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Generate impression based on findings. | Female 59 years old; Reason: 59F s/p umbilical hernia repair c/b colon perforation s/p colostomy with reversal with large incisional hernia History: incisional hernia ABDOMEN:LUNGS BASES: Right middle lobe scarring/linear atelectasis.LIVER, BILIARY TRACT: Scattered hypoattenuating liver lesions, several of which are too small to characterize, largest ones (measuring up to 2.2 cm) measure simple fluid, most likely cysts. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nonspecific mild left adrenal thickening. KIDNEYS, URETERS: Bilateral renal cysts. Lobulated renal contours (more pronounced with right kidney than left), may reflect sequela of chronic reflux disease or vascular insult. Nonobstructing 3 mm right-sided calcification. Relatively hyperdense indeterminate exophytic left renal lesion measuring 1.8 cm on image 75 series 4. RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes. Reference left para-aortic lymph node measuring 1.7 x 0.9 cm on image 74 series 4. Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Normal appendix. Large ventral abdominal hernia containing majority of left hepatic lobe, mesenteric fat and small and large bowel. Nonspecific left-sided mesenteric calcification subcentimeter. Hernia sac measures 24 cm in transaxial dimension by 9.6 cm in AP dimension by 16.3 cm in craniocaudal dimension, ventral abdominal wall defect measures 15.6 cm. No associated bowel obstruction. Right-sided clonic diverticulosis without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel spinal degenerative disease, most severe in lumber spine. Large ventral abdominal hernia containing majority of left hepatic lobe, mesenteric fat and small and large bowel. Nonspecific left-sided mesenteric calcification subcentimeter. Hernia sac measures 24 cm in transaxial dimension, ventral abdominal wall defect measures 15.6 cm. OTHER: No significant abnormality noted. | 1. Large ventral abdominal hernia, measuring 24 x 9.6 x 16.3 cm, as described. No associated bowel obstruction. |
Generate impression based on findings. | Check fixation Post distal fibular and medial malleoli are fixation unchanged without evidence of complication or alteration in alignment. Soft tissues remain significant for minimal soft tissue swelling overlying the medial aspects largely. Fracture planes are indistinct compatible with continued and essentially complete healing | Essentially complete interval fracture healing |
Generate impression based on findings. | Pain Comminuted humeral neck and tuberosity fracture observed with minimal lateral displacement. | Comminuted humeral head and neck fracture |
Generate impression based on findings. | Check fixation Distal fibular sideplate has been placed with interval continued healing of the underlying fibular fracture. No hardware complications. Alignment preserved. Ankle mortise intact other than mild underlying degenerative changes | Distal fibular fixation and partial healing |
Generate impression based on findings. | Pain Diffuse soft tissue swelling with irregularity and concern for a questionable subacute fracture with partial healing of the lung the dorsal lip of the distal radius. Please correlate with patient history and site of symptoms. The remainder of the wrist and metacarpals are otherwise unremarkable. | Questionable subacute distal radial fracture along the dorsal distal rim |
Generate impression based on findings. | Pain and stiffness. Questionable mild juxta-articular osteoporosis without additional acute or subacute abnormality. Specifically no discrete focal changes to support inflammatory arthritis such as erosions. Alignment preserved. Note is made of minor ulnar minus variance bilaterally, however specifically the lunates bilaterally appear intact | Juxta articular osteoporosis without additional acute or subacute arthritic changes. See detail provided |
Generate impression based on findings. | Pain Diffuse demineralization limits sensitivityRight hand: Mild interval progression of diffuse scattered changes most prominent involving the first MCP and distal articulations, specifically the third digit. Narrowing, sclerosis and small osteophytes. No overt definite marginal erosions, however small marginal changes are observed involving the base of the second and third proximal phalanx. The wrist is significant for persistent radiocarpal changes with ulnar subluxation and more pronounced degenerative changes involving the base of the first digit with near bone-on-bone narrowing, markedly progressed.Left hand: Mild interval new changes, specifically involving the MCP articulations of the first through third digits with marginal erosion observed in the second relative sparing of the distal articulations. Progressed degenerative changes involving the base of the first digit with similar ulnar subluxation of the radiocarpal joint and moderate degenerative changes. An old triquetral fracture is also suggested on the lateral view, potentially missed previously due to differences in positionFeet: Unchanged bilateral severe hallux valgus and degenerative changes involving the first MTP with more minimal changes in the midfoot seen bilaterally. Overall appearance is similar to prior exam, specifically no new focal inflammatory changes. Specifically a moderate to mild pes planus deformity, mild on the right and moderate on the left, is more pronounced although prior exam was not standing limiting sensitivity. Standing views also allow diagnosis of moderate hammertoe deformity | Mild continued progression of minimal changes again supporting rheumatoid arthritis including small marginal erosions as noted above. Changes are minimal since 2007. |
Generate impression based on findings. | Check fibular fracture Nondisplaced oblique distal fibular fracture with overlying moderate diffuse swelling. Ankle mortise remains intact and symmetric. | Distal fibular fracture without significant displacement |
Generate impression based on findings. | Female 64 years old; Reason: Cholangiocarcinoma please assess and provide index lesion measurements for baseline purposes prior to start of chemo History: As above CHEST:LUNGS AND PLEURA: Enlarging small pleural effusions. Evaluation of underlying lung parenchyma suboptimal due to respiratory motion artifact but nonspecific micronodules without significant change suggested, for example, 2 mm lung nodule left lower lobe, image 66 series 3. MEDIASTINUM AND HILA: Mild mediastinal lymphadenopathy. Precarinal lymph node measuring 1.6 x 0.8 cm, image 35 series 3. CHEST WALL: Post sternotomy as sequela. Heart borderline in size. Mild calcified coronary artery disease. Mitral valve disease.ABDOMEN:LIVER, BILIARY TRACT: Unchanged hepatic subcentimeter hypodensities, too small to characterize. For example, 10 x 4 mm focus in right hepatic lobe, image 100 series 3. Hepatic dome calcification. Heterogeneous hypoattenuating peripheral wedge-shaped defect in hepatic segment 3, image 108 series 3, may have been present previously to a lesser extent on prior exam, nonspecific but evolving hepatic infarct a consideration. Interval removal of previously seen percutaneous biliary drainage catheter with parenchymal heterogeneity seen at site. Common bile duct stent present. Expected small pneumobilia. Mild intrahepatic biliary duct dilatation, stable. Small perihepatic ascites. SPLEEN: No significant abnormality noted.PANCREAS: Mild interval decrease in size of pancreatic head mass, measuring 4 x 1 cm, image 114 series 3, previously measured 4.2 x 1.4 cm. Mild interval improvement in degree of pancreatic ductal dilatation, measuring up to 5 mm, previously 6 mm.ADRENAL GLANDS: Mild left adrenal nodularity, stable. KIDNEYS, URETERS: Again seen are bilateral renal hypoattenuating lesions, largest in left renal lower pole measuring 2.1 cm and consistent with simple fluid. Another hyperdense lesion in the left kidney is stable. Additional punctate focus in right renal lower pole most pronounced on prior study.RETROPERITONEUM, LYMPH NODES: Upper abdominal adenopathy. Periceliac lymph node measuring 2.2 x 1.1 cm, image 97 series 3, previously measured 2.3 x 1.1 cm. Mass superior mesenteric artery distally but no definite soft tissue encasement or associated luminal narrowing seen. Patent portal veins, splenic vein and SMV. Mild retroperitoneal lymphadenopathy. Reference left paraaortic lymph node measuring 1.1 x 0.7 cm, image 113 series 3, previously measured 1 x 0.6 cm, nonspecific. Mild pelvic lymphadenopathy. Stable right external iliac lymph node measuring 1.4 x 1 cm, image 175 series 3. Mild to moderate aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Minimal mesenteric induration.PELVIS:UTERUS, ADNEXA: Calcified fibroid uterus. Small pelvic free fluid.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Ventral abdominal subcutaneous induration. Breast microcalcifications, nonspecific. | 1. Mild interval decrease in size of pancreatic head mass with mild improvement in degree of pancreatic ductal dilatation.2. Heterogeneous hypoattenuating peripheral wedge-shaped defect in hepatic segment 3, may have been present previously to a lesser extent on prior exam, nonspecific but evolving hepatic infarct a consideration.3. Mediastinal and abdominopelvic adenopathy as above, metastatic disease not entirely excluded. 4. Small ascites. Enlarging bilateral pleural effusions. |
Generate impression based on findings. | Richter's transformation lymphoma, 100 today's status post allogenic stem cell transplant. Restaging exam.RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 195 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 no suspicious FDG avid focus to indicate tumor activity currently. Previous mild focal abdominal and pelvic lymph node and mesenteric activity have resolved and may have been inflammatory. The spleen has decreased significantly in size. Again present is diffuse homogeneous marrow activity, less intense than previous but again most likely benign stimulation. | 1.No FDG avid tumor currently.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Foot and lower leg pain Foot and ankle: No radiographic abnormalities observed in this limited non-standing evaluation. Specifically no findings to support a fractureLower leg and knee: No radiographic abnormalities | Normal exam |
Generate impression based on findings. | Beam-hardening artifact obscures portions of the lower neck. There are post-treatment findings in the neck with supraglottic edema, but no evidence of a measurable mass lesion. There are no enlarged lymph nodes by CT criteria. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter that loops within the vessel. There are mild calcifications in the carotid bifurcations. There are postoperative findings related to sinonasal surgery without evidence of local mass lesions. The imaged intracranial structures are unremarkable. There are mild degenerative changes of the cervical spine. There are numerous absent teeth. The imaged portions of the lungs are clear. | 1. Post-treatment findings in the neck without evidence of measurable residual laryngeal tumor or significant lymphadenopathy in the neck, within the limits of artifactual degradation.2. Postoperative findings related to sinonasal surgery without evidence of local mass lesions.3. The right internal jugular venous catheter loops within the vessel. |
Generate impression based on findings. | Osteosarcoma off therapy.VIEWS: Left knee AP/lateral (two views), left tibia-fibula AP/lateral (two views) 03/20/15 Longstem left total knee arthroplasty is again seen. The resection of the proximal fibula is again noted.No tumor recurrence is identified. There is no loosening of the prosthesis. | No evidence of tumor recurrence or complication from surgery. |
Generate impression based on findings. | Follow up exam Healing second metatarsal neck and head fracture without change in alignment.Otherwise no apparent interval change in the previously described fixation of the distal lower leg and fusion of the tail is to the calcaneus. Overall alignment and appearance is similar with no underlying associated hardware complications. Diffuse demineralization persists without significant new soft tissue abnormalities. | Healing second metatarsal head fracture |
Generate impression based on findings. | Reason: evaluate for bleed, aneurysm History: headache 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.The left common carotid artery originates from the innominate artery.The right submandibular gland is absentBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. There is a small protrusion off of the right communicating segment of the internal carotid artery at the expected location of the origin of the posterior communicating artery.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a mild degree are present.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.Incidental note is made of partial empty sella. | 1.There is a 2-mm aneurysm versus infundibulum at the expected location of the origin of the right posterior communicating artery which is unchanged when compared to the prior exam in January.2.No evidence for cervicocerebral occlusive disease.3.Absence of the right submandibular gland .4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related. |
Generate impression based on findings. | Pain, check alignment Interval replacement of the first MTP with a prosthetic base through the small phalanx no discrete hardware complication observed in this limited view, however sensitivity is limited without prior for comparison. Alignment preserved. Suspected hammertoe deformity without additional findings involving the second through fifth digits. Midfoot and hindfoot are also unremarkable. Incompletely visualized IM tibial rod. | No hardware complication |
Generate impression based on findings. | Pain Diffuse nonspecific changes, however most pronounced other than demineralization is marginal suspected erosions involving the first digit, specifically the head of the first metatarsal. Questionable small marginal erosion involving the base of the proximal phalanx is also suggested with relative sparing of the remaining digits. Although possibly inflammatory arthritis, compared to prior imaging or possibly the opposite foot would be helpful to confirm. Additionally gout must also be consideredOld fracture deformity of the distal fibula is also observed incompletely. Consider dedicated imaging. The remainder of the middle and hindfoot is otherwise grossly intact | Nonspecific changes involving the first MTP, raising concern for possible gout or less likely inflammatory arthritis. See detail provided |
Generate impression based on findings. | Pain Distal fibular and medial malleoli or fixation unchanged without evidence of complication. Underlying fracture demonstrates continued mild interval healing | Healing distal fibular and medial malleolus fractures |
Generate impression based on findings. | The colon is well distended. Mild retained fluid and particulate matter within the colon is well tagged. There is severe muscular hypertrophy and diverticulosis throughout the sigmoid colon. There is persistent narrowing of a segment of sigmoid colon, corresponding to site of prior diverticulitis identified on CT 03/08/11. This is consistent with a low-grade stricture, likely benign given the presence of diverticula in this region. No polyps > 6 mm or colonic masses are identified. Scattered colonic diverticula are identified in the left colon and sigmoid colon. Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny polyps < 5 mm), the presence or absence of which will not change management of the patient.EXTRACOLONIC | 1. Low-grade stricture in the sigmoid colon, likely benign.2. Cholelithiasis*OPTIONAL C-RADS CLASSIFICATION:C-1E- 1 *(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than three 6-9mm polyps or can't exclude >6mm in technically adequate study. Surveillance CTC or colonoscopy recommended.C3: Polyp, possibly advanced adenoma. (polyp >10mm or >three 6-9mm). Colonoscopy recommended.C4: Colonic mass, likely malignant. |
Generate impression based on findings. | Right knee pain Right patellar fracture repair is observed with two pins and a cerclage figure 8 wire. Alignment preserved. Fracture plane is less distinct, consistent with interval partial healing. No additional abnormalities | Healing right patellar fracture |
Generate impression based on findings. | Check for ankle fracture. Pain Mild subcutaneous soft tissue swelling without underlying osseous acute abnormality. Specifically no distinct fractures, however given mild demineralization, serial imaging may be indicated to exclude an occult fracture, if suspicion and history remains high. | Diffuse soft tissue swelling without a definite underlying acute fracture. See limitations described |
Generate impression based on findings. | Newly diagnosed non-small cell lung cancer. Initial staging.RADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 92 mg/dL. Today's CT portion grossly demonstrates an approximately 7 cm lung mass in the right lower lobe. Enlarged bilateral hilar and paratracheal lymph nodes are noted. Small right hydropneumothorax with chest tube at the right base. Extensive subcutaneous emphysema is also present on the right. Several small bilateral pulmonary nodules are also present. A small pericardial effusion is identified. Focal nodular right pleural thickening is also seen. Layering gallstones are present.Today's PET examination demonstrates a large markedly hypermetabolic right lower lobe lung mass (SUV max = 14.7), compatible with the patient's diagnosis of lung cancer.Multiple markedly hypermetabolic lymph nodes (SUV max = 10.3) are seen in bilateral hila, subcarinal, right paratracheal, and left prevascular locations, compatible with lymph node metastases. Hypermetabolic right supraclavicular lymph nodes indicate additional lymph node metastases.Multiple foci of markedly hypermetabolic activity stud the right mid and lower pleural surfaces (SUV max = 9.4), compatible with pleural seeding of tumor.Several small but abnormal hypermetabolic bilateral pulmonary nodules are highly suspicious for additional pulmonary metastases.No suspicious FDG avid lesion is seen within the abdomen, pelvis, or visualized skeleton | 1.Markedly hypermetabolic right lower lobe mass, compatible the patient's diagnosis of lung cancer.2.Multiple markedly hypermetabolic lymph node metastases involving bilateral hila, paratracheal, prevascular, and right supraclavicular locations.3.Multifocal hypermetabolic right pleural tumor seeding.4.Hypermetabolic bilateral pulmonary nodules compatible with additional metastases.5.No FDG avid abdominal or osseous tumor. |
Generate impression based on findings. | Wrist pain and foot pain Wrist: Distal ulnar and radial side plates are partially visualized without evidence of interval complication or abnormality ulnar minus variant is observed. Specifically deviation views do not demonstrate any evidence of instability. Soft tissues are unremarkableFoot: No acute radiographic abnormality. Alignment preserved. Note is made of a focal well corticated cystlike defect involving the first metatarsal head, thought to be a normal variant | Old wrist and forearm fixation without acute abnormalities involving the foot or wrist |
Generate impression based on findings. | Please evaluate the right internal auditory canal for a vestibular schwannoma: unilateral hearing loss in the right ear. Right: The internal auditory canal is not enlarged and there is no discernible canalicular mass. The external auditory canal is patent. The middle ear is well-pneumatized and clear. The ossicular chain is intact. There is minimal opacification of the mastoid air cells. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Left: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There is scattered sinonasal opacification. There are bilateral lens implants. | 1. The internal auditory canal is not enlarged and there is no discernible canalicular mass to suggest a schwannoma. However, CT has limited sensitivity for depicting small schwannomas. If clinical concern persists, an MRI with contrast is recommended.2. Scattered sinonasal opacification may represent rhinosinusitis. |
Generate impression based on findings. | 37 day old former 23 week gestational age patient with PDA ligation. History of bowel perforation.VIEWS: Chest and abdomen AP (two views) 03/20/15, 1222 Tube tip is below thoracic inlet. Feeding tube tip is in the stomach. PDA ligation clips are noted right upper extremity PICC tip is at junction of superior vena cava and right atrium.Cardiothymic silhouette is upper limits of normal in size. Hazy lung opacities are present bilaterally. Pulmonary interstitial emphysema continues.Moderately dilated bowel loops are present in a disorganized pattern. There is a paucity of gas in the right lower quadrant. No pneumatosis, portal venous gas, or free peritoneal air is seen. | Complications from surfactant deficiency. Bowel obstruction pattern. Possible post-NEC stricture. |
Generate impression based on findings. | Female 13 days old Reason: Eval lung fields History: Difficulty tolerating feeds, belly distensionVIEW: Chest AP and abdomen (two views) 3/20/15 at 1215 hrs. NG tube terminates in the stomach. Central line tip is at the right subclavian/innominate vein. Umbilical line has been removed. Cardiac silhouette size is normal. Bilateral diffuse lung haziness with no focal opacities. No effusions or pneumothorax.Generalized, nonspecific bowel distention with no evidence of obstruction or free air. No pneumatosis intestinalis or portal venous gas. No ascites. | Generalized, nonspecific bowel distention and diffuse lung haziness. |
Generate impression based on findings. | Pain Interval placement of 3 screws of which two are well-positioned affixing the impacted left hip neck fracture, however the more superior screw is fractured. Underlying moderate osteoarthritis of the hip is otherwise observed limited by diffuse demineralization. | Fractures hardware - service called. Pager 3473 |
Generate impression based on findings. | Female 76 years old Reason: 76F with complex medical history transferred with EC fistula, preparing for discharge History: EC fistula; LLQ pain Scout radiograph showed a nonobstructive bowel gas pattern. Multiple clips are noted in the abdomen and pelvis. Residual enteric contrast from prior CT scan is noted. There is a surgical staple margin in the left upper abdomen.Transit time to the colon was 40 minutes. There are scattered diverticula in the terminal ileum. The terminal ileum is otherwise unremarkable.There is enterocutaneous fistula in the left lower abdomen adjacent to the prior surgical anastomosis. There appears be a blind ending tract terminating within the left lower pelvis that corresponds to the fluid collection on CT near the colon. The fistulous connection appears to originate from the proximal ileum adjacent to the left iliac crest. There is a collection that projects over the left iliac bone connected to the fistulous tract.The bowel loop in the vicinity has an abnormal morphology with mucosal irregularity however, there is no bowel obstruction.TOTAL FLUOROSCOPY TIME: 5:40 minutes | Enteric cutaneous fistula from the proximal ileum to the skin in the left lower abdomen.Second blind ending tract terminating in the left pelvis adjacent to the colon.The enteric fistula connects with an abscess pocket overlying the left ilium likely in the subcutaneous tissues. |
Generate impression based on findings. | Male 83 years old; Reason: s/p DHT placement History: as above Enteric tube terminates in the region of the distal gastric body. The bowel gas pattern is nonobstructive.Postsurgical changes in the mediastinum. Multiple lines drains and support tubing project over the chest and upper abdomen. | 1.Enteric tube terminates in the region of the distal gastric body. |
Generate impression based on findings. | History of closed head trauma last January (hit head on top of car door), now with new migraines, nausea, vomiting, and photophobia. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Incidental note is made of a benign appearing round 6 mm T2 hyperintense lesion at the medial aspect of the left palatine tonsil on the axial images, but not seen on corresponding T1 sagittal images due to slice selection. | 1. No evidence of acute intracranial hemorrhage, mass effect, or acute infarct.2. Findings most suggestive of a 6 mm retention cyst at the medial aspect of the left palatine tonsil. Consider direct inspection as clinically warranted. |
Generate impression based on findings. | 56-year-old male with acute kidney failure. RIGHT KIDNEY: The right kidney measures 12.1 cm in length. Echotexture minimally increased. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.6 cm in length. Echotexture minimally increased. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: DecompressedOTHER: No significant abnormalities noted. | Minimally echogenic kidneys without obstruction. |
Generate impression based on findings. | Male; 50 years old. Reason: restaging CTs for hx richters transformation. Now 100 days post allogeneic stem cell transplant History: restaging CTs CHEST:LUNGS AND PLEURA: Stable 5 mm left lower lobe pulmonary nodule (series 6/65). Other scattered pulmonary micronodules are unchanged. No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size. No pericardial effusion. No visible coronary artery calcifications. Right chest wall port tip at the superior cavoatrial junction.CHEST WALL: Stable nonspecific sclerotic focus at the posterior aspect of the T1 vertebral body.ABDOMEN:LIVER, BILIARY TRACT: Stable 11 mm hypoattenuating focus in the right hepatic lobe, likely due to a cyst (series 401/82). Additional tiny hypoattenuating lesions in the right hepatic lobe are too small to characterize but likely due to additional cysts (series 401/87 and 127).SPLEEN: Mild splenomegaly, decreased since prior exam on 10/27/14. A small soft tissue implant seen posterior to the spleen on PET/CT from 9/18/14 has resolved.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable simple cyst right renal superior pole. Additional bilateral subcentimeter hypoattenuating foci are stable and likely due to additional cysts, including a hyperdense exophytic cyst at the inferior pole of the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable small sclerotic focus in the right iliac bone (series 401/155).OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Mild splenomegaly, decreased since prior CT chest on 10/27/14.2. Resolution of soft tissue implant posterior to the spleen seen on PET/CT from 9/18/14.3. No lymphadenopathy seen on the current examination. |
Generate impression based on findings. | Weight loss and possible abnormality seen on a lateral chest x-ray. Evaluate for malignancy. CHEST:LUNGS AND PLEURA: Mild scarring most prominent at the lung bases. The abnormality identified on the recent chest radiograph probably represents a summation artifact as there is no evidence of an intrapulmonary mass.Calcified granuloma the left lung base.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter probable hepatic cysts adjacent to the gallbladder. No enhancing lesions or intrahepatic biliary ductal dilatation.SPLEEN: Splenic granulomas.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Adrenal gland calcifications on the left.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Ventral hernia containing fat. No bowel dilatation. Colonic diverticulosis.BONES, SOFT TISSUES: Degenerative changes throughout the spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Ovaries not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No CT evidence of malignancy. The recent abnormality identified on chest radiograph probably represented a summation artifact. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is minimal mucosal thickening of the right maxillary sinus. The left maxillary sinus is clear. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: There is partial opacification of the left sphenoid sinus, which is somewhat aerated. The right sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is no significant nasal septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. | Minimal mucosal thickening of the right maxillary and partial opacification of the left sphenoid sinus. Other paranasal sinuses are clear. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. There are mild mucosal thickening of the bilateral ethmoid and maxillary sinuses.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | Unremarkable MRI of the brain and internal auditory canals. |
Generate impression based on findings. | 31-year-old female with right thumb pain. Three views of the right thumb demonstrate normal anatomic alignment, without evidence of acute fracture. There is mild soft tissue swelling. | No acute fracture or malalignment. |
Generate impression based on findings. | Male 24 years old; Reason: 24 year old man with diffuse large B cell lymphoma s/p chemotherapy. Enlarged mediastinal LN noted on prior CT, but no PET activity. Compare to prior scans. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Stable hypodense lesion in superior mediastinal area and located inferior to left thyroid lobe, measuring 3.2 x 1.9 cm on image 17 series 701, previously measured 3.2 x 2 cm. Mild interval enlargement of additional index lesion in prevascular/anterior mediastinal space, measuring 4.3 x 2.6 cm, image 30 series 701, previously measured 4 x 2.4 cm. Interval enlargement of index subcarinal lymph node, measuring 2.5 x 1.1 cm on image 39 series 701, previously measured 1.7 x 1 cm (remeasured on prior study). Stable index right axillary lymph node measuring 1.2 x 0.7 cm, image 19 series 701.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Again visualized are multiple hypoattenuating lesions throughout the liver, appear similar to earlier exam. Reference right hepatic lesion stable, measuring 1.7 x 1.2 cm, image 85 series 701. Stable mild intrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy. Stable index left para-aortic lymph node, measuring 1.2 x 1 cm, image 128 series 701, previously measured 1.2 x 1 cm.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Mild interval decrease in size of index left aggregate nodal mass in external iliac region, measuring 2.5 x 1.5 cm on image 189 series 701, previously measured 2.9 x 1.6 cm. Stable (when remeasured on earlier exam) index left inguinal lymph node, measuring 1.6 x 0.9 cm, image 208 series 701. At site of new hypermetabolic left external iliac nodal activity on PET portion of study is ill-defined soft tissue attenuation, making exact measurements difficult, 1.4 x 1.3 cm focus seen on image 189 series 701, appearance similar to prior CT exam. No CT measurable focus seen corresponding to hypermetabolic focus located anterosuperior to left sacroiliac joint. BONES, SOFT TISSUES: No significant abnormality noted. | 1. Interval enlargement of metastatic mediastinal adenopathy as described.2. Hepatic metastatic disease without significant change.3. Stable to mild decrease in size of abdominopelvic nodal disease.4. Please refer to concomitant PET exam from same day for additional findings. |
Generate impression based on findings. | 42 year old female who has a complaint of palpable left breast mass. Family history of breast carcinoma in her maternal grandmother. MAMMOGRAM: Three standard views of both breasts, and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. A triangular marker has been placed on an area of palpable concern overlying the lower slightly inner left breast. No discrete underlying mammographic abnormality is identified. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND: On physical examination, there is a soft, oval, mobile mass at the approximated 7 o'clock position of the left breast, 5 cm from the nipple. A targeted left ultrasound was performed for the palpable area of concern. A prominent fat lobule is noted at the site of palpable concern, and likely accounts for the finding on physical examination. There is no solid or cystic mass identified. | No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | A minimally displaced left supraorbital frontal bone fracture is present which extends inferomedially to involve the superior orbital roof and medial orbital wall (lamina papyracea). There is significant associated overlying periorbital edema and soft tissue swelling. Ipsilateral intraorbital and underlying intracranial structures are unremarkable. There is pan-opacification of the paranasal sinuses as well as fluid within the right middle ear cavity and mastoid air cells. The left middle ear cavity and mastoid air cells are clear. Slight hyperdensity within sinus secretions suggests intermixed hemorrhage within paranasal sinus fluid.The ventricles and sulci are normal in size. There are no intracranial masses, mass effect or midline shift. There is no evidence for acute intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. | A minimally displaced left supraorbital frontal bone fracture is present which extends inferomedially to involve the superior orbital roof and medial orbital wall (lamina papyracea). There is significant associated overlying periorbital edema and soft tissue swelling. Ipsilateral intraorbital and underlying intracranial structures are unremarkable. There is pan-opacification of the paranasal sinuses as well as fluid within the right middle ear cavity and mastoid air cells. The left middle ear cavity and mastoid air cells are clear. Slight hyperdensity within sinus secretions suggests intermixed hemorrhage within paranasal sinus fluid. |
Generate impression based on findings. | Male 65 years old Reason: hx of metastatic renal cancer evaluation for progression History: renal cancer CHEST:LUNGS AND PLEURA: Pulmonary nodules have decreased slightly in size. The reference nodule in the right middle lobe (image 40; series 5) measures 1.0 x 0.8 cm, smaller. Unchanged, trace left pleural effusion.MEDIASTINUM AND HILA: Adenopathy has regressed slightly. The reference left hilar lymph node (image 50; series 3) currently measures 1.9 x 1 .6 cm, smaller. Thyroid nodule unchanged.CHEST WALL: Left-sided sixth rib metastasis has decreased in size (image 60; series 3). Sternal metastasis is likewise regressed.ABDOMEN:.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Horseshoe kidney morphology again identified. The heterogeneous mass in the superior pole the right kidney has equivocally decreased in size and currently measures 8.8 x 8.7 cm (image 110; series 3). Infiltration of the fat planes of the posterior pararenal fascia has resolved. Nonobstructing right renal stone. RETROPERITONEUM, LYMPH NODES: Multiple large mesenteric lymph nodes again identified, decreased in size. BOWEL, MESENTERY: There is a new 5.8 x 4.8 cm fluid collection containing air encapsulated by a loop of small bowel in the right lower quadrant (image 164; series 3) which is concerning for either a bowel perforation or appendicitis with interloop abscess. Reference mesenteric lymph node measures 1.5 x 1.7 cm, smaller compared to prior (image 156; series 3).BONES, SOFT TISSUES: L4 left neuroforaminal bone metastases has decreased in size.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: L4 metastasis has decreased in size. | 1. The malignant disease has regressed. Reference measurements are given above.2. There is a new fluid collection, possibly an interloop abscess which may represent ruptured appendicitis in the right lower quadrant. This finding was discussed with Dr. Szmulewitz at the time of dictation. |
Generate impression based on findings. | Female 25 years old Reason: newly recurrent Ewing's sarcoma; assess for metastases Postoperative changes status post left below-the-knee amputation are again noted. New focus of mild to moderate activity in the left posterior fifth rib. While this is in the vicinity of the resected lung and could be post therapy appearance, new rib metastasis cannot be entirely excluded. Consider whole body FDG PET if there is strong clinical suspicion. Otherwise no suspicious osseous lesion. | New focus of activity in the left posterior fifth rib, which may reflect adjacent post therapy changes. New bone metastasis cannot be entirely excluded however; consider whole body FDG-PET if there is strong clinical suspicion. |
Generate impression based on findings. | 68 year-old female with history of buccal cancer CHEST:LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema. Debris noted within the trachea and mainstem bronchi may reflect excretions. No pleural effusion or pneumothorax.No suspicious pulmonary masses or nodules. No focal consolidation.MEDIASTINUM AND HILA: The heart size is normal. No pericardial effusion. Severe coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. Moderate to severe degenerative disease affects the thoracolumbar spine. No suspicious osseous lesions. Mild compression fracture of L2 is new with 30% loss of height. Loss of height of several other vertebral bodies appears similar when compared to the prior exam.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple small hepatic hypodensities, unchanged, consistent with cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small bilateral hypodensities, consistent with cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Prominent left gonadal vein.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild compression fracture of L2 is new with 30% loss of height. Loss of height of several other vertebral bodies appears similar when compared to the prior exam.OTHER: No significant abnormality noted. | New compression fracture of L2 with 30% loss of height. No specific evidence of metastatic disease. |
Generate impression based on findings. | 60 year-old female with history of colon cancer. Evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: Several micronodules are stable.MEDIASTINUM AND HILA: Stable prevascular lymph node on image 39/206 measuring 0.7 x 1.2 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No adenopathy. Vascular calcification.BOWEL, MESENTERY: Umbilical hernia containing colon is wide-mouthed. Second, more caudal ventral hernia contains small bowel. There is some narrowing of the bowel loop as seen on image 130/206 without proximal dilatation. There is mild dilatation of colon proximal to the surgical anastomosis in the left abdomen on image 107/206 with significant proximal fecal material. However there is fecal material and contrast beyond this point.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Umbilical hernia containing colon is wide-mouthed. Second, more caudal ventral hernia contains small bowel. There is some narrowing of the bowel loop as seen on image 130/206 without proximal dilatation. There is mild dilatation of colon proximal to the surgical anastomosis in the left abdomen on image 107/206 with significant proximal fecal material. However there is fecal material and contrast beyond this point.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence for recurrent disease.Abdominal wall hernias. See above.See comments on left colon. |
Generate impression based on findings. | Male 55 years old; Reason: evaluate for PNA in BMT patient with worsening hypoxemia and cervical pain History: hypoxemia, pain Evaluation is slightly limited by excessive respiratory motion.LUNGS AND PLEURA: Bilateral basilar patchy opacities, with areas of consolidation and atelectasis, representing infection. Aspiration may be considered given the distribution. Small right and moderate left pleural effusions. The left pleural effusion appears partly loculated.The previously seen 8 mm left upper lobe is not distinctly visible due to the aforementioned left lung findings. MEDIASTINUM AND HILA: Normal sized heart, with a small pericardial effusion. No coronary artery calcifications are evident. No lymphadenopathy is evident. CHEST WALL: Right jugular venous catheter tip at the RA/SVC junction. Sclerotic appearance of the bones, compatible with history of myelofibrosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenomegaly. Increased ascites is partially visualized. | 1. Bilateral basilar patchy opacities with consolidation and atelectasis, compatible with infection. 2. Increased ascites. |
Generate impression based on findings. | 63-year-old male with radicular pain. Four views of the lumbar spine demonstrate multilevel degenerative changes including disk space narrowing, most significant at L4-5 and L5-S1, with vacuum disk phenomenon. There is grade 1 anterolisthesis of L4 on L5. There is mild anterior vertebral body osteophyte formation of the lower lumber spine. The vertebral body heights are preserved. Mild degenerative changes affect the sacroiliac joints. No evidence of acute fracture. | Scattered degenerative disease as above. No evidence of acute fracture. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. No significant residual abnormal low density remains in the pons, in area of previous osmotic demyelination. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.There has been interval development of coarse calcification associated with the diminutive and abnormal appearing left globe, likely relating to evolving post traumatic and postoperative changes. There is new layering hyperdensity which is ill-defined in the posterior right globe which is incompletely visualized. The right lens is only partially visualized as well but appears grossly normally positioned. | 1. No acute intracranial abnormality. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended.2. Layering mild hyperdensity in the partially visualized right globe suggestive of hemorrhage which may be posttraumatic. Please correlate with physical exam and history.3. Evolved left phthisis bulbi. |
Generate impression based on findings. | Male; 54 years old. Reason: h/o met tongue ca, s/p chemo, eval response, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Reference posterior left pleural-based cavitary mass in measures 4.2 x 2.4, unchanged (series 5/29).Reference right upper lung nodule measures 1.3 x 1.2 cm, unchanged (series 5/26).Stable basilar areas of nodular left pleural thickening and and left basilar atelectasis/consolidation.Stable trace left pleural effusion.MEDIASTINUM AND HILA: Stable prominent mediastinal lymph nodes, but no mediastinal lymphadenopathy by CT size criteria. No hilar lymphadenopathy. Normal heart size. No pericardial effusion.CHEST WALL: Stable left lower chest wall mass/fluid collection measuring up to 5.9 x 3 cm, previously 5.9 x 3 cm (series 3/91). Stable adjacent erosive/sclerotic changes of the ribs.ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic segment 5 cyst.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: Small hiatal hernia. Large stool burden. No bowel obstruction. Fecalized small bowel seen without evidence of bowel dilatation, which may reflect an incompetent ileocecal valve.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesion of T6 vertebral body with increased surrounding sclerosis and slight loss of height of the vertebral body, likely due to interval treatment change. Stable subcentimeter sclerotic focus in right ilium and subcentimeter lucent focus in left ilium. | 1. Stable index lesions. No new sites of disease. 2. Lytic lesion of T6 vertebral body with increased surrounding sclerosis and slight loss of height of the vertebral body, likely due to interval treatment change. |
Generate impression based on findings. | Male 68 years old Reason: prostate cancer needs disease evaluation History: prostate cancer with bone metastases Multiple osseous lesions including T7 transverse process, left frontal bone, several ribs, and upper lumbar spine appearing similar to prior examination. No new osseous lesions. Degenerative changes are again noted in the shoulders and knees. | Stable osseous metastatic lesions, with no new lesions identified. |
Generate impression based on findings. | Male 68 years old; Reason: prostate cancer with bone mets CHEST:LUNGS AND PLEURA: Visualized lung fields stable in appearance, including right apical micronodules on image 22 series 5. Subcentimeter right lower lobe calcified granuloma. Biapical scarring/nodularity. MEDIASTINUM AND HILA: Unchanged small mediastinal lymph nodes. Mediastinal and hilar small calcifications likely reflect sequela of prior granulomatous disease. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable bilobar hepatic cysts. Additional hypoattenuating hepatic lesions too small to characterize but unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts. Possible punctate nonobstructing right lower pole calculus, image 137 series 3. Symmetric renal parenchymal enhancement. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Index para-aortic lymph node stable, measuring 1.8 x 1.4 cm, image 112 series 3, previously measured 1.8 x 1.5 cm.BOWEL, MESENTERY: Normal appendix. Moderate stool burden without bowel obstruction. Unchanged duodenal lipoma.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy. BLADDER: No significant abnormality noted.LYMPH NODES: Stable reference left common iliac lymph node, measuring 1.1 x 0.8 cm, image 153 series 3.BONES, SOFT TISSUES: Multilevel spinal degenerative disease. Unchanged sclerotic focus in L2 vertebral body. Please refer to concomitant nuclear medicine bone scan from same day for additional findings as scintigraphic imaging is more sensitive for the evaluation of osseous metastatic disease. | 1. Stable exam as described. |
Generate impression based on findings. | Female 69 years old; Reason: evaluation of right sided lung changes LUNGS AND PLEURA: Stable postsurgical changes are noted in the right lower lung from the prior wedge resection, with scarring/atelectasis about the sutures. Bronchial wall thickening is again noted, likely reflecting chronic aspiration. No new suspicious nodule/mass is identified.Severe upper zone predominant centrilobular emphysema is similar to prior. No specific evidence of pneumonia or edema.MEDIASTINUM AND HILA: No significant hilar/mediastinal lymphadenopathy. Calcified left hilar node stable compatible with prior infection.Moderate coronary artery calcifications and atherosclerotic calcification of the thoracic aorta.CHEST WALL: Marked degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Previously described hepatic hypodensity is not well characterized without contrast, however appears stable, likely benign. Stable nodular appearance of the left adrenal gland. Otherwise, no abnormality noted. | Stable right lower lobe post-surgical changes, with suspected scarring/atelectasis along the suture line. Recurrent/residual disease cannot be completely excluded and continued surveillance is recommended. No new suspicious nodule/mass. |
Generate impression based on findings. | Neck GSW status post exploration. The entrance wound was in the left submandibular area, and the bullet remained in the neck on the left side. The exam limited by beam hardening artifact, which limits assessment of the inferior portions of the major cervical vessels, but the superior portions of the major cervical vessels appear to be patent. There are postoperative findings related to neck exploration with a drain positioned in the superficial portion of the anterior neck and diffuse subcutaneous fat stranding. A bullet fragment that measures approximately up to 10 mm is lodged in the right paraspinous muscles lateral to the cervical spine at the C5 level. Another metallic foreign body that measures up to 7 mm is present in the right paratracheal space adjacent to the right common carotid artery. A punctate focus of hyperattenuation in the left upper mediastinum likely represents reflux of contrast into a vein. There is a comminuted and mildly displaced fracture of the anterior C4 vertebral body. There is scattered foci of emphysema in the neck and extensive areas of hyperattenuation and swelling in multiple compartments of the neck, including a retropharyngeal hematoma measuring up to 22 mm in thickness that extends into the upper mediastinum and results in mild airway narrowing at the inferior aspect of the endotracheal tube. There is scattered sinonasal opacification. There is also fluid surrounding the endotracheal tube in the pharynx. The left submandibular gland appears to be swollen suggestion and there appears to be a small amount of adjacent venous contrast extravasation medially. The other salivary glands and thyroid appear to be intact. There are scattered interstitial opacities in the partially imaged lungs. The imaged intracranial structures are unremarkable. | 1.Beam hardening artifact from various types of hardware limits the assessment of the inferior portions of the major cervical vessels, but the superior portions of the major cervical vessels appear to be patent. A Doppler carotid ultrasound may be useful for further evaluation, if clinically indicated.2.Postoperative findings related recent neck exploration with a residual bullet fragment lodged in the right paraspinous muscles lateral to the cervical spine at the C5 level and another metallic foreign body is present in the right paratracheal space adjacent to the right common carotid artery, which may represent another bullet fragment.3.Fracture of the anterior C4 vertebral body related to the gunshot injury. 4.Extensive contusions and hematomas in multiple compartments of the neck, including a retropharyngeal hematoma that extends to the upper mediastinum and results in mild airway narrowing at the inferior aspect of the endotracheal tube, and left submandibular gland swelling along with what may be a small amount of adjacent venous contrast extravasation. 5.Scattered interstitial opacities in the partially imaged lungs may represent pulmonary edema. Please refer to the separate chest CT report for additional details.Findings discussed with Dr. Bradley on 3/20/2015 at 3:08PM. |
Generate impression based on findings. | 61-year-old female with COPD and bronchial valve implant (05/2010) LUNGS AND PLEURA: Severe centrilobular paraseptal emphysema worse at the upper lungs.Two endobronchial valves are present in the right upper lobe with interval improvement of subsegmental atelectasis distally.Three endobronchial valves are noted on the left with increased atelectasis and volume loss in the left upper lobe.Central there was are patent. No pleural effusion or pneumothorax.Unchanged scattered nonspecific micronodules.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No visible coronary calcifications. The trachea and mainstem bronchi are patent. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Spinal canal cathete enters posteriorly at T2-T3 level and courses up above the field of view. New severe compression fractures of the T4, T6, T7, T9 vertebral bodies worst at T7. Posterior right third, fourth, and fifth rib fracture. Healing third through ninth left rib fractures. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Severe centrilobular paraseptal emphysema with bronchial valves as described above. Improved right upper lobe subsegmental atelectasis with worsening left upper lobe atelectasis distal to the endobronchial valves.2.New severe compression fractures of the T4, T6, T7, T9 vertebral bodies worst at T7. |
Generate impression based on findings. | 33-year-old male with HIV and Burkitt's lymphoma with new right groin pain and swelling. PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Non--- enlarged but enhancing lymph nodes right groin.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: In the right inguinal region in the superficial fat, there is a complex 4.4 x 5.5 cm low attenuation fluid collection which appears encapsulated but without internal flow. Portions of this are closely applied to the adjacent femoral vein, but there is a significant cleavage plane between this collection and the femoral artery. There is extensive infiltrative change in the subcutaneous fat of the anterior pelvic wall associated with this collection.OTHER: No significant abnormality noted | Complex fluid collection right groin as noted on preceding ultrasound. This contains no definite gas and could represents abscess/infected hematoma. The appearance is less likely to represent a separate lymph node. There is associated cellulitis. |
Generate impression based on findings. | MVC, hit head against car door; persistent right sided headache. There is no evidence of acute intracranial hemorrhage or skull fracture. 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 essentially clear. | No evidence of acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | 66 years, Male, Reason: prostate cancer follow up History: hx of prostate cancer. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Reference para-aortic node measures 1.9 x 1.4 cm (image 21; series 3), unchanged. Stable thyroid nodules. No hilar lymphadenopathy. Heart size is normal with trace pericardial fluid/thickening.CHEST WALL: Widespread bony metastases.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Prominent portacaval node measuring 1 cm (image 90; series 3), unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal hypodensities are stable, likely cysts.RETROPERITONEUM, LYMPH NODES: Cysts small retroperitoneal nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerotic metastases as noted previously with scattered small lytic metastases.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: Prominent left inguinal nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerotic metastases with scattered lytic metastases. Amidst the sclerotic metastases, there is a new 4.9 x 4.3 cm lytic lesion in the sacrum (image 144; series 3).OTHER: No significant abnormality noted. | New lytic metastasis in the sacrum as described above. Diffuse osseous metastases. Stable mediastinal adenopathy. |
Generate impression based on findings. | There is hypoattenuation involving the cortex and subcortical white matter of the anterior corpus callosal, cingulate gyrus, and paramedian left frontal lobe, similar in distribution to the abnormality seen on MR from 3/18. There is no evidence of hemorrhagic conversion and there is minimal mass effect with local sulcal effacement. The ventricles are normal in configuration and size. Additional, scattered areas of periventricular and subcortical white matter hypoattenuation are noted and suggestive of small vessel ischemic disease. The paranasal sinuses and mastoid air cells are clear. | Left ACA territory infarct appearing similar in distribution to the MR from 3/18. No hemorrhagic conversion, significant edema, or mass-effect. |
Generate impression based on findings. | 74 years, Male. Reason: assess NGT placement History: NGT placement There is a Dobbhoff tube with its tip projecting over the body of the stomach. Extensive chronic interstitial changes, left basilar atelectasis and left lower lobe pulmonary nodule; please see chest radiograph report from the same day for full evaluation of the lungs. There is an IVC filter in place. | Dobbhoff tube with its tip projecting over the body of the stomach. |
Generate impression based on findings. | 59 year-old female with right knee pain. Four views of the right knee demonstrate moderate to severe tricompartmental osteoarthritis of the right knee, which has not significantly changed in the interim. There is mild osteoarthritis seen on the frontal view of the left knee. No significant joint effusion, acute fracture or evidence of malalignment. | Moderate to severe tricompartmental osteoarthritis of the right knee. |
Generate impression based on findings. | 54-year-old female with right ankle pain. Three views of the right ankle demonstrate a side plate and screw device fixing the distal fibula in near-anatomic alignment. There is no specific radiographic evidence of hardware complication. There is chronic deformity of the distal fibula, suggesting a chronic fracture, with osseous bridging of the distal tibiofibular syndesmosis, which is not significantly changed when compared to prior exam. There has been mild interval progression of tibiotalar joint osteoarthritis, as evidenced by small osteophytes and narrowing of the tibiotalar joint space. There is also been mild progression of osteoarthritic changes affecting the talonavicular joint. | Orthopedic fixation of healed distal fibular fracture and moderate osteoarthritis as above, which has mildly progressed when compared to prior. |
Generate impression based on findings. | TxN2Mx squamous cell carcinoma status post chemotherapy. There is interval decrease in size of the cervical lymphadenopathy. For example, a left level 2A lymph node measures 15 mm in short axis, previously 38 mm and a left level 2B lymph node measures 8 mm in short axis, previously 17 mm. The aerodigestive track appears unchanged. The thyroid and major salivary glands are unremarkable. There is a right internal jugular venous catheter. There is mild plaque at the carotid bifurcations. There is multilevel degenerative cervical spondylosis. There is a left maxillary sinus retention cyst. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Interval decrease in size of the cervical lymphadenopathy, indicating treatment response. |
Generate impression based on findings. | 16 year old female with left knee pain. Four views of the left knee demonstrate normal anatomic alignment without evidence of acute fracture. No significant joint effusion or degenerative change is present. | Normal exam of the left knee. |
Generate impression based on findings. | Female 24 years old Reason: evaluate for gastroparesis History: pain and abdominal distention with eating Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 57 % of peak activity (normal >70 %)1 hour: 52 % of peak activity (normal 30-90 %) 2 hours: 18 % of peak activity (normal <60 %) 4 hours: 1 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | Female 32 years old Reason: hx of kidney stones and urinary retention now with right sided abdominal pain. History: see above Given the limitations of an unenhanced study, the following observations are made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis with. Evaluation of hepatic parenchyma is limited due to lack of IV contrast.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Ureteral stent has been removed. Punctate foci in the left kidney are compatible with nonobstructive renal stones. These have not changed compared to the prior examination. There is no evidence of hydronephrosis of either kidney. No stones identified in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Left renal calculi, nonobstructive and unchanged. Interval removal of right ureteral stent. No hydronephrosis. Cholelithiasis. |
Generate impression based on findings. | 66-year-old male with left shoulder pain and right knee pain. Three views of the left shoulder demonstrate two suture anchors along the greater tuberosity, which likely reflect previous rotator cuff repair, new from previous exam. Tiny glenohumeral osteophytes and humeral head cysts reflect mild degenerative arthritis. Ossific densities superior to the humeral head likely reflect calcification within the deltoid tendon. The glenohumeral joint demonstrates normal anatomic alignment. Lucency within the humeral head surrounding the suture anchors seen in the Grashey view is felt to be artifactual as it does not project on multiple views. Limited view of the left lung is unremarkable.Four views of the right knee demonstrate mild sharpening of the tibial spines and perhaps trace osteophyte formation, suggestive of mild osteoarthritis. There is no significant joint effusion or acute fracture. Alignment is anatomic. | Mild degenerative disease of the left shoulder and right knee as above. Status post orthopedic repair of the left rotator cuff. |
Generate impression based on findings. | Evaluate mandible post distraction. History of obstructive sleep apnea. There are postoperative findings related to bilateral mandibular angle osteotomy with mature fusion across the osteotomies and scar tissue along the incision planes, as well as tracheostomy with a tube in position. There is persistent crowding of the maxillary and mandibular dentition and narrowing of the oropharyngeal airway, but no significant residual retrognathism. There appears to be flattening and hypoplasia of the mandibular condyles, particularly on the right. There is opacification of the bilateral mastoid air cells, but the middle ear cavities are clear. There is redemonstration of Dandy-Walker variant malformation and mild ventricular dilatation. | 1. Interval fusion of the mandibular osteotomies without significant residual retrognathism, although there is persistent crowding of the maxillary and mandibular dentition and narrowing of the oropharyngeal airway related to glossoptosis.2. Dandy-Walker variant malformation and mild ventricular dilatation. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There is again patchy hyperdensity in the basal ganglia, most likely senescent mineralization. There are no areas of abnormal low attenuation or pathological enhancement. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is incidental empty sella. | Unremarkable contrast-enhanced CT of the brain. |
Generate impression based on findings. | Male 75 years old; Reason: evaluation for VATS bx, potential resection left side CHEST:LUNGS AND PLEURA: The spiculated left upper lobe nodule abutting the major fissure measures 2.2 x 1.6 cm (series 5, image 46), previously 2.1 x 1.8 cm. The additional 7-mm circumscribed left upper lobe nodule is unchanged (series 5, image 38). The 5-mm right upper lobe ill-defined nodule is unchanged (series 5, image 22). There are scattered nonspecific pulmonary micronodules. A right lower lobe subcentimeter nodular opacity is decreased in conspicuity, possibly inflammatory (series 5, image 73).MEDIASTINUM AND HILA: Normal-sized heart without pericardial effusion. Severe coronary artery calcifications. Mild atherosclerotic calcification of the thoracic aorta.Subcentimeter mediastinal lymph nodes. A left hilar lymph node measures 11 mm in short axis (series 3, image 56). Calcified mediastinal lymph nodes reflect prior infection.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hypoattenuating liver lesions, which are too small to characterize. Unchanged right hepatic calcification. Heterogeneously enhancing lesions in the liver (series 3, images 90 & 100) likely represent hemangioma.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: The left adrenal nodularity is unchanged. KIDNEYS, URETERS: Three heterogeneously hypoattenuating left renal soft tissue masses are present, suspicious for carcinoma. The largest of these, in the inferior pole, measures 8.6 x 7.7 cm (series 3, image 122).Multiple hypoattenuating renal lesions in the right kidney, several of which are too small to characterize, possibly representing cysts. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged mild compression deformities of the T12 and L5 vertebral bodies, with linear internal hypoattenuation, possibly representing intra-osseous hemangiomas. OTHER: A small Bochdalek hernia is noted. | 1.Stable size of the left upper lobe mass suspicious for lung cancer. 2.Stable appearance of the subcentimeter left upper lobe and right upper lobe nodules, which may represent synchronous malignancies or metastatic disease. 3.Three left renal lesions highly suspicious for renal cell carcinoma. |
Generate impression based on findings. | 22-year-old male with gunshot wound status post neck exploration for evaluation for retained bullet fragments. LUNGS AND PLEURA: Small bilateral pleural effusion with adjacent atelectasis. No pneumothorax. Bronchial wall thickening and mild thickening of the intralobular septa may reflect a component of pulmonary edema. No suspicious nodules or masses. MEDIASTINUM AND HILA: Soft tissue density fullness along the right tracheoesophageal groove consistent with a hematoma. Small focus of air posterior to the trachea (series 3, image 26) may be free air from recent surgical intervention. Adjacent to the trachea on the right at the level of T1-T2 is a 6-mm metallic radiodensity that may reflect a bullet fragment (series 3, image 11).ET tube tip is above the carina. Debris is noted within the trachea and may reflect secretions or aspirated material. Soft tissue stranding and edema in the soft tissues of the anterior neck with small foci of gas reflecting recent surgical exploration. No appreciable lymphadenopathy. No visible coronary artery calcification.Heart size is normal. No pericardial effusion. Low attenuation of the blood pool is suggestive of anemia.CHEST WALL: No significant axillary, cardiophrenic, or retrocrural lymphadenopathy. The osseous structures are within normal limits. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Partially visualized nonspecific diffuse concentric thickening of small bowel loops with surrounding free fluid. | 1.6-mm metallic radiodensity to the right of the trachea at T1-T2 level may reflect a bullet fragment.2.Soft tissue density fullness along the right tracheoesophageal groove consistent with a hematoma. 3.Postsurgical changes in the anterior soft tissues of the neck and superior mediastinum as described above.4.Partially visualized nonspecific diffuse concentric thickening of small bowel loops with surrounding free fluid.5.Probable mild pulmonary edema with small bilateral pleural effusions. |
Generate impression based on findings. | Female, 11 years old. Reason: Rule out abscess, diverticula, foreign body History: left sided 8/10 throat painVIEWS: Next tissue AP, lateral (two views) 3/20/2015, 1339 The osseous structures and joint spaces are normal.The adenoids are moderately enlarged, without obstruction of the nasopharyngeal airway.No prevertebral soft tissue swelling. No radiopaque foreign body is identified.Mild subglottic airway narrowing, slightly more prominent on the right. | Nonspecific mild subglottic airway narrowing. |
Generate impression based on findings. | 74-year-old female with history bilateral shoulder pain. Four views of the right shoulder demonstrate moderate degenerative changes affecting the glenohumeral and acromioclavicular joints, which have mildly progressed when compared to prior exam. No acute fracture is evident. Alignment is anatomic.Four views of the left shoulder demonstrate severe osteoarthritis affecting the glenohumeral joint, including joint space narrowing with bone-on-bone apposition, sclerosis, osteophytosis, flattening of the humeral head, and multiple loose bodies within the joint; this appears to have progressed since prior exam. Moderate osteoarthritis also affects the acromioclavicular joint, which also appears mildly progressed. Alignment is anatomic, and there is no evidence of acute fracture. | Interval progression of severe left and moderate right osteoarthritis of the shoulders. |
Generate impression based on findings. | Male, 12 years old. Reason: eval knee, injured while running, nonspecific exam History: c/o pain, no swellingVIEWS: Left knee AP, lateral, oblique (3 views) 3/20/2015, 1352 Fragmentation of the tibial tuberosity, with thickening of the patellar tendon and mild local soft tissue swelling.No acute fracture or malalignment. | Findings suggestive of Osgood-Schlatter disease. Recommend MRI for further evaluation. |
Generate impression based on findings. | Male, 17 years old. Reason: eval for fx/ dislocation History: eversion injury to L ankle, w/ pain swellingVIEWS: Left ankle AP, lateral, oblique (3 views) 3/20/2015, 1400 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | 68 year old male with hoarseness and difficulty swallowing. There is no evidence of mass lesions or significant cervical lymphadenopathy. There is a symmetric appearance of the larynx. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There are mild degenerative changes of the cervical spine with reversal of the cervical lordosis and grade 1 anterolisthesis of C4 on C5. The osseous structures are otherwise unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There is centrilobular emphysema. The imaged portions of the lungs are otherwise clear. There is a common origin the left internal carotid and right brachiocephalic artery. The left vertebral artery originates from the arch. Incidental retropharyngeal course of the right distal common and proximal internal carotid artery is incidentally noted. Please note that the AP window is not included within the field of view. | No evidence of mass or significant lymphadenopathy. |
Generate impression based on findings. | 70 year-old female with right adrenal lesion requiring further characterization. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific subcentimeter hypoattenuating lesion in the left hepatic lobe (series 7/37).SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal 2.5-cm nodule is well-circumscribed and measures fat-attenuation on precontrast images, compatible with benign adenoma.KIDNEYS, URETERS: 6-mm nonobstructing right renal stone at the mid pole. Bilateral renal simple cysts. Additional subcentimeter hypoattenuating foci are too small to characterize but likely due to additional cysts. Bilateral parapelvic cysts are also noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta.BOWEL, MESENTERY: Large, enhancing mass within the ascending colon measuring up to 7.5 x 5.5 x 8.9 cm (series 7/74 and series 80525/69), most likely due to primary colon cancer.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Large, enhancing mass within the ascending colon measuring approximately up to 7.5 x 5.5 x 8.9 cm (series 7/74 and series 80525/69), most likely due to primary colon cancer.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Large mass within the ascending colon, most likely due to primary colon cancer. Correlation with colonoscopy is recommended.2. Nonspecific, subcentimeter hypoattenuating focus in the left hepatic lobe.3. Benign right adrenal adenoma.Findings discussed with Dr. Govindarajan's nurse, Alandra, at Friends and Family Clinic by telephone at 2:55 p.m. on 3/20/15. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: The anterior ethmoid air cells are clear.Maxillary sinuses: There is mild mucosal thickening along the floor of the maxillary sinuses. The ostiomeatal units are clear.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: There is a small air-fluid level in the right sphenoid sinus. The left sphenoid sinus and bilateral sphenoethmoidal recesses are clear. There is no significant nasal septal deviation. The nasal turbinate morphology is within normal limits. The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. There is a small area of nonspecific rounded mild sclerosis within the right mandible along the base of the condylar process. | Very minimal sinus inflammatory changes, with questioned small air-fluid level in the right sphenoid sinus. Please correlate clinically for acute sinusitis. |
Generate impression based on findings. | 76-year-old male with history of pulmonary embolism LUNGS AND PLEURA: No pleural effusion or pneumothorax. Right lower lobe wedge-shaped pleural-based opacity continues to decrease in size now measuring 2.0 x 1.2 cm (series 5, image 217) previously 2.5 x 1.5 cm. Atelectasis and scarring in the lung bases. No suspicious nodules or masses.MEDIASTINUM AND HILA: Small amount of debris within the trachea may reflect secretions or aspirated material. Severe coronary artery calcification. Heart size is normal. No pericardial effusion. The pulmonary arteries are enlarged suggestive of chronic thromboembolic pulmonary hypertension.Previously referenced right hilar lymphadenopathy is difficult to discern due to lack of IV contrast but appears unchanged measuring 14 mm (series 3, image 47), previously 14 mm.CHEST WALL: Left upper back lipoma is again partially visualized. No significant axillary, retrocrural, or cardiophrenic lymphadenopathy. Mild degenerative disease affects the spine. No suspicious osseous lesions.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Multiple scattered hypodensities in bilateral lobes are too small to further characterize. | 1.Unchanged right hilar lymphadenopathy limited due to lack of IV contrast.2.Interval decrease in size of right lower lobe pleural-based opacity suggestive of resolving infarct or atelectasis.3.Marked PA hypertension. |
Generate impression based on findings. | Reason: hx of lung cancer s/p chemo and surgery with mult complications, ck response History: none CHEST:LUNGS AND PLEURA: Fluid continues to fill the left hemithorax within the pneumonectomy space.Stable scattered pulmonary micronodules. No new suspicious pulmonary nodule or right pleural effusion.MEDIASTINUM AND HILA: The mediastinum remains shifted into the left thoracic cavity. The heart size is unchanged. Extensive coronary artery calcification. Stable size of several small mediastinal lymph nodes. No interval mediastinal lymphadenopathy.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable cortical cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: High-density material in the retroperitoneal lymph nodes suggestive of contrast from prior lymphoscintigraphy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Anterior cervical fixation hardware partially visualized.OTHER: Extensive atherosclerotic disease of the abdominal aorta. | No evidence of metastatic disease. |
Generate impression based on findings. | 70 year-old female status post ORIF of left wrist. Three views of the left wrist again demonstrate a volar plate with screws affixing a distal radius fracture in near-anatomic alignment. There is no specific radiographic evidence of hardware complication. The bones appear diffusely demineralized. Within the limits of diffuse demineralization, the fracture plane is less well visualized on today's study, consistent with interval healing. Significant basilar joint osteoarthritis is similar when compared to prior exam. | Orthopedic fixation and interval healing of distal radial fracture as above. |
Generate impression based on findings. | 60 year-old female with lung nodule CHEST:LUNGS AND PLEURA: Irregularly marginated apical nodule causing adjacent bronchiectasis measures 11 x 10 x 9 mm (series 80697, image 22 and 80327, image 25) is unchanged. Again noted is extension to the pleural with mild tenting of the pleura. New ground glass nodule in the left upper lobe measuring 6 mm (series 80697, image 55) may represent atypical adenomatous hyperplasia or adenocarcinoma in situ. A groundglass nodule in the left upper lobe measures 9 mm (series 80697, image 100), previously a 3-mm nodule.Part solid and ground glass nodule with irregular margins measuring 7 mm in the right lower lobe (series 80 627, image 143) measures 7 mm, previously a solid nodule measuring 4 mm.Multiple additional nonspecific ground glass nodules scattered throughout the bilateral lungs are new or increased in size from the prior exam.Moderate upper lobe predominant centrilobular and paraseptal emphysema. No pneumothorax or pleural effusion.MEDIASTINUM AND HILA: The central airways are patent. Scattered subcentimeter mediastinal lymph nodes are unchanged since prior exam. Small amount pericardial fluid. The heart size is normal. Severe coronary artery calcification. No significant hilar lymphadenopathy.CHEST WALL: No significant 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: Status post cholecystectomy. No focal liver lesions.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Punctate calcifications in the left kidney may reflect nonobstructing renal stones or vascular calcifications.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta without evidence of aneurysmal dilatation. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Suture material is noted in the ascending colon reflecting prior surgery.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Irregularly marginated right apical nodule is unchanged in size.2.New ground glass nodule in the left upper lobe may represent atypical adenomatous hyperplasia or adenocarcinoma in situ. 3.A groundglass nodule in the left upper lobe measures demonstrates interval growth.4.Part solid and ground glass nodule with irregular margins also demonstrates interval growth5.Multiple additional groundglass nodules are either new or increase in size when compared to the prior exam. These warrant close follow-up, 3 months. |
Generate impression based on findings. | Brain: There is a possible, faint area of hypoattenuation in the left corona radiata to correspond to the previously seen area of restricted diffusion on prior MRI. Additional, scattered areas of white matter hypoattenuation are noted and are suggestive of small vessel ischemic disease. There is no evidence for intracranial hemorrhage. The ventricles and sulci are normal in size. There is no mass effect or midline shift. The visualized paranasal sinuses and mastoid air cells are clear. Head CTA: There are no intracranial arterial stenoses, occlusions or aneurysms identified. The Circle of Willis appears intact. There is no evidence for cerebral vasculitis and vascular malformations are identified. Neck CTA: There is minimal atherosclerotic calcification distal to the right carotid bifurcation without significant stenosis by NASCET criteria. Additionally, there is tortuosity of the proximal right internal carotid artery. There is mild, scattered atherosclerotic calcification at the origin of the right vertebral artery with good flow distally. There are no significant stenoses of the bilateral cervical carotid or vertebral arteries. A patulous right jugular vein is noted with artifact related to flow with the contrast column. Subcentimeter hypoattenuating nodule is noted in the right thyroid lobe. | 1. Possible focus of hypoattenuation in the left corona radiata corresponding to region of ischemic infarct seen on prior brain MR. No evidence of hemorrhagic conversion, significant edema, or mass effect.2. No significant stenosis of the intracranial or cervical vasculature and minimal atherosclerotic changes. |
Generate impression based on findings. | Reason: h/o HNC and chemo, compare to previous images History: none CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules unchanged in size and number. The largest is pleural-based in the lingula (5/70) measuring 5 mm. No suspicious pulmonary nodule or interval pleural effusion.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Moderate coronary artery calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: New right port catheter that terminates at the right atrium.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left cortical cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. Stable scattered pulmonary micronodules. |
Generate impression based on findings. | 13 day old term male with unilateral right arm and leg jerking and concern for herpes encephalitis. There is no evidence of intracranial hemorrhage. 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. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage. If there is concern for herpes encephalitis, MRI with contrast is recommended. |
Generate impression based on findings. | Female 30 years old; Reason: Evaluate for thymic tissue or enlargement. History: Pt has weakness and fatigue due to MG LUNGS AND PLEURA: No significant abnormality noted. No specific evidence of infection or edema. No pleural effusions.MEDIASTINUM AND HILA: Normal sized heart without pericardial effusion. No coronary artery calcifications are evident. No mediastinal lymphadenopathy. A right hilar lymph node measures 1.2 cm in short axis (series 3, image 39).A small amount of soft tissue density in the anterior mediastinum likely represents hyperplastic thymic tissue or a thymoma. A nodular hyperattenuating portion of this tissue measures 1.8 x 1.5 cm (series 3, image 36). CHEST WALL: No significant abnormality noted. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. No splenomegaly. | Soft tissue density in the anterior mediastinum likely representing hyperplastic thymic tissue or a thymoma. |
Generate impression based on findings. | Reason: Pt is a 51 yo male w/ hx of lymphoma; pre-allo sct evaluation History: Evaluate LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Moderate coronary calcifications are present, the heart and pericardium otherwise normal in appearance.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small accessory splenule. Aortic calcifications are present. | No significant abnormality. |
Generate impression based on findings. | Male 42 years old Reason: Hx of head and neck cancer, OPM demonstrated slowed transit and prolonged stasis of contrast in the mid and distal esophagus. Evaluate for possible motility disorder History: substernal retention of food Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave. Note was made of a small hiatal hernia. A 13-mm barium tablet was administered and was transiently delayed just below the level of the thoracic inlet; however, no associated obstructing mass lesion was noted.TOTAL FLUOROSCOPY TIME: 3:28 minutes | 1.Transient delay of a 13-mm barium tablet at the level of the thoracic inlet without obstructing mass lesion.2.Small hiatal hernia. |
Generate impression based on findings. | Male, 10 months old. Reason: evaluate lung fields, evaluate for atelectasis History: increased work of breathing, trach and vent dependentVIEW: Chest AP (one view) 3/20/2015, 1345 Tracheostomy tube in place. Enteric tube extends below the lower margin of the image.The heart is upper normal in size.Patchy right lower lobe and left lower lobe opacities, compatible with atelectasis, not significantly changed from the prior exam. No new focal pulmonary opacities. | Chronic lung disease, with unchanged bibasilar atelectasis. |
Generate impression based on findings. | Reason: h/o laryngeal ca, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Very mild coronary calcifications are seen as well as calcification of the aortic root; the heart and pericardium otherwise appear normal. Water density structure inferior to but contiguous with the right hilum is most likely a benign pericardial cyst. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Accessory splenule, otherwise unremarkable.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No sign of metastases, or other significant abnormality.2. Pericardial cyst noted above, almost certainly a benign process. |
Generate impression based on findings. | Left lower lobe lung nodule. Pathology revealed carcinoid tumor. LUNGS AND PLEURA: There is evidence of wedge resection at the left lower lobe, with surgical clips, atelectasis/scarring, and small pleural effusion. No residual nodule is evident. No new suspicious nodules/masses are seenFocal areas of pleural-based nodularity along the left upper lobe may are non-specific and may be post-surgical. Scattered calcified and non-calcified pulmonary micronodules are present. MEDIASTINUM AND HILA: Normal sized heart without pericardial effusion. Severe coronary artery calcifications. Moderate aortic calcifications. Enlarged main pulmonary artery, compatible with pulmonary hypertension, similar to prior. No mediastinal or hilar lymphadenopathy by CT size criteria. CHEST WALL: Mild to moderate degenerative changes of the thoracic spine. Fracture deformity of the right eighth rib is unchanged. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Hepatic granuloma. Small splenules. Subcentimeter upper abdominal lymph nodes, similar to prior. | Post-surgical changes in the left lower lobe, without residual nodule evident. |
Generate impression based on findings. | Male 59 years old Reason: hx esophageal has stent placed with new finding on CT scan with concerns for abscess/infection vs recurrent malignancy History: abnormal finding on CT Scout radiograph of the chest showed an esophageal stent in the mid to distal thoracic esophagus.There is a short segment of fixed luminal narrowing just proximal to the esophageal stent, measuring approximately 8 mm in diameter, overall an approximately 50% reduction caliber. Extravasation of contrast was noted along the right proximal portion of the stent; however, no extension into the pleural space was evident.TOTAL FLUOROSCOPY TIME: 1:28 minutes | 1.Fixed narrowing of the esophagus by approximate 50% just proximal to the esophageal stent.2.Extravasation of contrast along the right proximal aspect of the stent compatible with leak, without evidence of pleural extension. |
Generate impression based on findings. | Female, 18 months old. Reason: evaluate for lung pathology History: decreased breath sounds, increased secretionsVIEW: Chest AP (one view) 3/20/2015, 1358 Tracheostomy tube in place. Left chest port, or projecting over the left superior mediastinum, location uncertain.The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.Air space opacities in the lingula and left lower lobe. Small left pleural effusion. | Left lung opacities compatible with pneumonia, with a small left pleural effusion. |
Generate impression based on findings. | 66 show female with history of HCC status post RFA. Here for follow-up. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Nonspecific hyperattenuating focus seen on arterial phase in the left hepatic lobe measures approximately 0.6 cm (image 34, series 9) is stable. Right hepatic lobe hypoattenuating post-ablation defects in segment 7. The subcentimeter arterially enhancing focus (image 40; series 9 and image 55; series 80656) in segment 7 adjacent to the right hepatic vein persists. Unchanged background cirrhotic liver morphology. Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Again seen is an enhancing left adrenal nodule that measures 2.2 x 1.9 cm (image 28, series 11), unchanged.KIDNEYS, URETERS: Atrophic kidneys with bilateral nephrolithiasis and renal vascular calcifications. Hypoattenuating bilateral renal lesions are too small to characterize, but are unchanged from prior exams and most likely represent cysts.RETROPERITONEUM, LYMPH NODES: Tortuous abdominal aorta with aortic atherosclerotic disease. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Stable hypervascular focus at the right margin of previously radio-frequency ablated area in segment 7. IR notified. 2. Nonspecific hyperattenuating focus seen on arterial phase in the left hepatic lobe. Continued follow up is advised. |
Generate impression based on findings. | Reason: history of chronic type B dissection and lung nodule History: 6 mo f/u LUNGS AND PLEURA: Previously referenced solid nodular right upper lobe adjacent to the anterior mediastinum has decreased in size, measuring 6 x 13 mm (3/36), as compared to 13 x 15 mm. Additional right upper lobe nodule unchanged in size (4/27). Scattered calcified granulomas are stable. Stable paraseptal emphysema.No new suspicious pulmonary nodule or interval pleural effusion.MEDIASTINUM AND HILA: Using similar measurement technique off the axial images, the size of the descending thoracic aorta with a chronic type B dissection is stable. For example, at the level of the carina, the true and false lumens measure 5.0 cm transverse (3/39). At the level of the left inferior pulmonary vein, the descending thoracic aorta including the true and false lumens measures 4.3 cm (3/56).The heart size is unchanged. Resolution of prior pericardial effusion. Mild left anterior descending coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Stable size of axillary lymph nodes.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Several sutures in the abdominal midline are included in the field of view. There is mild biliary ductal dilatation. The pancreatic head and gallbladder are not included in full field of view. This appears more prominent than the prior CT chest abdomen/22/13. Several surgical staples are noted in the mid upper abdomen adjacent to the stomach Further evaluation with a CT abdomen is recommended. | Referenced right upper lobe nodule decreased in size 6 x 13 mm.Stable scattered calcified granulomas and addition a right upper lobe nodule.Type B dissection stable in transverse dimensions, as above. |
Generate impression based on findings. | Male 60 years old Reason: 60 male with esophageal CA s/p EGD/stent/PEG on 3/18, now with severe upper esophageal pain. requesting UGI per Dr. Waxman History: Esophageal pain Scout radiograph of the chest showed an esophageal stent in place. Left basilar opacity suggestive of atelectasis.Single contrast evaluation of the of the esophagus demonstrated no contrast extravasation to suggest leak. Contrast progressed promptly through the stent without evidence of obstruction.TOTAL FLUOROSCOPY TIME: 1:40 minutes | Esophageal stent without evidence of leak or obstruction. |
Generate impression based on findings. | Male 68 years old; Reason: Need triple phase CT for liver eval and kidney cyst eval History: Abdominal distension and hepatomegaly ABDOMEN:LUNG BASES: Dense, thick pericardial calcification which may represent prior pericarditis/pericardial hematoma. Small thick walled right pleural effusion suggestive of chronic pleural effusion, no definite enhancement of wall, no gaseous foci seen within effusion.LIVER, BILIARY TRACT: The liver is normal in size. Cholelithiasis. No intra or extrahepatic biliary dilatation. Patent hepatic vasculature.SPLEEN: Small foci in the region of the pancreatic tail/splenic hilum may represent small accessory splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypoattenuating lesions within the kidneys, many of which are too small to characterize. The largest is on the left side and measures 2.1 x 2.2 cm. This is compatible with a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Dense pericardial calcification may relate to prior pericarditis/pericardial hematoma.2.Chronic small right pleural effusion.3.Cholelithiasis. |
Generate impression based on findings. | Reason: thymoma, s/p chemo and resection. Pls c/w previous study and evaluate ddz status. History: thymoma CHEST:LUNGS AND PLEURA: Right lung post radiation fibrosis and volume loss, and a right pleural effusion that is only slightly larger than on the prior study.No evidence of pulmonary or pleural metastases. MEDIASTINUM AND HILA: Residual soft tissue density in the region of the thymus is unchanged, likely representing post treatment fibrotic tissue with fluid. There is no reliable evidence of thymoma recurrence.There is no mediastinal or hilar lymphadenopathy.Severe coronary calcifications are present, but no pericardial effusion.A right jugular catheter still terminates in the SVC.The large hiatal hernia is stable.CHEST WALL: Sternotomy hardware is present, unchanged.Degenerative abnormalities affect the thoracic spine.There is no evidence of skeletal metastases.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Slightly thick left adrenal glands is stable.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Slightly larger right pleural effusion.2. Residual soft tissue and fluid in the anterior mediastinum unchanged, with no specific evidence of recurrent thymoma. |
Generate impression based on findings. | Female 83 years old Reason: R/O obstruction History: dysphagia Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus demonstrated several areas of esophageal narrowing, which disappeared during full esophageal distention, perhaps reflecting tortuosity, extrinsic compression or tertiary contractions. Esophageal mucosal irregularity most suggestive of esophagitis. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated abruption of the primary peristaltic wave at the level of the aortic arch with proximal escape to the level of the thoracic inlet.TOTAL FLUOROSCOPY TIME: 3:36 minutes | 1.Esophageal mucosal irregularity suggestive of esophagitis. Direct visualization is recommended as clinically indicated.2.Minor motor abnormality.3.Esophageal luminal narrowing, not evident during full distention, suggestive of tortuosity, extrinsic compression or tertiary contractions. |
Generate impression based on findings. | 71 year old female with right sided parietal headache. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are grossly unchanged patchy foci of low attenuation throughout the supratentorial white matter most compatible with chronic small vessel ischemic disease. There is atherosclerotic calcification of the distal internal carotid arteries. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. There are bilateral lens implants. | 1.No evidence of intracranial hemorrhage.2.Moderate chronic small vessel ischemic disease. |
Generate impression based on findings. | 42 year old female who has a complaint of non-focal left breast pain. 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. If her left breast pain continues, the patient should return to her primary care physician for management of her symptoms. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 55 years old Reason: Pt is a 55 yo female with chronic abdominal pain, and nausea after meals. Diagnosed with SMA in the past s/p SMA surgical relief with duodenojejunostomy. need to be assess under fluoroscopy and assess for anastomotic site stenosis. History: abdominal pain, nausea Limited evaluation of the esophagus was without mucosal or mural abnormality.The stomach was mildly patulous. There was persistent narrowing of the pyloric channel, measuring 1.0 cm during maximal distention, a nonspecific finding, but possibly reflecting sequelae of gastritis. The stomach was initially aperistaltic; however, shortly after administration of contrast, normal peristalsis was evident. Postsurgical changes related to a side-to-side duodenojejunostomy are present. Contrast progressed promptly from the first portion of the duodenum to the mid to distal jejunum, without evidence of fixed narrowing to suggest stenosis. The duodenojejunostomy anastomosis was widely patent.TOTAL FLUOROSCOPY TIME: 5:05 minutes | 1.Post surgical changes related to duodenojejunostomy, with a widely patent anastomosis and no fixed narrowings to suggest stenosis.2.Nonspecific narrowing of the pyloric channel, measuring up to 1 cm during maximal distention, which may reflect sequelae of gastritis. Correlation with direct visualization is recommended as clinically indicated. |
Generate impression based on findings. | Female 65 years old Reason: Areas of uptake, please quantify any distant metastases History: Thyroid cancer metastatic to lung and adrenal s/p surgery, withdrawn for thyroid hormone There is expected I-131 activity in the salivary glands, stomach, colon, and urinary bladder. Functioning thyroid tissue in the thyroid bed is noted most likely representing remnant. Small focus in the midline anteriorly superior to the thyroid bed may represent thyroglossal duct remnant tissue over metastasis, although the latter is conceivable. No other evidence of iodine avid tumor.SPECT CT: Subcentimeter nodule in the right lung may be still present but not clearly visualized which may be due to slice selection or patient breathing motion artifact. No iodine avid lesion was seen in this vicinity.Probe uptake of the neck is 0.66%. | Residual thyroid tissue in the thyroid bed, and in probable thyroglossal duct remnant. No conclusive iodine avid disease elsewhere. |
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