable. The imaged paranasal sinuses and mastoid air cells are clear. The airways are patent. The imaged intracranial structures are unremarkable. | Slight interval increase in size of suprahyoid lymph nodes, which is nonspecific. Otherwise, the lower cervical, supraclavicular, and partially imaged mediastinal lymphadenopathy appear to be stable to slightly smaller. |
Generate impression based on findings. | Male, 13 years old. Reason: s/p chemotherapy for osteosarcoma History: see above LUNGS AND PLEURA: Scattered micronodules are unchanged. No new suspicious pulmonary nodules or masses. No focal consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedUPPER ABDOMEN: Upper abdomen | No evidence of metastatic disease to the chest. |
Generate impression based on findings. | Male 57 years old; Reason: 57M hx ampullary stenosis s/p ERCP with PD stent placement. Need to assess PD stent passage History: s/p ERCP The bowel gas pattern is nonobstructive. Multiple clips are noted in the right upper abdomen. No definite free intraperitoneal air. Previously placed pancreatic duct stent is not evident on exam and has likely passed. | 1.Nonobstructive bowel gas pattern.2.No evident pancreatic duct stent. |
Generate impression based on findings. | Humeral fracture.VIEWS: Left humerus AP and lateral 3/20/15 (number of views views) There is a posterior, distal metaphyseal fracture of the left humerus. Alignment is near anatomic. Cast material obscures fine bone detail. | Left humeral fracture as described. |
Generate impression based on findings. | Male 73 years old; Reason: assess for intraabdominal pathology, OGT placement History: firm abdomen Bowel gas pattern is nonobstructive. A right central venous catheter projects over the chest.Enteric tube projects over the level of the fundus.Bilateral iliac stents are noted in the sitting of calcific arteriosclerotic disease. | 1.Enteric tube terminates in the region of the gastric fundus. |
Generate impression based on findings. | SDH with resolution. Evaluate for recurrence or abnormality: headaches There are postoperative findings related to right calvarial burr hole subdural collection drainage. The bilateral cerebral convexity subdural hematomas have nearly resolved with minimal residual low attenuation extra-axial fluid. There is no significant midline shift. The brain parenchyma appears unremarkable. The ventricles appear unchanged. The paranasal sinuses are clear. There is minimal nonspecific opacification of the mastoid air cells. | Postoperative findings with near interval resolution of the bilateral cerebral convexity subdural collections and no evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Male; 61 years old. Reason: Hx of Follicular NHL History: Chemo complete 5/2012; compare to previous CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. A prominent right hilar lymph node is not significantly changed since prior study. Normal heart size. No pericardial effusion. Mild calcifications coronary arteries.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable subcentimeter hypoattenuating focus in the right lobe of the liver is too small to accurately characterize but likely a cyst (series 3/86). No suspicious liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. Retroaortic left renal vein is a normal variant.RETROPERITONEUM, LYMPH NODES: No new mesenteric or retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Colonic diverticulosis without evidence of active inflammation.BONES, SOFT TISSUES: Mild multilevel degenerative changes are seen of the spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Reference left femoral lymph node measures 10 mm, unchanged (series 2/197). No new pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable appearance of the chest, abdomen, and pelvis. No new findings. |
Generate impression based on findings. | Male 60 years old; Reason: obstr History: pain There is persistent mild gaseous distention of the small bowel. Oral contrast has reached the descending colon over a two day period.No free intraperitoneal air.There is left lower lobe atelectasis. | 1.ileus |
Generate impression based on findings. | Male 53 years old; Reason: OG placement History: OG placement Enteric tube terminates in the region of the gastric body. Upper abdominal small bowel pattern is nonobstructive.Air bronchograms are noted in the left lower lobe representing either atelectasis and/or consolidation. | 1.Enteric tube is in the region of the gastric body. |
Generate impression based on findings. | 60 year old female status post left mastectomy in 1993 in the Philippines for recurrent cystic change, as per patient, presents today for routine follow up. No current breast complaints. No family history of breast cancer. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 40 years old Reason: 40 yr old patient with peritoneal cancer s/p 2 cycles of Doxil compare to 1-7-15 scan. 8-14-14 had TAH/BSO, colon resection, ileocecel resection and appy. History: none CHEST:LUNGS AND PLEURA: No suspicious pleural nodules or masses identified.MEDIASTINUM AND HILA: The heart size is normal as is the caliber the great vessels. There is no evidence of pleural or pericardial effusion. The trachea and mainstem bronchi are patent. CHEST WALL: Left chest wall Port-A-Cath with tip terminating at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: The patient is status post cholecystectomy. There are calcifications of the hepatic capsule, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes related to partial colectomy as well as omentectomy again evident. Decreased peritoneal thickening along the anterior abdominal wall (image 164, series 3), consistent with peritoneal disease. There has been interval decrease in size of the soft tissue mass in the left upper quadrant, now measuring 2.1 x 1.5 cm (image 116; series 3). Unchanged minimal development of apparent asymmetric low-density thickening of the lateral wall of the cecum, which remains nonspecific, but could represent serosal disease.BONES, SOFT TISSUES: No significant abnormality identified.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: The patient is status post hysterectomyBLADDER: 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. | Interval regression of disease with reference measurements given above. |
Generate impression based on findings. | 10-year-old male with Hodgkin lymphoma CHEST:LUNGS AND PLEURA: No focal lung opacities. No pleural effusion or pneumothorax. Mild scarring adjacent to the right upper mediastinal mass likely secondary to radiation. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart size is normal without pericardial effusion. Interval decrease in size of right superior mediastinal soft tissue mass measuring 6.0 x 3.2 cm (series 3, image 19), previously measuring 6.7 x 3.2 cm. Mildly prominent mediastinal lymph nodes. Unchanged mild prominence of AP window lymph node measuring 6 mm (series 3, image 27), previously measuring 6 mm. No significant internal mammary, cardiophrenic, or retrocrural lymphadenopathy.CHEST WALL: Right chest wall port catheter tip in the SVC. No significant axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation. Calcified gallstone is at the bladder neck, unchanged. The portal vessels are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys enhance symmetrically without focal lesion.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal lymphadenopathy by CT size criteria. Reference left periaortic lymph node measures 5 mm in width (series 3, image 19), previously measuring 6 mm.BOWEL, MESENTERY: The bowel is normal in appearance without evidence of bowel wall edema, obstruction, pneumatosis, or free air. A normal appendix is identified.BONES, SOFT TISSUES: No osseous lesion is present.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: The bowel is normal in appearance without evidence of bowel wall edema, obstruction, pneumatosis, or free air. A normal appendix is identified.BONES, SOFT TISSUES: No osseous lesions are present.OTHER: No significant abnormality noted | 1. Slight interval decrease in superior right mediastinal mass.2. No significant change in mild prominence of mediastinal lymph nodes. |
Generate impression based on findings. | Female; 73 years old. Reason: Patient with pancreatic NET on sunitinib. Disease surveillance. History: ascites Lack of intravenous contrast limits sensitivity for solid organ pathology.CHEST:LUNGS AND PLEURA: Scattered subcentimeter pulmonary nodules are unchanged. No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Reference right cardiophrenic lymph node measures 3.2 x 2.4 cm (series 4/67), previously 3.2 x 2.4 cm.CHEST WALL: Scattered sclerotic foci within the thoracic spine unchanged.ABDOMEN:LIVER, BILIARY TRACT: Large liver lesion straddling the left and right hepatic lobes measures 8.6 x 7.2 cm, previously 8.6 x 7.2 cm (series 4/81). Other hepatic hypodensities are unchanged. SPLEEN: No significant abnormality noted.PANCREAS: Stable nonspecific pancreatic hypodensities. No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Peripancreatic bilobed mass measures 3.9 x 3.1 cm, previously 3.9 x 3.1 cm (series 4/86).Reference left para-aortic lymph node measures 2.3 x 1.6 cm, previously 2.3 x 1.6 cm (series 4/17). BOWEL, MESENTERY: Small bowel is normal in caliber. The extensive peritoneal and omental carcinomatosis there is extensive upper abdominal and pelvic ascites the volume of which is nearly stable.Right lower abdominal ostomy with enhancement of the wall and thickening suspicious for disease.Large omental mass is not significantly changed accounting for differences in positioning and measures up to 11.2 x 4.7 cm (axial series 4/123 and coronal series 8038/73), previously 11.8 x 4.7 cm.BONES, SOFT TISSUES: Diffuse body wall anasarca.Scattered sclerotic foci in the lumbar spine.OTHER: Moderate abdominal ascites, similar to prior.PELVIS:UTERUS, ADNEXA: Increased soft tissue at the apex of the vagina in the pelvis is similar to prior study.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered pelvic sclerotic foci.OTHER: Moderate pelvic ascites, similar to prior. | No significant interval change in index lesions. No new sites of disease. |
Generate impression based on findings. | Male 19 months old Reason: Follow-up scan History: Left UPJ S/P pyeloplasty; hydronephrosis The posterior abdominal radionuclide angiogram demonstrates prompt, symmetrical perfusion of the kidneys. Sequential renal images show the kidneys to be of normal size and morphology. There is prompt uptake and excretion of the radiopharmaceutical by both kidneys. The estimated contribution of the right kidney to total renal function is 50.3% and that of the left kidney is 49.7%. There are no abnormalities of the ureters or bladder.Following administration of the diuretic, there was prompt washout of collecting system radiotracer into the bladder without evidence of current obstruction. The T1/2 washout from the previously dilated left collecting system was 3.75 minutes. Previous findings suspicious for left sided obstruction no longer evident. | Normal symmetric renal parenchymal function. No evidence of current collecting system obstruction. Previous suspected left sided obstruction has resolved. |
Generate impression based on findings. | RIGHT TEMPORAL BONE: The inner ear structures are unremarkable. The external auditory canal is patent, however, there is cerumen. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course.LEFT TEMPORAL BONE: The inner ear structures are unremarkable. The external auditory canal is patent, however, there is cerumen. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The facial nerve describes a normal course.MISCELLANEOUS: There is minimal paranasal sinus mucosal thickening. | 1.No evidence of bony inner ear abnormalities. 2.Cerumen within the bilateral external auditory canals. |
Generate impression based on findings. | Proximal humerus fracture. Evaluate healing.VIEWS: Left shoulder AP/Grashey/Y (3 views) 03/20/15 Fracture of the proximal humeral diaphysis is again seen. Lateral angulation of the distal fracture fragment is seen. Callus formation has developed in the interval and surrounds the fracture. The humeral head is well directed in to the glenoid fossa. | Healing proximal humeral fracture. |
Generate impression based on findings. | 93 year old female status post left lumpectomy in 2013 for invasive mammary carcinoma with mixed ductal and lobular features, presents today for routine follow up. Patient received radiation therapy and hormonal therapy. No current breast complaints. Family history of breast carcinoma in her sister, daughter, and a maternal aunt. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Expected postsurgical changes are present in the left breast, including architectural distortion and surgical clips, unchanged. Diffuse skin thickening is noted of the left breast. A biopsy marking clip is present within the central outer right breast. Scattered benign calcifications are present. No dominant mass, suspicious microcalcifications or areas of nonsurgical architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 63 year old female status post heart transplant experiencing aphasia. The ventricles and sulci are unchanged in size or shape without evidence of hydrocephalus. There are no masses, mass effect or midline shift. Gray/white interfaces are maintained. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are unremarkable. | No CT evidence of acute intracranial process. If there is continued clinical concern for acute ischemia, MRI would be recommended. |
Generate impression based on findings. | Reason: lung cancer sp chemo radiation, has CKI no contrast History: cough CHEST:LUNGS AND PLEURA: Index right paramediastinal mass is not clearly visualized to lack of IV contrast. Within these limitations, the approximate measurements are 3.1 x 2.6 cm, previously 3.5 x 3.0 cm (series 4, image 21). Right upper lobe interstitial septal thickening and paramediastinal fibrosis and atelectasis with traction bronchiectasis is likely due to radiation changes. Interval resolution of right pleural effusion. No pneumothorax. Debris is again noted within the trachea compatible with either secretions or aspirated material.Mild left apical paraseptal emphysema is again noted. Scattered calcified and noncalcified nodules are unchanged.Interval resolution of nonspecific basilar predominant groundglass opacities.MEDIASTINUM AND HILA: Multiple prominent mediastinal lymph nodes are again noted. Reference right paratracheal lymph node now measures 7 mm, previously 10 mm (series 4, image 24). The heart size is normal. No pericardial effusion. Mild coronary artery calcification.The aorta is enlarged measuring 4.3 cm.CHEST WALL: No axillary, cardiophrenic, or retrocrural lymphadenopathy. No suspicious osseous lesions.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: Atrophic left kidney with large staghorn calculus is again noted. Multiple hypodense renal lesions are not significantly changed provided differences in technique.PANCREAS: Hypodense pancreatic lesion is slightly larger in size, 6 mm, previously 4 mm (series 4, image 125) when compared to the prior exam now with more convex borders as opposed to having a linear appearance.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the aorta. Mild ectasia of the infrarenal abdominal aorta. Mild aneurysmal dilatation of the partially visualized right common iliac artery.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: The osseous structures are within normal limits. No suspicious osseous lesions.OTHER: No significant abnormality noted. | Interval decrease in size of right paramediastinal mass provided differences in technique. No significant change in surrounding radiation change. Interval resolution of bilateral pleural effusions. Small interval increase in size of hypodense pancreatic lesion presumed to be an IPMN. |
Generate impression based on findings. | Sacral decubitus ulcer. History of chronic osteomyelitis. Evaluate for evolution of osteomyelitis. There is redemonstration of destruction/absence and sclerosis of the left superior and inferior pubic rami along with the left ischium, appearing similar to the prior examination. Overlying soft tissue inflammatory change with areas of heterotopic bone are still identified. Additionally, a soft tissue defect extending to the bone overlying this region appears more delineated likely representing interval debridement. A discrete fluid collection posterior to the right sacroiliac joint is no longer identified. However, there is still inflammatory change within this region. Cortical destruction of the lateral aspect of the right sacrum appears similar to the prior examination.A right femoral intramedullary rod with interlocking screw is identified without evidence of hardware complication. The left femur is surgically absent. There is diffuse atrophy of the right thigh musculature.Foci of gas are again noted in or adjacent to the urethra which remains concerning for an underlying fistula with the ischial decubitus ulcer.Patient is status post cystoprostatectomy with ileal conduit formation. There is a right lower quadrant ostomy. Small amount of fluid is noted within the pelvis. Surgical clips are noted within the retroperitoneum. The left psoas muscle is absent along with atrophy of the left paraspinal musculature. | 1. Left ischial decubitus ulcer with sclerosis of the remaining left pubic rami and ischium appearing similar to the prior study. 2. Stable right sacral cortical destruction with overlying soft tissue inflammatory change without discrete fluid collection.3. Foci of gas in or adjacent to the urethra is concerning for a fistula as seen on the prior examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Partially obscured masses in the right upper breast.No suspicious microcalcifications or areas of architectural distortion are present. | Partially obscured masses in the right breast, for which additional views including spot compression views and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Left forearm osteotomyVIEWS: Left forearm AP/lateral (two views) 03/20/15 Compression plate and screws device along the radial diaphysis is intact. Ulnar fracture and radial osteotomy have healed. Alignment is anatomic. | Anatomic alignment of the forearm. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Stable bilateral benign intramammary lymph nodes.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female; 68 years old. Reason: Evaluate for disease recurrence s/p distal pancreatectomy, splenectomy, and cholecystectomy for pancreatic islet cell tumor History: follow-up ABDOMEN:LUNG BASES: No significant abnormality.LIVER, BILIARY TRACT: No focal hepatic lesions. Minimal intrahepatic biliary ductal prominence is stable. Status-post cholecystectomy. Main portal vein and branches are patent.SPLEEN: Status post splenectomy. PANCREAS: Stable postsurgical changes of distal pancreatectomy. Residual pancreatic head and uncinate process enhance homogeneously. No evidence of local recurrence. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Deformity of the lower pole of the right kidney compatible with scarring, unchanged.RETROPERITONEUM, LYMPH NODES: No enlarged abdominal or retroperitoneal lymph nodes. Stable prominent periportal and peripancreatic lymph nodes. Moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small intraperitoneal soft tissue attenuation nodules (series 2; images: 128, 149, and 190) have each decreased in size and may be due to postoperative changes or fat necrosis. PELVIS:UTERUS, ADNEXA: Coarse uterine calcifications and mild uterine enlargement compatible with uterine fibroids.BLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathyBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small intraperitoneal soft tissue attenuation nodules (series 2; images: 128, 149, and 190) have each decreased in size and may be due to postoperative changes or fat necrosis. | 1.Postsurgical changes of distal pancreatectomy/splenectomy. Residual pancreas enhances homogenously. 2.Stable borderline enlarged peripancreatic and periportal lymph nodes. 3.Three intraperitoneal soft-tissue attenuation nodules have decreased in size and may represent post-surgical changes/fat necrosis but continued attention at follow-up is recommended. |
Generate impression based on findings. | Thyromegaly and calcified structure external to thyroid gland. The thyroid gland is not particularly enlarged, but there is a subcentimeter nodules in the left lobe. There is no evidence of abnormal calcifications in the neck. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | The thyroid gland is not particularly enlarged and there is no evidence of abnormal calcifications in the neck. |
Generate impression based on findings. | Distal radius fracture, need to evaluate multiple fragments. Pain. There is a comminuted, slightly impacted fracture of the distal radial metaphysis. There is slight volar angulation of the distal fracture fragment. The articular surface is intact with normal positioning of the radiocarpal joint and distal radioulnar joint. The ulna and carpal bones appear normal. | Slightly impacted, comminuted fracture of the distal radial metaphysis without intraarticular extension. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional left MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Circular skin markers were placed over both breasts. Benign calcifications in both breasts, including arterial calcifications are unchanged.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, additional left MLO view, and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Circular skin marker was placed over the right breast. Scattered benign calcifications 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, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 72-year-old male with esophageal cancer status post chemoradiation CHEST:LUNGS AND PLEURA: Apical scarring/atelectasis is not significantly changed.No pleural effusion or pneumothorax. No focal consolidation. Multiple scattered nonspecific calcified and noncalcified micronodules. No new nodules.MEDIASTINUM AND HILA: Mild cardiomegaly. No pericardial effusion. Mild coronary artery calcifications are detected. The trachea and mainstem bronchi are patent. Anterior mediastinal soft tissue density lesion measures 2.2 x 1.2 cm (series 4, image 43) previously 2.5 x 1.4 cm. Circumferential thickening of the distal esophagus leading up to the GE junction is not significantly changed since prior exam. The upper esophagus is patulous.Several prominent, nonspecific, subcentimeter mediastinal lymph nodes are not significantly changed since the prior exam. Prominent right hilar lymph node is not significantly changed.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. No suspicious osseous lesions. Healing right eighth rib fracture.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unchanged cholelithiasis without CT evidence of cholecystitis. Unchanged hypodense subcentimeter liver lesions are too small to further characterize.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy with no soft tissue density to suggest local recurrence. Multiple subcentimeter hypodense lesions in the left kidney are small characterize. No hydronephrosis.PANCREAS: Punctate calcifications in the pancreas are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Residual barium within large bowel diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Circumferential thickening of the distal esophagus reflecting patient's known malignancy is unchanged the prior exam. Slight interval decrease in size of anterior mediastinal soft tissue mass. No significant interval change in size of scattered mediastinal and hilar lymph nodes. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy approximately 40 years ago. Family history of breast cancer diagnosed in sister in her 60s. Two standard digital views of both breasts were performed for a total of 8 images and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Circular skin markers are placed over both breasts. Stable benign calcified 6 o'clock hyalinizing fibroadenoma. Bilateral benign calcifications are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left breast biopsy in 1973. Two standard digital views and cleavage view of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Bilateral benign calcifications are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 82 year old female status post right lumpectomy in 2012 for DCIS, presents today for routine follow up. Patient received chemotherapy. No current breast complaints. No family history breast carcinoma. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker is in place on the scar overlying the lower central right breast, with expected underlying postsurgical changes including architectural distortion and surgical clips. Scattered benign calcifications are present. Stable bilateral asymmetries are present. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 78-year-old male with intraventricular hemorrhage and possible ischemia Redemonstrated is a hemorrhage within the right midbrain which is unchanged. Associated intraventricular blood has redistributed. Ventricular sizes are unchanged. There is no interval hemorrhage.As before, there is embolic material present in the right ambient and quadrigeminal plate cisterns.A ventriculostomy enters the right frontal lobe and courses into the right lateral ventricle with tip in the region of foramen of Monro, unchanged in position.There is redemonstration of a hypodense focus in the right basal ganglia and right cerebellar hemisphere. Periventricular and subcortical white matter hypodensities of a moderate degree are again present.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses demonstrate a mucous retention cysts along the maxillary sinuses. The patient is intubated. There is partial opacification of the nasal cavity. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Stable right midbrain hematoma. Intraventricular hemorrhage has redistributed. There is no interval new hemorrhage.2.The ventricles are stable in size. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered bilateral benign calcifications are stable. Stable subcentimeter circumscribed ovoid mass in the left inner upper breast.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Puncture wound. Question of foreign body. Pulse oximeter over the right second digit along with IV tubing obscures evaluation of the underlying soft tissues.No acute fracture is evident. No radiopaque foreign object is identified. Vascular calcifications are noted. | No radiopaque foreign object is identified. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. Benign calcifications in the left medial breast have slightly progressed in a benign fashion.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Reason: eval for vessel stenosis History: L weakness, dysarthria Neck CTA: 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.A small emphysematous bleb is present the right lung apexBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No intracranial stenosis is appreciated.There is extracranial origin of the left posterior inferior cerebellar artery.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The anterior communicating artery is medium size. The left A1 segment is small. The posterior communicating arteries are very small. There is a 2-mm dilation at the expected origin of the right posterior communicating artery.The left vertebral artery is larger than the right vertebral artery.CT head: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. | 1.Findings a raise a question of a small aneurysm versus infundibulum at the origin of the right posterior communicating artery.2.No evidence for cervicocerebral occlusive disease. |
Generate impression based on findings. | Mild diffuse cerebral volume loss without a lobar specific pattern. Hypoattenuation of the periventricular and subcortical white matter compatible with age indeterminant small vessel ischemic disease. No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or hydrocephalus. No extra-axial fluid collections. The imaged paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. | 1.No evidence for acute intracranial abnormality. Please note CT is not sensitive for detection of acute nonhemorrhagic ischemia and MRI can be considered for further evaluation, if clinically indicated.2.Mild diffuse cerebral volume loss. |
Generate impression based on findings. | Male; 75 years old. Reason: choledocholithiasis s/p ERCP with dilation of ampulla and cystic duct. now with rigidity on abdominal exam History: see above ABDOMEN:LUNG BASES: New small pleural effusions with underlying bibasilar dependent subsegmental atelectasis. Cardiomegaly.LIVER, BILIARY TRACT: New moderate amount of inflammatory changes in the porta hepatis with new gallbladder wall thickening and pericholecystic fatty stranding and fluid, most compatible with acute cholecystitis. There is also moderate wall thickening of the descending duodenum, but there is no no free air or contrast leak. Free fluid extends down the left paracolic gutter into the pelvis with new moderate pelvic ascites.SPLEEN: No significant abnormality noted.PANCREAS: Subcentimeter cystic lesions in the pancreas are unchanged. No pancreatic ductal dilation.ADRENAL GLANDS: Small left adrenal adenoma, unchanged.KIDNEYS, URETERS: Stable renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Stable prostatomegaly with heterogeneous appearance.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate pelvic ascites. | Findings most compatible with acute cholecystitis with new moderate inflammatory changes in the porta hepatis. Adjacent duodenal wall thickening is also seen, but there is no free air or contrast leak.Findings discussed with the medicine resident caring for the patient (pager 2702) at 11 a.m. on 3/20/15. |
Generate impression based on findings. | Status post distal radius fracture. Status post reduction and casting. Cast material obscures evaluation of fine bone detail. Interval reduction of a distal radius fracture which appears in gross anatomic alignment. | Interval casting and reduction of a distal radius fracture. |
Generate impression based on findings. | 68-year-old male with history of NSCLC status post therapy CHEST:LUNGS AND PLEURA: Left paramediastinal and perihilar radiation reaction is not significantly changed since the prior exam.Mild subpleural reticulonodular opacities in the lingula and anterior left lower lobe compatible with bronchiolitis and scarring, unchanged since the prior exam.Calcified micronodule the right lower lobe is unchanged. No new focal consolidation, nodule or mass. Scattered nonspecific micronodules are unchanged.MEDIASTINUM AND HILA: No significant lymphadenopathy.Heart size is normal. No significant pericardial effusion.Severe coronary artery calcification.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. Moderate degenerative disease affects the thoracic spine. No suspicious osseous lesions. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cysts and small nonspecific hypodensities, unchanged from the prior exam.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Perinephric soft tissue density compatible with a postoperative changes/necrosis unchanged in appearance from the prior exam. No hydronephrosis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Scattered unchanged mesenteric lymph nodes not significantly enlarged by CT size criteria.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No specific evidence of metastatic disease, status post lung cancer treatment. |
Generate impression based on findings. | 60 year-old female preop bone length study. Views of the right leg demonstrate severe osteoarthritis of the right knee with bone on bone apposition and subchondral sclerosis as well as osteophytosis; mild osteoarthritis affects the right hip. Mechanical axis radiographs reveal approximately 7 degrees of varus alignment of the knee with respect to the neutral mechanical axis. | Osteoarthritis and varus deformity as detailed above. |
Generate impression based on findings. | 72-year-old female with a strong family history of breast and ovarian cancer. 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 focal asymmetry is again seen at posterior lower inner quadrant in the right breast.No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: eval for vessel stenosis History: L weakness, dysarthria Neck CTA: 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.A small emphysematous bleb is present the right lung apexBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No intracranial stenosis is appreciated.There is extracranial origin of the left posterior inferior cerebellar artery.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The anterior communicating artery is medium size. The left A1 segment is small. The posterior communicating arteries are very small. There is a 2-mm dilation at the expected origin of the right posterior communicating artery.The left vertebral artery is larger than the right vertebral artery.CT head: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. | 1.Findings a raise a question of a small aneurysm versus infundibulum at the origin of the right posterior communicating artery.2.No evidence for cervicocerebral occlusive disease. |
Generate impression based on findings. | Reason: 63 year old female with bilateral episcleral vessel dilation, left-sided hemi-retinal vein occlusion, significantly elevated left eye pressure; with clinical concern for C-C or low-flow dural fistula History: 63 year old female with bilateral episcleral vessel dilation, left-sided hemi-retinal vein occlusion, significantly elevated left eye pressure; with clinical concern for C-C or low-f Right common carotid artery: There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no angiographic evidence for vasculitis. There is opacification of the cavernous sinus.Right external carotid artery: There is no evidence for arteriovenous fistula. The right ophthalmic artery originates from the middle meningeal artery. There is opacification of the left superior ophthalmic vein which then drains into the cavernous sinus and opacifies in. Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissectionLeft internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no evidence for aneurysm, AVM or AV fistula. There is opacification of the left cavernous sinus. There is opacification of the left superior ophthalmic vein which slowly drains into the left cavernous sinus.Left external carotid artery: There is no evidence for arteriovenous fistula. There is no evidence for AVM. There is no angiographic evidence for vasculitis.Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. The vertebral arteries are similar in size . There is a reverse filling of the posterior communicating arteries which are small. There is no angiographic evidence for vasculitis. There is extracranial origin of the left posterior inferior cerebellar artery which is a fairly dominant vessel the left vertebral artery is the nondominant vertebral artery.Right subclavian artery: The right subclavian artery has an aberrant origin from the distal aortic arch.Right vertebral artery: There is a reverse filling of the posterior communicating arteries which are small. There is no angiographic evidence for vasculitis.Right common iliac artery: There is no contraindications for the deployment of a closure device. | 1.No evidence for a cavernous carotid fistula. Both the superior opthalmic veins to drain towards the cavernous sinus.2.Findings were discussed with Dr Ksiazek at the time of this dictation. |
Generate impression based on findings. | 54 years, Female. Reason: Toxic Megacolon? History: Diarrhea, sepsis Distended transverse colon measuring up to 11 cm in maximal diameter, which could reflect toxic megacolon in the appropriate clinical setting. | Distended transverse colon measuring up to 11 cm in maximal diameter, which could reflect toxic megacolon in the appropriate clinical setting. |
Generate impression based on findings. | 58-year-old female with right breast cyst presents for aspiration. The lesion to be aspirated is a circumscribed, anechoic cyst at the 3 o'clock position of the right breast, 2 cm from the nipple.The procedure, risks including bleeding, infection, mistargeting, and benefits of ultrasound guided cyst aspiration were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing.The right breast was cleansed with chlorhexidine. Local anesthesia was obtained superficially using one-percent lidocaine. Using a 19-gauge needle, continuous ultrasound guidance, and aseptic technique, a needle was placed into the target and internal fluid was aspirated. No appreciable fluid was aspirated, as the cyst dissipated upon the needle rupturing the cyst wall. Post procedure ultrasound demonstrates resolution of the cyst. The skin entry site was closed with a band-aid.Postprocedure digital right CC and ML views shows near complete resolution of the mass in the right breast at the 3 o'clock position.Post aspiration instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well and the left the Radiology Department in stable condition.The procedure was performed by Dr. Happ. Dr. Schacht was present during the procedure at all times. | Successful fine needle aspiration of a cyst in the right breast, with complete resolution on mammogram and ultrasound. No cytology sample was sent, as no appreciable fluid was aspirated as a result of the cyst dissipating upon contact of the needle with the cyst wall. As long as the patient's physical examination is unchanged, annual screening mammogram is recommended. Results and recommendations were discussed with the patient on completion of today's imaging. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram. |
Generate impression based on findings. | 52 years, Male. Reason: assess OGT placement History: s/p OGT There is a nasogastric tube with its tip projecting over the body of the stomach. There is a nonobstructive bowel gas pattern. Pleural drain projects over the left upper quadrant. Bibasilar atelectasis and pleural effusion. | Nasogastric tube with its tip projecting over the body of the stomach. |
Generate impression based on findings. | Male; 93 years old. Reason: prostate cancer with rising PSA. reeval History: prostate cancer ABDOMEN:LUNG BASES: Minimal bibasilar subsegmental atelectasis and/or scarring. No suspicious pulmonary nodules or masses in the visualized lung bases.LIVER, BILIARY TRACT: No suspicious hepatic lesions. Stable punctate calcification along the right posterior segment, likely due to prior granulomatous process. Gallbladder appears unremarkable. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable low attenuation exophytic lesion arising from the midportion of left kidney, most likely representing a cyst. Left kidney appears smaller than the right kidney, unchanged. No hydronephrosis or hydroureter. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple diverticuli in the colon without evidence of diverticulitis.PELVIS:REPRODUCTIVE TRACT: Decreased size of the prostate gland since prior study with brachytherapy seeds noted.BLADDER: No significant abnormality.LYMPH NODES: No pelvic lymphadenopathy. Previously referenced left peri prostatic lymph node is no longer discretely visualized.BOWEL, MESENTERY: Multiple diverticuli in the colon without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes in the lumbosacral spine.OTHER: No significant abnormality noted | No evidence of a residual or recurrent disease. No evidence of metastatic disease. Please follow-up final report for bone scan, which will be more sensitive for bony metastases. |
Generate impression based on findings. | Left ankle fracture status post ORIF. Evaluate fracture. Three views of the left ankle with weight-bearing show a side plate and screw device affixing a distal fibular fracture with two syndesmotic screws and two orthopedic screws affixing the medial malleolus. The fracture lines appear less distinct suggestive of healing. There is increased periosteal reaction along the distal fibula. Alignment is anatomic. No ankle joint effusion is identified. The ankle mortise is intact. | Orthopedic fixation of distal fibula and tibia fractures. |
Generate impression based on findings. | Male 49 years old Reason: determine recurrence HL extent and staging History: Monitor lymphoma stagingRADIOPHARMACEUTICAL: 15.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 104 mg/dL. Today's CT portion grossly demonstrates left chest port with tip in the SVC. Bilateral groundglass opacities most likely inflammatory in etiology. Small right pleural effusion. Extensive mediastinal calcified lymph nodes. Dilated left collecting system and left ureter, new since prior exam.Today's PET examination demonstrates complete resolution of lymph node activity in the right inferior posterior triangle. There is also near complete resolution of muscle and lymph node activity in the left pelvis, with single subcentimeter left obturator lymph node with mild to moderate residual activity with SUV max of 3.3. This may represent inflammation or slight residual tumor activity. Left posterior upper lung parenchyma demonstrates increased activity correlating with inflammatory appearance on CT. Interval increase in activity in the left renal parenchyma, with corresponding dilatation of the left collecting system and left ureter. No new FDG avid lesion seen. | 1.Significant metabolic response to therapy with near complete to complete resolution of previous tumor activity. Single decreased but residual subcentimeter left obturator lymph node activity may represent inflammation or possibly small residual tumor activity. No new FDG avid lesion.2.New left renal parenchymal dysfunction with CT findings concerning for obstruction as the etiology. Alternative etiologies include external beam radiation effect. Renal Lasix scintigraphy may be useful for further evaluation if clinically desired. |
Generate impression based on findings. | 37-year-old male with left knee pain. Four views of the left knee demonstrate suture anchors projecting over the lateral femoral condyle. Mild osteoarthritis affects the knees, left greater than right, including mild joint space narrowing of the medial compartment, sharpening of the tibial spines, and osteophytosis. There is no evidence of joint effusion or acute fracture. Alignment is anatomic. | No evidence of acute fracture or malalignment. Mild bilateral osteoarthritis. |
Generate impression based on findings. | Male, 2 months old. Elbow injury. Evaluate for fracture.VIEWS: Left elbow, AP and lateral (two views) 3/20/2015, 1055 A posterior fat pad is present from a joint effusion.Callus formation encircles the distal humerus, more prominent on the ulnar aspect, compatible with a fracture as previously questioned. | Healing corner fracture of the distal humerus. |
Generate impression based on findings. | Left hip pain. AP view of the pelvis and single view of the left hip show sclerosis of the superior acetabulum of the bilateral hips. There is no flattening of the femoral heads. No acute fracture is evident. | Early mild osteoarthritis of the bilateral hips. |
Generate impression based on findings. | Status post ROH. Evaluate clavicle fracture. Two views of the right clavicle show interval removal of an intramedullary rod affixing a mid-clavicular fracture. The fracture line is less distinct with increased callus formation compatible with healing. Alignment is grossly anatomic. | Healing right clavicle fracture. |
Generate impression based on findings. | Pain, cracking. Three views of the left ankle show no acute fracture or malalignment. The ankle mortise is intact. No ankle joint effusion or soft tissue swelling is seen. There is pes planus deformity.Three views of the right ankle show no acute fracture or malalignment. The ankle mortise is intact. No ankle joint effusion or soft tissue swelling is identified. There is pes planus deformity. | Bilateral pes planus deformity. |
Generate impression based on findings. | 1-year-old male with history of thin liquid aspirationEXAMINATION: Oropharyngeal motility study 3/20/15 Dana Sussman, speech and language therapist, supervised the examination.92 seconds of fluoroscopy was used.Oral deficits were present including positive premature spillage into the hypopharynx and increased oral transit time. Penetration was present with thin liquids and half strength nectar without cough. Trace aspiration was present with thin liquids without cough. | Trace aspiration of thin liquids without cough.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | 82-year-old male status post right hip hemiarthroplasty. Two views of the right hip demonstrate hardware components of a right hip hemiarthroplasty, in near-anatomic alignment. There is no evidence of hardware complication. Ossific densities superolateral to the greater trochanter and inferolateral to the acetabulum likely reflect heterotopic mineralization, new from prior exam. The acetabulum appears intact. | Status post right hip hemiarthroplasty as above. |
Generate impression based on findings. | Shoulder pain. Four views of the right shoulder show a reverse ball-and-socket right total shoulder arthroplasty in anatomic alignment without evidence of hardware complication. No acute fracture is evident. A small amount of heterotopic bone is noted along the lateral aspect of the joint.A vascular stent is noted. | Reverse total shoulder arthroplasty. |
Generate impression based on findings. | Knee pain. Left hip pain. Four views of the left knee show no acute fracture or malalignment. There are tiny patellar osteophytes indicating minimal osteoarthritis, unchanged. No large joint effusion is identified.AP view of the pelvis and two views of the left hip show small osteophyte formation of the bilateral hips, similar to the prior study. No acute fracture is evident. | Minor degenerative changes as above. |
Generate impression based on findings. | Right hip pain and limited range of motion. Evaluate position of prosthesis and evaluate for infection. Two views of the right hip show a right hip bipolar hemiarthroplasty device situated in anatomic alignment without evidence of hardware complication. No acute fracture is evident. Minimal lucency about the acetabular component of the prosthesis is similar to the post-operative radiograph. There is minimal heterotopic bone formation adjacent to the greater trochanter. | Right hip bipolar hemiarthroplasty device without evidence of complication. Minimal lucency surrounding the acetabular component of the prosthesis is unchanged from the immediate postop radiograph, however, continued normal surveillance is recommended. |
Generate impression based on findings. | 24-year-old male with diffuse large B-cell lymphoma status post chemotherapy. Recent PET last month question residual disease in left pelvis. Restaging exam.RADIOPHARMACEUTICAL: 15.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates the previous suspicious lymph node in the left pelvis internal iliac chain just superior to the sacroiliac joint has increased significantly in size and metabolic activity from previous (SUV max = 10.4 previously, = 16.0 currently), consistent with tumor progression.A new markedly hypermetabolic enlarged left external iliac lymph node (SUV max = 15.6), indicates additional tumor progression.Previous questioned right pelvic bowel based activity has resolved and may have been inflammatory.In the anterior/superior mediastinum there is vague but new mild to moderately hypermetabolic curvilinear activity along the periphery of rounded vaguely enhancing soft tissue density lesions (SUV max = 3.4). This is suspicious for additional tumor progression but could also represent inflammation post prior therapy of tumor in this location.No additional suspicious FDG avid lesion is identified. | 1.Progression of hypermetabolic tumor in the left pelvis and possibly also in the superior mediastinum.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | With thyroid thyroid cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence for recurrent disease. No change. |
Generate impression based on findings. | 53-year-old male with pain and swelling of the right elbow. Two views of the right elbow demonstrate mild osteoarthritis affecting the elbow joint. There is no significant joint effusion, acute fracture or malalignment within this limited study. | There is no acute fracture or malalignment. |
Generate impression based on findings. | Male, 2 months old. Reason: Interval Skeletal Survey History: Interval changes to fracturesEXAMINATION: Thoracolumbar spine AP, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (19 views) 3/20/2015, 0851 Healing fractures are again seen in the posterior left 10th and 11th ribs.The previously visualized healing fractures along the posterior left ninth and right ninth and 10th ribs are less conspicuous on this exam.Casting material obscures fine osseous detail and left arm, forearm, and hand. Left distal humerus fracture better evaluated on same day dedicated elbow radiograph.Periosteal reaction along the left tibia is similar to the prior exam.No other acute or healing fractures noted.The cardiothymic silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.Nonobstructive bowel gas pattern. | Healing fractures of the posterior ribs as detailed above. A left distal humerus fracture has significant new callus formation, compatible with acute presentation on 3/4/2015. Periosteal reaction along the left tibia is similar to the prior exam. |
Generate impression based on findings. | Three-month status post posterior spinal fixation. Evaluate implant position. Three views lumbar spine show screws in the pedicles of L4 and L5 with posterior stabilization rods and interposed disk spacer material. No acute fracture is evident. Alignment is anatomic. No definite bony fusion is observed. | Lower lumbar posterior spinal fixation as above. |
Generate impression based on findings. | Chronic and decreased range of motion of the bilateral shoulders. Pain, popping sensation at the left shoulder with lifting a box. Three views of the right shoulder show no acute fracture or malalignment. Mild osteoarthritis affects the acromioclavicular glenohumeral joints.Three views of the left shoulder show no acute fracture or malalignment. There is mild osteoarthritis of the glenohumeral joint and subchondral degenerative changes of the humeral head. Mild osteoarthritis affects the acromioclavicular joint. | Mild osteoarthritis as above. |
Generate impression based on findings. | Male 69 years old Reason: History laryngeal cancer sp laryngectomy with peristomal recurrence, concern for metastasesRADIOPHARMACEUTICAL: 15.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 70 mg/dL. Today's CT portion grossly demonstrates extensive postoperative changes in the neck. Scattered solid and ground glass opacities bilaterally, most consistent with an inflammatory process. Gastrojejunostomy catheter is noted in place. Atherosclerotic calcification of the abdominal aorta.Today's PET examination demonstrates large, markedly hypermetabolic soft tissue mass surrounding the surgical bed in the neck with SUV max of 17.3 consistent with tumor recurrence. There are several small moderately hypermetabolic lymph nodes in the bilateral axilla and right lower paratracheal area with SUV max of 3.7. Given their small size this most likely represents inflammatory process, however a superimposed metastasis cannot be excluded. There are multiple scattered bilateral pulmonary parenchymal foci of increased activity with SUV max 6.3 corresponding to ground glass inflammatory opacities on CT. Although metastasis cannot entirely excluded. No suspicious lesion is seen in the abdomen or pelvis. | 1.Large hypermetabolic anterior midline neck mass consistent with peristomal recurrence. No additional suspicious lesions in the neck.2.Scattered, multifocal hypermetabolic lung activity corresponding to ground glass opacities, as well as bilateral axillary hypermetabolic nodes. Most appear inflammatory, however superimposed metastasis cannot be entirely excluded. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are ultrasound images (3/13/15) performed at Northshore University Healthcare System Per outside radiology report, the patient with history of bilateral mastectomies had a palpable lump in the left medial chest wall. There are two mixed hypo/iso-echoic masses, measuring 7 mm and 12 mm, respectively. Mild blood flow is detected in one of the masses. | Two mixed hypo/iso-echoic masses in the left medial chest wall. Fat necrosis is likely diagnosis, but malignancy cannot be ruled out. Needle biopsy for both masses is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | T1N1 oral tongue squamous cell carcinoma initially treated in 2008 followed by recurrence with lung metastases and left chest wall mass in May 2014, treated with chemotherapy. Neck: There are stable post-treatment findings, including absence of the right submandibular gland. There is no evidence of mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and remaining salivary glands are unremarkable. The major cervical vessels are patent. There is unchanged mild spondyloarthropathy with mild retrolisthesis of C5 upon C6. The osseous structures are otherwise unremarkable. The airways are patent. There are partially imaged left posterior pleural-based lesions, a cavitary left lung lesion, and a spiculated right lung mass that measures up to 15 mm.Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The imaged mastoid air cells are clear. There is a lytic lesion in the right frontal calvarium that measures up to 20 mm. There is a right lens implant. There may be a small amount of fluid in the left maxillary sinus. | 1.No evidence of locoregional tumor recurrence or significant lymphadenopathy in the neck.2.No evidence of intracranial metastases.3. A lytic lesion in the right frontal calvarium may represent a metastasis. 4. Multiple lesions in the partially imaged lungs. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Female 57 years old; Reason: follow up for RCC History: hx of RCC CHEST:LUNGS AND PLEURA: Visualized lung fields unchanged in appearance, including 2 mm right apical micronodules. No suspicious lung nodule. No pleural effusion. Scattered pleural blebs/bullae. MEDIASTINUM AND HILA: Evaluation of thyroid gland demonstrates stable right lobe heterogeneity with either dominant 1.9 x 1.7 cm heterogeneous nodule versus smaller micronodules. Trace pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post left nephrectomy. Stable nodularity in superior aspect of left nephrectomy bed in left paraaortic area, may be due in part to left diaphragmatic crus and postsurgical sequela. Stable oblong hyperattenuating focus just inferior to this level, image 98 series 3, may be postsurgical in etiology and of uncertain clinical significance, unchanged. No new enhancing soft tissue nodularity seen in postoperative bed to suggest tumor recurrence or metastatic disease. Markedly atrophic native right kidney, unchanged subcentimeter focus extending from lateral aspect of lower pole, image 108 series 3. Right iliac fossa transplanted kidney. Stable mild fullness of intrarenal collecting system. Unchanged lobular contour with areas of cortical scarring. Subcentimeter hypoattenuating renal focus, too small to characterize.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Moderate to large stool burden, no bowel obstruction.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: At level of previously seen rim enhancing fluid collection in left ventral abdominal wall is small linear attenuation/scarring. Multilevel spinal degenerative disease with sequela or of prior spinal surgery. Unchanged L4 on L5 anterolisthesis. | 1. Stable nonspecific nodularity in superior aspect of left nephrectomy bed (likely primarily reflecting left crus of diaphragm), as described.2. Unchanged right thyroid nodularity, may be further assessed with dedicated sonography if clinically desired.3. Interval resolution of ventral abdominal wall fluid collection with residual scarring seen. |
Generate impression based on findings. | Headache. 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 appears to be a small amount of fluid in the left maxillary sinus. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage, mass, or ventriulomegaly.2. Suggestion of acute sinusitis. |
Generate impression based on findings. | Female, 8 years old. Reason: adenoid hypertrophy History: mouth breathingVIEWS: Neck soft tissue, lateral (one view) 3/20/20 pain, 1111 Mild to moderate enlargement of the adenoids, without obstruction of the posterior nasopharynx.The palatine tonsils are markedly enlarged, extending to the level of the epiglottis.The visualized osseous structures and joint spaces are normal. | Mild to moderate adenoid hypertrophy and marked hypertrophy of the palatine tonsils. |
Generate impression based on findings. | Female 73 years old Reason: r/o aspiration and stricture. Hx: esophageal webbing and irritation History: vomiting, feels like food is getting stuck Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Right neck catheter terminates at the cavoatrial junction.Single contrast evaluation of the esophagus shows no obstructing lesion. The imaged portions of the mucosa are normal. No reflux was elicited.Patient had no difficulty swallowing.Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave.TOTAL FLUOROSCOPY TIME: 1:44 minutes | Unremarkable single contrast esophagram. |
Generate impression based on findings. | Female 64 years old; Reason: Had CT concern for SBO. Now having some flatus, observe for improvement in SBO/ileus History: As above Enteric tube terminates in the left upper abdomen in the region of the gastric body. There multiple dilated loops of small bowel with air-fluid levels compatible with a developing obstruction. There is some gas within the rectum. Multiple surgical staples are noted in the pelvis. The right hemidiaphragm is elevated. No definite free intraperitoneal air.Catheter type devices project over the lower abdomen and pelvis. | 1.Findings suspicious for a developing small bowel obstruction. |
Generate impression based on findings. | Epilepsy, with seizure today with possible fall: agitation, headache. 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 appears to be intact. There is a possible supraorbital scalp contusion. | Possible small supraorbital scalp contusion, but no evidence of acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | Immunocompromised due to myelofibrosis status post SCT with right C5 pain radiating to left paraspinal and fevers. The images are degraded by patient motion. Head: There is no evidence of acute intracranial hemorrhage or mass. There is a hypoattenuating area in the right posterior frontal lobe. The ventricles are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening in the right maxillary sinus. There is partial opacification of the mastoid air cells. There is diffuse sclerosis of the osseous structures. The scalp soft tissues are unremarkable. Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is diffuse patchy sclerosis of the osseous structures. There is a cystic lesion surrounding the crown of an unerupted right maxillary molar that measures up to 20 mm. The airways are patent. There is a right internal jugular venous catheter. There are partially-imaged bilateral pleural effusions. | 1. A hypoattenuating area in the right posterior frontal lobe may represent an infarct of indeterminate age. No evidence of acute intracranial hemorrhage or mass. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct and intracranial infection.2. No definite fluid collection in the neck, although assessment for abscess is limited without intravenous contrast. MRI may be useful for further evaluation, if there are no contraindications.3. Partially-imaged bilateral pleural effusions. Please refer to the separate chest CT report for additional details.4. Diffuse osteosclerosis related to myelofibrosis. 5. A cystic lesion surrounding the crown of an unerupted right maxillary molar may represent a dentigerous cyst. |
Generate impression based on findings. | Metacarpal fracture.VIEWS: Right hand PA/lateral/obluique (three views) 03/20/15 The K wires have been removed. A cast has been applied. Callus formation surrounds the little finger distal metacarpal. Anterior angulation of the distal fracture fragment is again seen. | Healing fracture of little finger metacarpal. |
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