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Generate impression based on findings. | 79-year-old female with suspicious right upper lobe nodule CHEST:LUNGS AND PLEURA: Interval increase in size of right apical nodule measures 12 mm, previously 9 mm (series 5, image 44).The index right upper lobe pulmonary lesion cannot be accurately measured on the current study due to resolution of the walled cyst and the presence of surrounding atelectasis. On review the prior study, this area appears to be atelectatic and no visible solid nodule is present. Associated traction bronchiectasis is present.Severe upper lobe predominant centrilobular emphysema.Unchanged therapeutic volume loss related to radiation therapy in the right lung.Right lower lobe mass-like opacity appears decreased in size when compared to the prior exam now measuring 4.8 x 1 .8 cm, previously 5.3 x 2.5 cm (series 5, image 148); this could represent evolving fibrosis.No pleural effusion or pneumothorax. Central airways are patent.MEDIASTINUM AND HILA: Severe atherosclerotic calcification of the thoracic aorta and its branches. Mild aneurysmal dilation of the origin of the left brachiocephalic artery. Heart size is normal. No pericardial effusion. Severe coronary artery calcification. Very small bulge upon the inferior margin of the aortic arch is unchanged. CHEST WALL: Prior vertebroplasty of T8 unchanged. Left 6th and 7th rib fracture. No significant axillary, cardiophrenic, or retrocrural lymphadenopathy.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic kidneys with significant atherosclerotic calcifications and multiple hypodense renal lesions, the largest of which appear benign and unchanged. Additional subcentimeter hypoattenuating renal lesions are too small to further characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcification of the abdominal aorta and its branches with aneurysmal dilatation of the infrarenal aorta measuring 5.8 cm using similar measurement parameters. There is a focal widemouthed aneurysm arising from the anterior wall of this aneurysmal segment (series 3, image 119). IVC filter is 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.Interval increase in size of right apical nodule.2.Assessment of right upper lobe lesion is complicated by postradiation reduction and atelectasis. Interval improvement of the walled cystic component.3.Right lower lobe mass-like opacity appears decreased in size and may represent evolving fibrosis.4.Interval increase in size of abdominal aortic aneurysm with new focal anterior aneurysmal component.Findings discussed with Dr. Villaflor at 1633 on 3/20/15. Phone-call was attempted to Dr. Eton. |
Generate impression based on findings. | 50 year-old female with hip and knee pain. Moderate stool and gas obscure the fine details of the pelvis. However, mild osteoarthritis affects the hips and sacroiliac joints.Mild osteoarthritis affects the right knee. There is no evidence of significant joint effusion or acute fracture. Alignment is preserved. | Mild osteoarthritis of the sacroiliac joints, the hips, and the right knee. |
Generate impression based on findings. | Low back pain. Three views of the lumbar spine show no acute fracture. There is a very mild leftward curvature of the lumbar spine. Vertebral body heights and disk spaces are maintained. | No acute fracture is evident. |
Generate impression based on findings. | Left knee pain. Four views of the left knee show moderate to severe joint space narrowing of the medial compartment and moderate narrowing of the lateral femoral compartment. Medial compartment osteophytes are noted. No acute fracture is evident.A side plate and screw devices affixes the proximal right tibia on the frontal view. | Moderate to severe osteoarthritis of the left knee. |
Generate impression based on findings. | Pain. Three views of the right shoulder show no acute fracture or dislocation. There is near severe osteoarthritis of the right glenohumeral joint with near bone on bone apposition.Three views of the left shoulder show no acute fracture or malalignment. The glenohumeral and acromioclavicular joints appear normal. | Near severe right shoulder osteoarthritis. |
Generate impression based on findings. | 66 -year-old male with left shoulder pain. Three views of the left shoulder demonstrate mild osteoarthritis, including mild joint space narrowing and subchondral sclerosis. Alignment is anatomic, there is no evidence of fracture. Osteoarthritis also affects the acromioclavicular joint. | Mild osteoarthritis of the left shoulder. |
Generate impression based on findings. | 73-year-old female with neck pain. Four views of the cervical spine demonstrate slight demineralization, suggestive of osteopenia. There is severe disk space narrowing of the cervical spine and anterior vertebral body osteophyte formation, sparing C2-3 and C7-T1 levels. Bulky osteophytes cause moderate bilateral neural foramina narrowing of the lower cervical spine, beginning at the level of C3, with relative sparing of C7-T1.Three views of the left shoulder demonstrate mild osteoarthritis, including subtle subchondral sclerosis and joint space narrowing. Mild osteoarthritis affects the acromioclavicular joint. | Degenerative disease of the cervical spine and left shoulder as above. |
Generate impression based on findings. | Male 17 years old Reason: foot fracture? History: pain swelling tender to L 4th metatarsalVIEWS: Left foot AP lateral and oblique 3/20/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Female 70 years old; Reason: mediastinal parathyroid adenoma History: s/p thyroidectomy LUNGS AND PLEURA: No specific evidence of infection or edema. No focal airspace opacities or pleural effusions. A ground glass micronodule in the left upper lobe is nonspecific (series 5, image 54).MEDIASTINUM AND HILA: An 8 x 7 mm nodule is again seen anterior to the pulmonary trunk (series 80332, image 37). No mediastinal or hilar lymphadenopathy is present. Calcified lower mediastinal lymph nodes reflects prior infectionNormal-sized heart without pericardial effusion. No appreciable coronary artery calcifications.CHEST WALL: No significant abnormality noted. No axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. A small hiatal hernia is present. Otherwise, no significant abnormality noted. | Unchanged 8 mm mediastinal nodule anterior to the pulmonary trunk. |
Generate impression based on findings. | Male 93 years old Reason: history of rising PSA with prostate cancer History: prostate cancer with rising PSA No abnormal osseous foci are identified to indicate metastatic disease. Increased uptake consistent with degenerative disease is again noted in both shoulders, knees, right L4-5, and right clavicular head, unchanged from prior exam. | No evidence of bone metastases. |
Generate impression based on findings. | Female 44 years old Reason: metastatic breast cancer, needs surveillance imaging History: vaginal discharge Again seen are multiple osseous metastatic lesions, including in the lumbar spine, upper thoracic spine, skull and the ribs. There is suggestion of new lesion at L4-5, the right inferior sacroiliac, left proximal femur. The left lateral mid rib also appears larger. These findings are suggestive of slight interval progression. | Findings suspicious for slight interval progression of osseous metastatic disease. |
Generate impression based on findings. | Anemia. Evaluate for retroperitoneal bleed. ABDOMEN:LUNG BASES: Bilateral pleural effusions (right greater than left) with overlying compressive atelectasis. Please refer to yesterday's chest CT for more details; these are not changed.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortic balloon pump. No evidence of retroperitoneal hematoma.BOWEL, MESENTERY: Dobbhoff tube terminates in the stomach. Nonobstructing right abdominal wall hernia containing colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter decompresses the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Right femoral central venous catheter. | No evidence of retroperitoneal hematoma as clinically queried. Aortic balloon pump. Bilateral pleural effusions, unchanged. Nonobstructive abdominal wall hernia. |
Generate impression based on findings. | Restaging head and neck uvula cancer status post chemoradiation therapy.RADIOPHARMACEUTICAL: 11.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates posttherapy changes in the neck. Right chest Port-A-Cath with tip in the SVC. Gastrostomy tube is noted.Today's PET examination demonstrates significant interval decrease in size and metabolic uptake of previous hypermetabolic left parapharyngeal lesion (SUV max = 12.2 previously, = 5.0 currently). The current moderate residual activity could reflect inflammation or some residual tumor metabolism.More inferiorly, a subcentimeter left jugular lymph node remains moderately hypermetabolic, unchanged from previous (SUV max = 5.3 previously, = 5.3 currently). This is of some suspicion for persistent tumor metabolism but could also represent inflammation.No new or additional suspicious FDG avid lesion seen elsewhere in the neck, chest, abdomen or pelvis. | 1.Significant interval decrease in left parapharyngeal lesion indicating a significant metabolic response to therapy. Small residual moderate activity at this site and the stable moderate activity in a more inferior subcentimeter left jugular lymph node may reflect some residual tumor metabolism versus inflammation. Attention to these regions on future follow-up exams can be made.2.No additional suspicious FDG avid lesion elsewhere in the neck, chest, abdomen or pelvis. |
Generate impression based on findings. | There has been evolution of the previously seen subdural hematoma over the right cerebral convexity. This collection has decreased in attenuation and now measures 9 mm in maximal thickness, previously 10 mm. There is no new intracranial hemorrhage. Scattered areas of white matter hypoattenuation suggests small vessel ischemic disease. There is global cerebral volume loss, particularly affecting the temporal lobes bilaterally. The ventricles are normal in morphology and size without hydronephrosis. The paranasal sinuses and mastoid air cells are clear. | Continued evolution of the right subdural hematoma without new intracranial hemorrhage. |
Generate impression based on findings. | 58 year old male with altered mental status on anti-coagulation. 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 is opacification and atelectasis of the left maxillary sinus. The imaged paranasal sinuses and mastoid air cells are otherwise clear. The skull and extracranial soft tissues are unremarkable. | No evidence of intracranial hemorrhage. |
Generate impression based on findings. | Healing fractures are again seen in the posterior left 10th and 11th ribs.The previously visualized healing fractures along the posterior left ninth and right ninth and 10th ribs are not visualized on this exam.Healing fracture of the clavicle high more callus formationCasting material obscures fine osseous detail and left arm, forearm, and hand. Left distal humerus fracture better evaluated on same day dedicated elbow radiograph.Periosteal reaction along the left tibia is similar to the prior exam.No other acute or healing fractures noted.The cardiothymic silhouette is normal. No focal pulmonary opacities, pleural effusions, or pneumothorax.Nonobstructive bowel gas pattern. | Healing fractures of the left 10th and 11th posterior ribs and left clavicle as detailed above. A left distal humerus fracture has significant new callus formation, compatible with acute presentation on 3/4/2015. Periosteal reaction along the left tibia is similar to the prior exam. |
Generate impression based on findings. | There is interval significant thickening and enhancement of the right frontal scalp, likely related to prior frontal scalp wound noted on medical records. Stable thickening of the right parietal scalp, which also appears enhancing on this contrast CT. No associated osseous changes noted.There are unchanged postoperative findings related to suboccipital craniotomy and prior posterior inferior cerebellar artery aneurysm clipping. There is an unchanged left transparietal ventricular shunt catheter terminating in the right frontal horn. The efferent catheter of the shunting system is incompletely imaged and appears to terminate regional to the dorsal aspect of the thecal sac at C1, also unchanged. There is unchanged appearance of the ventricles. There is stable focus of cystic encephalomalacia in the right caudate head. There is no acute intracranial hemorrhage or mass effect. There is no significant midline shift or herniation. | 1.Interval new thickening and enhancement of the right frontal scalp, likely at least in part related to prior wound and interval postprocedural changes. Correlation with physical exam is recommended as superimposed soft tissue infection would have a similar appearance. No focal fluid collection or abscess identified.2.No significant change in ventricular shunt or ventricular caliber. |
Generate impression based on findings. | Female; 40 years old. Reason: assess for metastatic disease CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Right chest wall Port-A-Cath tip in the superior cavoatrial junction.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Stable punctate nonspecific hypoattenuating focus in segment 6 (series 401/71).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: Mild retroperitoneal lymphadenopathy has slightly decreased since prior study. Reference left periaortic lymph node measures 10 x 10 mm, previously 12 x 10 mm (series 41/117).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Small amount of endometrial fluid, likely physiologic.BLADDER: No significant abnormality noted.LYMPH NODES: Mild pelvic lymphadenopathy has slightly decreased since prior study. Reference proximal left common iliac lymph node measures 11 x 13 mm, previously 14 x 18 mm. Again prominent lymph nodes are seen along the right and left common iliac chains, as well as the external iliac and obturator chains, stable to slightly decreased since prior study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable bone island in the posterior column of the left acetabulum.OTHER: Small amount of pelvic free fluid, similar to prior study and likely physiologic. | Mild retroperitoneal and pelvic lymphadenopathy has slightly decreased in size since prior study. Please see report from PET examination performed concomitantly. |
Generate impression based on findings. | 13-year-old female with tenderness to palpationVIEWS: Left tibia-fibula AP, lateral (two views) 3/20/15 No fracture or malalignment. No significant soft tissue swelling. | No fracture or malalignment. |
Generate impression based on findings. | Rheumatoid arthritis. Evaluate for disease progression. Three views of the left hand again show chronic erosive changes of the fifth metacarpophalangeal joint. Scattered arthritic changes affecting the interphalangeal joints appear similar to the prior study except for mild increased osteoarthritis of the middle finger DIP joint. No new erosions are identified.Three views of the right hand show chronic appearing erosions of the metacarpophalangeal joints appearing similar to the prior study. No new erosions are identified. There is narrowing of scattered interphalangeal joints which likely represents a combination of rheumatoid arthritis and osteoarthritis, appearing similar to the prior study.Three views of the left foot show no acute fracture or malalignment. No new erosive changes are identified.Three views of the right foot show no acute fracture or malalignment. No new erosive changes are identified. | No evidence of progression of rheumatoid arthritis. |
Generate impression based on findings. | Rheumatoid arthritis. Evaluate for erosive disease. Three views of the left hand reveal juxtaarticular osteopenia. A small erosion is noted at at the ulnar aspect of the lunate bone and the triquetrum. No fracture is evident.Three views of the right hand show juxtaarticular osteopenia. Small erosions are noted along the ulnar aspect of the scaphoid and triquetrum. No acute fracture is evident.Three views of the left foot show no acute fracture or malalignment. No erosive changes are identified.Three views of the right foot show no acute fracture or malalignment. No erosive changes are identified. | Bilateral carpal erosions compatible with rheumatoid arthritis. |
Generate impression based on findings. | 55 year old female status post right mastectomy in 2004 for breast carcinoma, presents today for routine follow up. Patient received hormonal therapy. No current breast complaints. No family history of breast cancer. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female, 5 months old. Reason: concern for VOD in stem cell transplant patient History: edema, tachycardia DOPPLER: Spectral and color Doppler of the inflow and outflow vessels of the liver and spleen was performedPORTAL VENOUS: Patent hepatopetal portal flow measures 0.3 m/sec.HEPATIC ARTERIES: Normal hepatic arterial waveform with peak systolic velocity of 0.8 m/sec and resistive index of 0.66.HEPATIC VEINS: Patent, with normal phasic flow.INFERIOR VENA CAVA: PatentLIVER: The liver measures 9.3 cm. homogeneous echotexture, without focal lesion.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.2 cm.PANCREAS: Visualized portions of the pancreas are normal.SPLEEN: The spleen measures 5.6 cm. Normal directional splenic vascular flow. Splenic artery flow velocity of 0.4 m/sec. Splenic vein flow velocity of 0.2 m/sec.KIDNEYS: Normal echotexture, without focal lesion or significant hydronephrosis. The right kidney measures 6.2 cm. The left kidney measures 6.0 cm. OTHER: No significant abnormality noted. | Normal examination. |
Generate impression based on findings. | Reason: mandibular or maxillary fracture History: fall onto face Head: No acute intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or hydrocephalus. No extra-axial fluid collections. Generalized cerebral volume loss. The imaged orbits are intact. Max/Facial: Multiple mandibular and maxillary dental periapical lucencies compatible with dental disease. There are several missing teeth/missing crown with residual dental root. Paranasal sinuses and imaged mastoid air cells are clear. The ostiomeatal complexes are normal with intact uncinate processes and patent infundibuli. The intersphenoid septum is normal. The nasal turbinates and nasal septum are normal. The cribriform plate, fovea ethmoidalis and lamina papyracea appear normal. Mild left degenerative changes of the TMJ. Degenerative disease of the imaged cervical spine. | 1.No fracture is identified.2.Multiple mandibular and maxillary dental periapical lucencies compatible with dental disease.3.No acute intracranial hemorrhage. |
Generate impression based on findings. | 16-year-old male with history of constipationVIEW: Abdomen AP (one view) 3/20/15 The abdomen radiograph is underexposed. Gastrostomy tube is present. Severe lumbar levoscoliosis. Nonobstructive bowel gas pattern with a small to moderate stool burden. No pneumatosis, free air, or portal venous gas. The right femoral head is abnormally placed in relation to the acetabulum consistent with development hip dysplasia. | Small to moderate stool burden. |
Generate impression based on findings. | 48-year-old female with history of left shoulder pain, decreased range of motion, sarcoidosis. Three views of the left shoulder demonstrate minimal osteoarthritis affecting the glenohumeral and acromial clavicular joints. Partially visualized sternotomy wires are unremarkable. There is no acute fracture or malalignment.Three views of the right shoulder demonstrate minimal osteophytes at the glenohumeral and acromioclavicular joints. Multiple surgical clips project over the right axilla. There is no evidence of acute fracture or malalignment.Three views of the left hand demonstrate mild juxta-articular osteopenia, but no other evidence of rheumatoid arthritis, specifically no marginal erosions. There is no acute fracture or malalignment. The joint spaces appear preserved.Three views of the right hand also demonstrate mild juxta-articular osteopenia, without other discrete evidence of inflammatory arthritis, specifically no marginal erosions. There is no acute fracture or malalignment. The joint spaces appear preserved. | 1.Minimal osteoarthritis of the shoulders.2.Juxta-articular osteopenia of the carpal and metacarpal joints in the hands, without other discrete evidence of inflammatory arthritis. |
Generate impression based on findings. | 4-month-old female, evaluate pulmonary anatomy, history of chylothorax LUNGS AND PLEURA: Diffuse bilateral coarse pulmonary opacities with more confluent consolidation in the right and left upper lobes. No significant pneumothorax. Trace left pleural effusion. Left chest tube with tip near the apex. Endotracheal tube tip between the thoracic inlet and the carina.MEDIASTINUM AND HILA: Hypodensity of the blood is consistent with anemia. The heart size is normal without pericardial effusion. Left lower extremity central line terminates in the right atrium. 1.0-cm linear calcification along the left brachiocephalic vein likely represents a calcified thrombus from a prior PICC.CHEST WALL: Soft tissue edema is present diffusely. Several left lateral rib focal areas of sclerosis and periosteal reaction likely secondary to prior chest tubes.UPPER ABDOMEN: Nasogastric tube tip is in the gastric body. The noncontrast liver, stomach, and spleen are normal in appearance. Punctate right renal calculus. | 1.Diffuse bilateral coarse pulmonary opacities. 2.Trace left pleural effusion. 3.Linear calcification in the region of the left brachiocephalic likely represents a calcified thrombus. 4.Several left lateral rib fractures likely secondary to chest tubes. |
Generate impression based on findings. | Male 66 years old Reason: follow up for prostate cancer History: prostate cancer Again seen is widespread osseous metastatic disease in a so-called SuperScan distribution. While interval change of this disease is difficult to assess given its widespread nature, there are no new definite lesions identified, with multiple lesions appearing less conspicuous. There is also some normalization of the soft tissue to bone ratio suggesting some overall improvement. | Widespread osseous metastatic disease with likely improvement over previous exam with no definite new lesion. |
Generate impression based on findings. | Reason: CVA History: CVA. Left hemiparesis and visual field defect. Right hemispheric syndrome. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hyperdense MCA and ICA sign present.There is loss of the gray-white distinction along the middle cerebral artery distribution of the right temporal lobe, right frontal lobe and right parietal lobe associated with loss of the right insular stripe.There are more punctate foci of hypodensity in the basal ganglia bilaterally.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Findings are suggestive of early evidence for right middle cerebral artery territory acute ischemic stroke due to right carotid terminus occlusion. 2.No evidence for acute intracranial hemorrhage or mass effect.3.On a couple hypodense foci in the basal ganglia bilaterally are suspected to be vascular related. They could represent prior lacunar infarcts.4.These findings were discussed with doctor Ardelt to determine the treatment course at the time the exam was acquired. |
Generate impression based on findings. | Pain. History of JIA. Three views of the left hand show juxtaarticular osteopenia. There are erosions at the base of the ulnar styloid and lunate. Narrowing of the distal articulations is noted, most predominately affecting the MCP joints, without clear erosions. The carpal articulations are narrowed. Swan-neck deformities are noted of the third through fifth digits.Three views of the right hand show juxtaarticular osteopenia. There are erosions at the base of the ulnar styloid, scaphoid, and lunate. Narrowing of the distal articulations is noted, most predominately affecting the MCP joints, without clear erosions. The carpal articulations are narrowed. Swan-neck deformities are noted of the third through fifth digits.Three views of the left foot show marked hallux valgus deformity with near complete dislocation. There is dislocation of the remaining metatarsophalangeal joints. No definite erosions are seen.Three views of the right foot show marked hallux valgus deformity with near complete dislocation. There is dislocation of the remaining metatarsophalangeal joints. No definite erosions are seen. | Inflammatory arthritic changes as described above. |
Generate impression based on findings. | Male, 47 days old. Increased work of breathing. Evaluate for aspiration.EXAMINATION: Oropharyngeal motility study 3/20/2015, 1330 Beth Harrison, speech and language therapist, supervised the examination.1 minute 53 seconds of fluoroscopy was used.Decreased expression of fluid with slow flow presentation, with 2 - 3 sucking motions per swallow. Improved expression with medium flow presentation.Delayed trigger of pharyngeal swallow, with deficient laryngeal closure.Penetration of thin liquids via slow flow, half-strength nectar via slow flow, nectar thick via slow flow in medium flow. No cough. A greater degree of penetration is seen with nectar thick liquids. No aspiration. | Penetration without aspiration as detailed above.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Reason: Pleural mesothelioma please compare to prior exam provide bi-dimensional measurements per RECIST 1.1 criteria History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Pleural thickening/nodularity and loculated pleural effusion within the left hemithorax compatible with the stated history of mesothelioma.Level the subclavian vein (series 3 image 19): One o'clock position 12 mm thickness, 5 o'clock position 9 mm thickness. Note, this apical pleural thickening may be more accurately measured on the coronal projection where it measures 9 mm (series 8028 image 51).Level of the left pulmonary artery (series 3 image 35): 11 o'clock position 7 mm.MEDIASTINUM AND HILA: The scattered subcentimeter mediastinal lymph nodes. No significant hilar mediastinal lymphadenopathy. The heart size is normal. No pericardial effusion. Mild coronary artery calcification.CHEST WALL: Status post right mastectomy and ipsilateral axillary lymph node dissection with saline breast prosthesis. Left chest port with tip in the superior vena cava.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: Stable left adrenal nodularity.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.Nodularity and loculated pleural effusions in the left hemithorax as described compatible with the history of mesothelioma. Findings are not significantly changed since the outside hospital exam on 2/6/15.2.No evidence of metastatic disease in the upper abdomen. |
Generate impression based on findings. | 44-year-old female with history of orthopedic fixation of left ankle fracture. Three views of the left ankle again demonstrate a plate and screw device affixing a fracture of the distal fibular diaphysis, in near-anatomic alignment. There is no radiographic evidence of hardware complication. A K-wire and screw also affix the fracture of the medial malleolus, in near-anatomic alignment. The fracture plane appears less distinct on the current study, with interval callus formation, particularly along the tibiofibular syndesmosis, compatible with healing. The fracture line is indistinct along the nondisplaced "posterior malleolus" fracture of the distal tibia. There is persistent diffuse soft tissue swelling, not significantly changed. | Orthopedic fixation of distal fibular and tibial fractures as above. |
Generate impression based on findings. | 62 year-old female status post removal of left elbow hardware. Four views of the left elbow again demonstrate evidence of previous orthopedic fixation of the olecranon, not significantly changed when compared to prior exam. There is been interval resolution of soft tissue gas, which was likely postoperative. There is mild diffuse soft tissue swelling. No acute fracture is evident. The bones again appear demineralized. Ossific densities posterior to the olecranon are unchanged. | Stable exam without evidence of acute fracture. Chronic deformities as above. |
Generate impression based on findings. | Images are limited secondary to portable technique, with areas of beam hardening and other artifact. There is a focal area of low density in the high right cerebellum, with more extensive abnormal low density in the right inferior cerebellum which appears predominantly to be a true finding although there may be a mild component of beam hardening artifact. There is no significant cerebellar tonsillar herniation at this time, although the right cerebellar tonsil does extend more caudally than the left and impending herniation is likely. There is additional abnormal low density within the anterior left parietal lobe extending into the deep white matter. There is associated sulcal effacement.There is partial effacement of the fourth ventricle. The ventricles and sulci are otherwise within normal limits. There is no midline shift. There is no intracranial hemorrhage. There is no extraaxial fluid collection. There are air levels in the maxillary sinuses. There is near complete opacification of the frontal, ethmoid, and sphenoid sinuses. There is trace fluid within bilateral mastoid air cells. There is a partially visualized nasogastric tube. Prominent right-sided subgaleal swelling is noted. | 1. Scattered areas of abnormal low density, the largest in the right inferior cerebellum, suggestive of embolic acute infarcts. Continued follow-up is recommended for impending cerebellar tonsillar herniation. No acute intracranial hemorrhage.2. Extensive paranasal sinus with air-fluid levels and mastoid opacification. Please correlate clinically.Dr. Yang discussed these findings over the telephone with Dr. PATEL, ROSHAN on 3/20/2015 4:45 PM, who was already aware. |
Generate impression based on findings. | 46 your old male status post left total hip arthroplasty. Single view of the left hip demonstrates hardware components of a total hip arthroplasty in near-anatomic alignment; no evidence of fracture or dislocation. Surgical drain and iatrogenic gas are present in the soft tissues. Frontal view of the pelvis demonstrates mild osteoarthritis affects the right hip. | Total left hip arthroplasty as above. |
Generate impression based on findings. | Female 40 years old Reason: assess for metastatic cervical cancer RADIOPHARMACEUTICAL: 13.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 99 mg/dL. Today's CT portion of the neck demonstrates no gross pathology.Today's PET examination demonstrates subcarinal hypermetabolic lymph nodes which have slightly decreased in size, and activity. There are numerous markedly avid hypermetabolic lymph nodes with SUV previously 10.8 now 8.3, consistent with persistent tumor hypermetabolism. Previous extensive hypermetabolic retroperitoneal and iliac lymph nodes have decreased moderately in size, number and metabolic activity, with SUV previously 15.1 now 9.7. There is significant abnormal metabolic activity involving multiple retroperitoneal and bilateral iliac lymph nodes is present indicating hyperactive metastatic disease in these locations as well. Previous hypermetabolic left supraclavicular lymph node is not well visualized but this region is not well seen due to hypermetabolic brown fat. Metabolically active brown fat is also seen in the thorax and upper abdomen. | Moderate improvement in metabolic activity but some significant persistent metabolically active metastases involving multiple retroperitoneal and subcarinal lymph nodes.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 63-year-old female status post left total hip arthroplasty. Single view of the left hip demonstrates hardware components of a total hip arthroplasty in near-anatomic alignment; no evidence of fracture or dislocation. Surgical drain, and iatrogenic gas are present in the soft tissues. Frontal view of the pelvis demonstrates a partially-visualized right total hip arthroplasty. Degenerative disease affects the lower lumbar spine and sacroiliac joints. | Total hip arthroplasty as above. |
Generate impression based on findings. | Male, 8 years old. PMH of fevers x1 week and persistent abdominal pain. Would like to evaluate for alternate etiology ABDOMEN:LUNG BASES: New small bilateral pleural effusions, with mild associated compressive atelectasis bilaterally.LIVER, BILIARY TRACT: Normal hepatic enhancement, without focal lesion. No biliary ductal dilatation. The gallbladder is normal in appearance.SPLEEN: Normal in size and enhancement.PANCREAS: Normal in size and enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: MIld improvement in right renal cortical enhancement, with residual areas of decreased enhancement in the upper and lower poles, in a lobar distribution.Wedge-shaped areas of decreased enhancement on the left, more apparent than prior.Stable grade 1-2 pelvicaliceal dilatation bilaterally. No significant hydronephrosis. No hydoureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple fluid-filled nondilated loops of small bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Moderately distended.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No inflammatory changes are seen in the right lower quadrant. The appendix is normal and retrocecal.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Free pelvic fluid, increased from the prior exam. | Mild improvement in right-sided pyelonephritis. Left pyelonephritis is more apparent compared to the prior exam. New bilateral pleural effusions and increased free peritoneal fluid. |
Generate impression based on findings. | Male 24 years old; Reason: G-tube placement History: evaluate for G-tube placement Gaseous distention of small bowel and colon most suggestive of an ileus.Enteric contrast outlines the rugal folds of the stomach indicating the placement of the gastrostomy catheter.Postsurgical changes in the thoracolumbar spine, tracheostomy catheter, vascular catheters. | 1.Administered contrast outlines the rugal folds of the stomach confirming intragastric tube placement. |
Generate impression based on findings. | There is trace grade 1 retrolisthesis of L3 on L4 and L4 on L5. The scout lateral view and the sagittal reformatted images demonstrate the lumbar spine to otherwise be in normal alignment, with a normal lumbar lordosis. There is mild anterior wedging of the L1 vertebral body. The vertebral body heights are otherwise well-maintained. There is multilevel disk space narrowing, to moderate-severe in degree at L3-L4.There are innumerable lucencies of varying sizes throughout the visualized vertebrae. There is extensive destruction involving the right hemisacrum with infiltration of the right S1-S2 foramen by tumor. At the L1 level, there is posterior vertebral body cortical disruption along the right side with evidence of epidural component of the tumor as seen on 4/10 measuring approximately 9 x 11 mm in greatest axial dimensions, by 18 mm CC. There is moderate narrowing of the central spinal canal at this level. At the L3 level, tumor within the left proximal transverse process likely extends into the left lateral epidural space as seen on 4/32. Within the right L3 lamina, there is a soft tissue mass which extends into the immediate right paraspinal fat. These are all findings consistent with known metastatic disease, progressed since previous body CT. At T12-L1, there is a mild disk bulge with right foraminal prominence resulting in minimal right foraminal narrowing.At L1-L2, there is a trace disk bulge with mild bilateral foraminal narrowing and mild suggest metastasis.At L2-L3, there is a mild disk bulge with left-sided prominence. There is mild to moderate central spinal canal stenosis and mild-moderate bilateral foraminal narrowing.At L3-L4, there is a mild diffuse posterior osteophyte disk complex. There is significant left facet arthropathy with overall moderate central spinal canal stenosis as well as moderate-severe left and moderate right foraminal narrowing.At L4-L5, there is a diffuse disk bulge with bilateral facet arthropathy and ligamentum flavum thickening there is overall moderate to severe central spinal canal stenosis as well as moderate-severe bilateral foraminal narrowing.At L5-S1, there is a trace disk bulge with no significant stenosis.There are numerous bilateral pelvic surgical clips. There is a partially visualized right total hip replacement. | 1. Progression of diffuse osseous lytic metastatic disease involving the visualized lumbosacral spine. Anterior wedge deformity of L1, consistent with pathologic compression fracture. Dorsal epidural spread of tumor at this level with moderate narrowing of the central spinal canal. Possible minimal extension of tumor into the epidural space at the L3 level from the metastatic lesion in the left transverse process. MR of the lumbar spine recommended for a more complete evaluation2. Destruction of the right hemisacrum with extension of tumor into the right S1-S2 foramen.3. Multilevel spondylotic changes as detailed above, including trace degenerative grade 1 subluxations. |
Generate impression based on findings. | Adenocarcinoma metastatic to the brain of unknown primary.RADIOPHARMACEUTICAL: 16.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 97 mg/dL. Today's CT portion grossly demonstrates left craniotomy defect with intraparenchymal hot areas of high and low density with intracranial air, similar to recent head CT. Prior right craniotomy defect also noted. Pulmonary emphysema atelectasis is present. Extensive atherosclerosis including coronary arterial calcifications are seen.Today's PET examination demonstrates altered are distribution with increased skeletal muscle activity suggesting a nonfasting/high insulin state which has the potential to limit the exam. A small markedly hypermetabolic focus is seen involving the sigmoid colon (SUV max = 6.2). While this may well represent an unusually focal benign physiologic colonic appearance, given the history, colonic neoplasm is conceivable.No additional abnormal FDG avid focus is identified. Decreased activity is seen involving bilateral cerebral hemispheres consistent with regions of tumor resection. | 1.Small hypermetabolic sigmoid colon focus is present and while usually benign, colonic neoplasm is a consideration given the history. If there has not been a recent colonoscopy, this would be useful for further evaluation.2.Otherwise no suspicious FDG avid lesion. |
Generate impression based on findings. | Gastroesophageal cancer. Chemotherapy last given two weeks ago. Restaging exam.RADIOPHARMACEUTICAL: 14.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 86 mg/dL. Today's CT portion grossly demonstrates a large right and medium left pleural effusion. Large esophageal stent is noted. Ascites is present. There is extensive atherosclerotic including coronary arterial calcifications. Scattered sclerotic osseous foci are seen most notably within the pelvis.Today's PET examination demonstrates extensive benign brown fat hypermetabolism in the neck, chest, and upper abdomen which somewhat limits the interpretation. Moderately hypermetabolic distal esophageal region activity (SUV max = 7.9) is compatible with the patient's diagnosis of gastroesophageal cancer. More mildly FDG avid activity extends superiorly surrounding the esophageal stent which may reflect inflammatory reaction and/or tumor extension.Several small mildly hypermetabolic lymph nodes in the paraesophageal and gastrohepatic regions (SUV max = 3.9), are suspicious for regional lymph node metastases.Multiple small subtle but abnormal hypermetabolic osseous foci are seen including involvement of the left scapula, spine, bilateral iliac wings, bilateral acetabulae, bilateral proximal femurs, and left parasymphyseal region (SUV max = 4.2), highly suspicious for osseous metastases. | 1.Distal esophageal hypermetabolic lesion, compatible the patient's history of gastroesophageal cancer.2.Several small hypermetabolic paraesophageal and gastrohepatic region lymph nodes, suspicious for regional lymph node metastases.3.Numerous subtle hypermetabolic osseous foci, highly suspicious for multifocal bone metastases. |
Generate impression based on findings. | Neuroblastoma status-post MIBG therapy. Multiple areas of abnormal radiotracer uptake are again seen within the left supraclavicular region, the posterior right mediastinum, the distal left paraspinal region, and in a large portion of left retroperitoneum/ left upper abdomen. These areas appear somewhat decreased in size and uptake in all locations although do remain significantly MIBG avid. No osseous MIBG avid tumor is identified. No new MIBG avid lesion. | Multifocal disease in the left supraclavicular, chest, and abdomen while similar in distribution to previous has decreased somewhat in size and uptake although remain significantly MIBG avid. No osseous MIBG avid tumor. No new MIBG avid lesion. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial hemorrhage. Signs and symptoms: Headache and head injury with loss of consciousness. Nonenhanced head CT:No detectable acute intracranial process. Unremarkable calvarium and soft tissues of the scalp. Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age of 82.Unremarkable paranasal sinuses and mastoid air cells and orbits. | No acute intracranial findings. |
Generate impression based on findings. | Clinical question: Evaluate for bleed. Signs and symptoms: AMS and possible fall. Unenhanced head CT:No detectable acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces as well as gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp, unremarkable orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: 45-year-old male with metastatic cancer. Now with right facial droop. Rule out CVA or hemorrhage. Signs and symptoms: As above. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are tiny foci of low-attenuation in the bilateral cerebellum inferiorly and a tiny focus in the head of left caudate nucleus which are nonspecific. Recommend follow-up with an MRI exam.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells with the exception of tiny dictation cysts in the maxillary sinuses. | 1.No acute intracranial hemorrhage, mass effect, midline shift or hydrocephalus.2.Tiny foci of low-attenuation in bilateral inferior cerebellum and left caudate head of unknown etiology. Follow-up with an MRI is recommended to exclude possibility of ischemic strokes. |
Generate impression based on findings. | Clinical question: Evaluate for fracture or intracranial hemorrhage. Signs and symptoms: Head trauma, intoxicated and unclear history. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is been sensitive for early detection of acute nonhemorrhagic ischemic strokes.There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable orbits.A small retention cyst in the right maxillary sinus and unremarkable paranasal sinuses are otherwise. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Concern for encephalopathy versus intracranial hemorrhage. Signs and symptoms: Concern for abuse. Nonenhanced head CT:There is no evidence of an acute intracranial process. The cerebral cortex, cortical shoulders right, ventricular system, CSF spaces and gray -- white matter differentiation is within normal.Calvarium is unremarkable.Soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.Patchy opacification of bilateral paranasal sinuses, mastoid air cells and right middle ear cavity concerning for otitis media. | 1.Unremarkable nonenhanced head CT.2.Patchy opacification of bilateral mastoid air cells and right middle ear cavity concerning for otitis. Patchy opacification of paranasal sinuses. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial changes, elevated pressure, hemorrhage, infection progression, herniation. Signs and symptoms: Left-sided weakness weakness and brain tumor. Nonenhanced head CT:Unremarkable images through posterior fossa and with normal size of fourth ventricle being midline.Examination demonstrates significant interval increase in vasogenic edema in the right frontal lobe which extends into the right basal ganglia and with result in significant mass effect on the right lateral ventricle and leftward deviation of midline approximately 13.5 mm.there is no evidence of ventriculomegaly. There is no evidence of hemorrhage.Unremarkable orbits, paranasal sinuses and mastoid air cells. Calvarium demonstrate chronic expected postoperative changes are the right large frontal craniotomy. | 1.Significant interval increase in vasogenic edema in the right frontal lobe on this nonenhanced exam and likely secondary to metastatic disease Rituxan up with an MRI exam is recommended.2.Mass effect and deviation of midline to the left of approximately 13.5 mm.3.No evidence of hemorrhage or hydrocephalus. |
Generate impression based on findings. | Clinical question: AMS, thrombocytopenia. Signs and symptoms: AMS. Nonenhanced head CT:There is no detectable intracranial hemorrhage or mass effect.There are enlarged supratentorial ventricular system. There is a right posterior temporal approach ventricular catheter entering the right occipital horn, extending superiorly into the anterior body of left lateral ventricle. No prior exams for comparison. The cortical sulci are identified and prominent. Periventricular subcortical low attenuation white matter is noted which is a nonspecific finding however as representing microvascular ischemic changes of indeterminate age. | 1.No acute intracranial process.2.Enlarged supratentorial ventricular system with a ventricular catheter as detailed. No prior exams for comparison.3.Age indeterminate small vessel ischemic strokes of mild-to-moderate degree. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: 15 minutes of slurred speech, has been drinking. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is a focus of well demarcated low attenuation in the right basal ganglia with resultant expansion of right frontal horn of lateral ventricle and consistent with a large chronic lacunar infarct. If clinical concern for stroke persist recommend MRI exam. Moderate intracranial large vessel arterial calcification is noted.Unremarkable intracranial contents otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Chronic right basal ganglia lacunar infarct with ex vacuo dilatation right frontal horn. |
Generate impression based on findings. | Female, 4 years old. Reason: open fx History: ttpVIEWS: Right hand, PA, lateral, oblique (3 views) 3/20/2015, 1712 The osseous structures and joint spaces are normal.No significant joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male, 7 years old. Reason: please eval for obstruction or malrotation History: bilious emesisVIEW: Abdomen AP (one view) 3/20/2015, 1730 Nonobstructive bowel gas pattern.Small to moderate colonic stool burden. | No evidence of obstruction. |
Generate impression based on findings. | Female 94 years old Reason: Patient with chronic cough, SOB, expiratory wheezing + inspiratory upper airway sounds, CXR with LLL consolidation, possible mucous plugging . Please evaluate, rule out endobronchial lesion. LUNGS AND PLEURA: Small left lower lobe consolidation may represent focal atelectasis or pneumonia. Mild bronchiectasis in the right lung base. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Ascending thoracic aortic aneurysm measuring 4.7 cm in maximum diameter. Within the ascending aorta there is a linear hyperdensity which raises the possibility of a dissection flap, however this would be better evaluated on a gated, contrast enhanced examination. Surgical changes involving mitral annulus and aortic root. Mildly dilated main pulmonary measuring 3.2 cm in diameter compatible with pulmonary hypertension. Mild cardiac artery atherosclerotic calcification. No pericardial effusion.AP frontal lymph node is upper limits normal in size measuring 10 mm in short axis (series 4 image 37).CHEST WALL: Severe degenerative changes affect the thoracic spine with chronic appearing vertebral compression fracture at T11.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Partially visualized indeterminate cystic lesions in the superior pole of the right kidney. | 1.Left lower lobe consolidation may represent focal atelectasis or pneumonia. No definite endobronchial lesion is identified as clinically queried.2.Ascending thoracic aortic aneurysm with findings suspicious for a type A dissection as described. This is better evaluated with a dedicated contrast enhanced gated exam. |
Generate impression based on findings. | Male, 8 years old. Reason: interval changes History: s/p esophageal dilationVIEW: Chest AP (one view) 3/20/2015, 1850 Mediastinal clips are again seen. New lower extremity central venous catheter tip at the IVC/RA junction.Persistent rightward mediastinal shift. Cardiac silhouette size cannot be evaluated.Postoperative changes in the right hemithorax, with a loculated apical pneumothorax and chronic volume loss. Increasing opacity of the right hemithorax.Mildly improving left lung base streaky opacities. Small left pleural effusion. | Decreasing right lung aeration. |
Generate impression based on findings. | Female, 17 days old. Reason: r/o clavicle fracture. 2 week w/ protrusion of clavicle. History: protrusion of clavicleVIEW: Chest AP (one view) 3/20/2015, 1948 The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax.Periosteal callus formation around the mid to distal left clavicle, indicating healing.Lateral fracture fragment with inferior angulation. | Healing left clavicular fracture. |
Generate impression based on findings. | Male, 7 years old. Reason: Rule out abd obstruction History: bilious emesis, abd pain, h/o pyloric stenosis s/p repairVIEWS: Abdomen AP, upright and supine (two views) 3/20/2015, 2005 Nonobstructive bowel gas pattern.No pneumatosis, portal venous gas, or free air. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female, 4 years old. Reason: rule out constipation History: abdominal painVIEW: Abdomen AP (one view) 3/20/2015, 2015 Nonobstructive bowel gas pattern.No significant stool burden. | No evidence of obstruction. |
Generate impression based on findings. | Chest pain and shortness of breath. Evaluate for pulmonary embolism. PULMONARY ARTERIES: No pulmonary embolus. Pulmonary arteries are normal in size.LUNGS AND PLEURA: Paramediastinal fibrosis, postradiation changes, and right upper lobe atelectasis are similar to prior exam. Small loculated right pleural effusion is also similar to prior.MEDIASTINUM AND HILA: The heart is normal in size. Severe coronary artery atherosclerotic calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No pulmonary embolism other findings to account for the patient's acute symptoms.2.Stable postradiation changes in the right upper lung.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Male, 16 years old. Reason: rule out fracture History: tooth displacement, mandibular injuryVIEWS: Mandible Panorex (one view) 3/20/15, 2048 No acute fracture. The temporomandibular joints are normal.The maxillary sinuses are clear.Orthopedic hardware is noted comment can be better evaluated on physical exam. | No acute fracture. |
Generate impression based on findings. | Female 98 years old Reason: Evaluate for pulmonary embolus History: pleuritic CP, elevated D-Dimer 18 PULMONARY ARTERIES: Multiple, acute, large bilateral pulmonary emboli in the bilateral main pulmonary arteries and extending into the right middle, right lower, and left lower pulmonary arteries. Enlarged main pulmonary measuring 3.5 cm in diameter compatible with pulmonary hypertension. The interventricular septum is straightened suggesting a component of right heart strain.LUNGS AND PLEURA: Ground glass and reticular peripheral opacity in the right lower lobe is most compatible with a developing infarct. No additional areas of focal airspace consolidation. Trace right pleural effusion.MEDIASTINUM AND HILA: The heart is upper limit of normal in size. Pulmonary artery enlargement and evidence of right heart strain as described above. Moderate coronary atherosclerotic calcifications. Patulous esophagus. No mediastinal or hilar lymphadenopathy.CHEST WALL: Moderate multilevel degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Indeterminate well-defined hypodense focus in the caudate lobe of the liver likely represents a proteinacious or hemorrhagic cyst but is incompletely evaluated on this noncontrast exam. Splenic calcifications compatible with prior granulomatous infection. | 1. Multiple acute bilateral pulmonary emboli with evidence of right heart strain as described.2. Right lower lobe opacity with features compatible with a developing pulmonary infarct.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Positive. |
Generate impression based on findings. | Female 6 days old Reason: abdomen is loopy after a few days of starter feeds, evaluate for signs of NEC History: abdominal distensionVIEW: Chest and abdomen AP (two views) 3/21/15 at 711 hours. Interval removal of umbilical line and resolution of portal venous gas. NG tube terminates in the stomach. Cardiac silhouette size is normal. Large lung volumes with no focal opacities, effusions or pneumothorax.Generalized, nonspecific bowel distention. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval removal of umbilical line and resolution of portal venous gas.Generalized, nonspecific bowel distention. |
Generate impression based on findings. | Female, 5 months old. Reason: ate, PNA, PE History: desatsVIEW: Chest AP (one view) 3/20/15, 2130 Enteric tube with distal side port below the GE junction.Large remedy CVC tip at the IVC/RA junction.The cardiothymic silhouette is normal.Increasing lung haziness, and scattered opacities, prominently in the left upper lobe. | Scattered lung opacities, most prominent in the left upper lobe. |
Generate impression based on findings. | . Venous lower leg wound. Question of osteomyelitis. Three views of the right tibia/fibula show non-specific chronic periosteal reaction along the tibial and fibular diaphyses, similar to the prior study in 2013. No acute fracture is evident. There is edema in the soft tissues.Three views of the left tibia/fibula show non-specific chronic periosteal reaction along the tibial and fibular diaphyses, similar to the prior study in 2013. No acute fracture or cortical destruction is identified. There is edema in the soft tissues.Three views of the right ankle show no acute fracture or malalignment. Again seen is periosteal reaction along the tibial and fibular diaphyses. Vascular calcifications are noted. There is diffuse soft tissue swelling. Diffuse inflammation around the Achilles tendon obscures visualization.Three views of the left ankle show no acute fracture or malalignment. Again seen is periosteal reaction along the tibial and fibular diaphyses. Vascular calcifications are noted. There is diffuse soft tissue swelling. Diffuse inflammation around the Achilles tendon obscures visualization.Three views of the right foot show a post-surgical findings of the bunionectomy with flattening of the medial aspect of the first metatarsal head. There are old fractures of the second and third metatarsals. There is soft tissue swelling about the dorsum of the foot.Three views of the left foot show subluxation of the first metatarsophalangeal joint. No acute fracture is evident. Soft tissue swelling is noted about the dorsum of the foot. | Chronic periosteal reaction along the bilateral tibial and fibular diaphyses is non-specific; this may can be seen with multiple entities and osteomyelitis cannot be excluded. |
Generate impression based on findings. | Female, 5 months old. Reason: tube placement History: new intubationVIEW: Chest AP (one view) 3/21/15, 0720 ET tube tip is in the right bronchus intermedius. Lower extremity CVC tip is in the IVC. Enteric tube terminates in the stomach.Interval opacification of the left hemithorax, with volume loss, compatible complete atelectasis of left lung. Additional right upper lobe atelectasis.The cardiothymic silhouette cannot be evaluated.Mild right perihilar opacities, similar to prior exam. | Right bronchus intermedius intubation, with associated right upper lobe and complete left lung atelectasis.Findings discussed with Dr. Lauren Rust via telephone at 8:00 a.m. on 3/21/15. |
Generate impression based on findings. | Female 30 days old Reason: change s/p distraction of mandible History: Obstructive sleep apnea.VIEWS: Skull AP and lateral 3/20/15 (two views) NG tube is present. Bilateral mandibular distractors are noted. Normal configuration of the skull. | Postsurgical changes as described. |
Generate impression based on findings. | 60-year-old male. Obstruction. ABDOMEN:LUNG BASES: Bibasilar atelectasis. Small left pleural effusion, new from prior.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality noted. No splenic artery aneurysm. Splenic vein is patent.PANCREAS: Extensive peripancreatic fat stranding and fluid around the body and tail tracking down the left anterior renal fascia consistent with acute pancreatitis, increased from prior. Slight increase in mild heterogeneity of the distal tail may represent small intrapancreatic collections or focal small area of necrosis (<10%).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Additional subcentimeter hypoattenuation too small to characterize, but likely also cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Circumferential mild edematous wall thickening of the distal transverse colon and proximal descending colon near the pancreas due to secondary inflammation. No small bowel traction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral femoral head subchondral sclerosis and lucency consistent with avascular necrosis.OTHER: No significant abnormality noted | 1. Increased peripancreatic fat stranding/fluid around the body and tail consistent with acute pancreatitis. Slight increase in mild heterogeneity of the distal tail may represent small intrapancreatic collections or focal small area of necrosis (<10%).2. New small left pleural effusion.3. No small bowel obstruction as clinically questioned. |
Generate impression based on findings. | Male 66 years old Reason: 66M with h/o metastatic RCC to liver now with 2 weeks of RUQ pain, nausea /vomitting and low grade fevers and new doe/sob, eval for PE and tumor progression vs intra-abd infection History: abd pain, n/v CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Significant increase in the size and number of liver metastases. Index lesion in the right lobe measures 6.5 x 6.5 cm on image number 73, series number 3. Most of the right lobe the liver is not replaced by metastatic disease. There also additional metastatic lesions in the left lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post right nephrectomy. Cyst in the left kidney are unchanged. Evaluation of the right nephrectomy bed is again limited due to poor opacification of the small bowel loops on the right side. However, there is likely returns involving the right psoas muscle. MRI may be helpful for better evaluation of the returns in the right nephrectomy bed.RETROPERITONEUM, LYMPH NODES: Again noted thrombus in theinfrahepatic IVC. There is ill-defined soft tissue surrounding the IVC and possibly invading IVC. Again MRI may helpful for further evaluation of these lesions.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously described subcutaneous nodule in the right side is increased in size and now measures 2.3 x 1.9 cm on image number 139, series number 3. There are also new subcutaneous metastatic disease in the posterior right chest wall image number 107, series number 3.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: Sclerotic/lytic lesions in the right iliac bone, unchanged.OTHER: No significant abnormality noted | Significant interval increase in the size and number of liver metastases. Subcutaneous nodule in the right lower quadrant has also increased in size.Soft tissue density in the right nephrectomy bed likely representing recurrent disease. Evaluation of this soft tissue density extending into the retroperitoneum is limited due to poor small bowel opacification and decreased intravenous contrast. MRI of the liver may be helpful for better evaluation of the returns in the right nephrectomy bed, if clinically indicated.Again noted thrombus in the infrahepatic IVC which may be invaded by the returns mass. |
Generate impression based on findings. | Female 2 days old Reason: evaluate bowel gas, evaluate for obstruction History: abdominal distentionVIEW: Abdomen AP (one view) 3/21/15 at 441 hours NG tube terminates in the stomach. Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Female 2 days old Reason: evaluate ABD gas pattern, bowel dilation History: no lines - increasing respiratory distress; increasing O2 requirementVIEW: Chest and abdomen AP (two views) 3/20/15 at 1805 hrs. NG tube terminates in the stomach. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Minimal diffuse line haziness consistent with TTN. No focal lung opacities. No effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Minimal diffuse lung haziness consistent with TTN versus RDS.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Male 38 days old Reason: Please assess bowel gas pattern History: Abdominal distention, mechanical ventVIEW: Chest and abdomen AP (two views) 3/21/15 at 749 hours. ET tube terminates below thoracic inlet. NG tube tip is at the stomach. Right upper extremity PCVC terminates at the right atrium. Mediastinal tube unchanged.Cardiac silhouette size is enlarged but stable. Persistent diffuse, coarse lung haziness with pattern of PIE, no effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Persistent diffuse lung haziness with pattern of PIE.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Male, 16 years old. Reason: eval R iliac vein patency History: swelling, pain VASCULAR:Arterial phase of contrast makes evaluation of the iliac veins suboptimal.Left common iliac venous stent at the level of overlying common iliac artery. Possible low density filling defect within the right common femoral and external iliac veins.The aorta, common iliac arteries and visualized branches are normal, without focal narrowing.LOWER ABDOMEN:The visualized portions of the liver, spleen, gallbladder, and kidneys appear normal.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Increased diameter of the right thigh.OTHER: No significant abnormality noted | Possible thrombus within the right common femoral and external iliac veins, although evaluation of the venous system is poor due to suboptimal contrast timing. Recommend repeat Doppler exam for further evaluation. |
Generate impression based on findings. | Male 38 days old Reason: Eval lung fields History: s/p PDA repairVIEW: Chest and abdomen AP (two views) 3/20/15 at 1759 hrs. ET tube terminates below thoracic inlet. Central line tip is in the right atrium. NG tube terminates in the stomach. Mediastinal tip unchanged. Cardiac silhouette size is top normal. Persistent , diffuse, coarse lung haziness with pattern of PIE, no effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Persistent lung changes are prolonged surfactant deficiency.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Female 12 years old Reason: view valve setting on shunt History: s/p valve adjustment in settingVIEWS: Abdomen AP and lateral 3/20/15 (two views) Hakim valve setting is 25 mm of water. There no evidence of LP shunt kinking or discontinuity. Moderate stool burden with no evidence of obstruction or free air. | Hakim valve set at 25 mm of water. |
Generate impression based on findings. | Fall, shoulder pain, decreased range of motion. Question of fracture or dislocation. Three views of the right shoulder and two views of the right humerus show a impacted, transverse, and comminuted fracture through the surgical neck of the proximal humerus. No evidence of dislocation. | Comminuted fracture of the surgical neck of the humerus. |
Generate impression based on findings. | Clinical question: Evaluate for cause of cognitive impairment. Signs and symptoms: paranoia and cognitive impairment. Nonenhanced head CT:No detectable acute intracranial process. CT is insensitive for early detection of fracture nonhemorrhagic ischemic strokes.Very mild periventricular low-attenuation a white matter likely representing age indeterminate small vessel ischemic strokes considering patient's stated age of 84.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Findings suggestive of mild age indeterminate small vessel ischemic strokes |
Generate impression based on findings. | Male 8 years old Reason: 8 yo M with abd pain, CT scan with free peritoneal fluid and incr pleural effusions, please eval VIEWS: Chest AP/lateral (two views) 3/20/15 2120 hrs Cardiac silhouette size is normal. No focal opacities, effusions or pneumothorax. | Effusion previously described on CT are not visualized. Note is made that chest CT the much more sensitive for the diagnosis of small pleural effusions. |
Generate impression based on findings. | 37-year-old female. Left flank pain. Hematuria. History of kidney stones. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted. Cholecystectomy clips.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive left renal stone. No ureteral stone. No hydronephrosis or perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: A cystic structure in the left adnexa is 4.1 x 4.7 cm, may represent a physiologic cyst though follow-up US in 3 months suggested to confirm resolution.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild to moderate degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | 1. Punctate nonobstructive left renal stone. No ureteral stones or hydronephrosis. 2. A cystic structure in the left adnexa is 4.1 x 4.7 cm, may represent a physiologic cyst though follow-up US in 3 months suggested to confirm resolution. |
Generate impression based on findings. | Female 60 years old Reason: eval for intraabdominal or fascial infection History: purulent drainage around g tube ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Again noted metallic stent in the common bile duct and pneumobilia. Biliary prominence is unchanged.SPLEEN: No significant abnormality notedPANCREAS: Focal dilatation of the pancreatic duct in the region of the pancreatic head is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Previously described changes of pyelonephritis involving the left kidney have improved. No evidence of hydronephrosis bilaterally. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrostomy tube is in place. There is mild facet trending in the anterior abdominal wall around the tube. Small paraumbilical fat containing hernia.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 | Fat stranding on the gastrostomy tube without evidence of drainable collection.Interval improvement in the left pyelonephritis findings. |
Generate impression based on findings. | Fall, deformity, pain. Evaluate for fracture or dislocation. Three views of the right shoulder show no acute fracture or dislocation. Mild osteoarthritis affects the glenohumeral joint. Moderate osteoarthritis affects the acromioclavicular joint. Deformity of the distal clavicle is likely related to old trauma. There is ossification of the coracoclavicular ligament. | No acute fracture is evident. |
Generate impression based on findings. | Clinical question: ICH in the left putaminal. Signs and symptoms: Hemorrhage, rule out enlargement. Nonenhanced head CT:Small focus of acute hemorrhage in the left putamina measures at 8.5 x 5.5-mm in transaxial dimensions and without appreciable surrounding vasogenic edema. No prior exams for comparison.Findings suggestive of minimal age indeterminate a small muscle ischemic strokes are also noted and unremarkable nonenhanced head CT otherwise.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | 1.8.5 x 5.6 millimeter hematoma of the left putamina. No prior exam for comparison.2.Minimal age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Pain and ecchymoses status post fall one week ago. Most severe at second through fourth metatarsal joints. Question of fracture. Three views of the ankle show diffuse soft tissue swelling. No acute fracture or malalignment is evident. No ankle joint effusion is identified. A small ossific density superior to the anterior tail appears well corticated likely represents an accessory ossicle.Three views of the left foot show no acute fracture or malalignment. | Soft tissue swelling without acute fracture. |
Generate impression based on findings. | 55-year-old female with intraventricular hemorrhage There is extensive right periventricular hypoattenuation compatible with encephalomalacia along the entire MCA territory with significant ex vacuo dilatation of the right ventricle. Large left parietal lobe intraparenchymal hemorrhage with dissection into the left ventricle, third ventricle, and fourth ventricle with a small amount in the right ventricle. The hematoma measures 5.5 x 3.5 cm with regional mass-effect and surrounding edema. There is approximately 8 mm of rightward midline shift.A right trans-frontal approach ventriculostomy catheter tip terminates in the right ventricle near the foramen of Monroe. Small amount of subcutaneous air is noted which may reflect recent insertion. A small amount of extra-axial high density material over the right frontal convexity reflect an extra-axial component of the hemorrhage. Left nasogastric tube is partially visualized. The imaged paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. No depressed calvarial fractures. Postsurgical changes of a prior right frontal craniotomy. | 1.Large left parietal lobe intraparenchymal hemorrhage with extensive intraventricular component with surrounding edema as described above.2.Encephalomalacia along the right MCA territory with ex vacuo dilatation of the right ventricle.3.Right trans-frontal ventriculostomy catheter tip is in the right ventricle near the foramen of Monroe. |
Generate impression based on findings. | Female, 8 months old. Reason: rule out fracture History: concern for abuseEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 3/20/2015, 2306 No acute or healing fracture identified.The skull and cervical soft tissues are normal.The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax.Nonobstructive bowel gas pattern. | No acute or healing fracture identified. |
Generate impression based on findings. | Clinical question: Facial abscess? Retro-orbital cellulitis? Signs and symptoms: Right upper face and lip swelling history of severe acne, adjacent steroids. Enhanced maxillofacial CT:Examination demonstrate normal density of retro-orbital fat and without abnormal enhancement. Normal appearing bilateral extra ocular musculature and with normal pattern of enhancement.Unremarkable bilateral globes and optic nerves without enhancement.Unremarkable lacrimal glands.Unremarkable images through the skull base and including cavernous sinuses.There is a scattered subtle fat stranding of bilateral soft tissues of facial region likely secondary to patient's history of severe acne. Defining appears slightly more prominent on the left. There is however no detectable abscess formation on this exam.The maxillary and mandibular teeth are unremarkable and without evidence of any significant decay or periapical abnormalities.Paranasal sinuses demonstrate mild mucosal thickening of bilateral maxillary sinuses which results in compromise of bilateral ostiomeatal units. Mild patchy bilateral ethmoid sinus disease is noted. Mild mucosal thickening in the dependent portion of right frontal sinus is also noted. Sphenoid sinus remains well pneumatized and unremarkable. | 1.Unremarkable images through the orbits. 2.No evidence of facial or retro-orbital abscess formation.3.Mild chronic sinus disease as detailed.4.Mild subcutaneous fat stranding of bilateral facial soft tissues slightly more on the left however without detectable abnormal enhancement. |
Generate impression based on findings. | Female 14 days old Reason: Eval lung fields History: On CPAPVIEW: Chest and abdomen AP (two views) 3/21/15 at 346 hours. NG tube terminates in the stomach. Left upper extremity PICC tip is at the confluence of the right subclavian and innominate vein.Cardiac silhouette size is normal. Persistent bilateral diffuse lung haziness with no focal opacities, effusions and pneumothorax.Normal abdominal gas pattern with no evidence of obstruction or free air. No bowel distention or ascites. No pneumatosis intestinalis or portal venous gas. | No change in diffuse lung haziness.Improvement in bowel distention. |
Generate impression based on findings. | Swelling, pain. Question of fracture. Three views of the right ankle show no acute fracture or malalignment. Soft tissue swelling is noted about the ankle, lateral greater than medial. Three views of the right foot show no acute fracture or malalignment. | Soft tissue swelling without acute fracture. |
Generate impression based on findings. | 49-year-old female. Liver transplant, abdominal pain. Evaluate for obstruction. Additional history from clinical service: packing material was placed around liver. EPIC history liver transplant 3/10 and 3/11 for subcapsular liver hematoma. Lack of intravenous contrast limits evaluation for solid organ pathology.ABDOMEN:LUNG BASES: Trace left pleural effusion. Bibasilar atelectasis. Calcified nodules consistent with prior infection.LIVER, BILIARY TRACT: Post surgical findings of a liver transplant. Large heterogeneous perihepatic collection consistent with packing material. Mild hyperdensity at its periphery may represent small amount of residual hematoma. Multiple foci of air are seen within the packing material. A larger pocket of air in the central nondependent abdomen (series 3, image 61) may also relate to the packing material however a small amount of pneumoperitoneum due to viscus perforation cannot be excluded.Ill-defined heterogeneity of the right hepatic lobe, not well characterized on this noncontrast exam.Surgical drain entering in the right lower quadrant terminates at the anterior aspect of the hepatic dome.SPLEEN: Mild splenomegaly measuring 15 cm. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter.BOWEL, MESENTERY: Mild diffuse small bowel dilatation is suggestive of ileus. Nonspecific wall thickening of small bowel, may relate the large amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large amount of abdominopelvic ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foci of air scattered throughout the lumen of the bladder, correlate with recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse small bowel dilatation suggestive of ileus. Two enteric tubes, one terminates in the proximal jejunum and the other in the distal gastric antrum.BONES, SOFT TISSUES: Small amount of hematoma in the right anterior thigh. Mild degenerative changes of the lower lumbar spine.OTHER: Large amount of abdominopelvic ascites. | 1. Diffuse bowel dilatation is suggestive of an ileus. Large amount of abdominopelvic ascites.2. Mild nonspecific heterogeneity of the right hepatic lobe. Large amount of perihepatic packing material with possible small amount of residual hematoma at its periphery.3. A pocket of air in the central nondependent upper abdomen may relate to the packing material however a small amount of pneumoperitoneum due to viscus perforation cannot be excluded. |
Generate impression based on findings. | Male, 4 years old. Reason: rule out fracture History: concern for abuseEXAMINATION: Skull AP/lateral, cervical spine AP/lateral, thoracolumbar spine AP/lateral, right humerus AP, left humerus AP, right forearm AP, left forearm AP, right hand PA, left hand PA, chest AP, ribs right oblique/left oblique, pelvis AP, right femur AP, left femur AP, right tibia fibula AP, left tibia fibula AP, right foot AP, left foot AP (24 views) 3/20/15, 2344 A posterior fat pad is identified in the left elbow, suggestive of a joint effusion. No fracture line is identified.No other evidence of acute or healing fracture.The skull and cervical soft tissues are normal.The aortic arch, cardiac apex, and stomach are left-sided.The cardiothymic silhouette is normal.No focal pulmonary opacities, pleural effusions, or pneumothorax.Nonobstructive bowel gas pattern. | Suggestion of a left elbow joint effusion. Occult fracture is not excluded. Recommend repeat dedicated elbow images in two weeks or correlation with point of maximum tenderness. No other traumatic fracture identified.Findings discussed via telephone with Dr Kahn in the ED at 9:10 AM on 3/21/2015 |
Generate impression based on findings. | Female 3 days old Reason: is the ett in proper position are the lungs clear History: rds, preterm reintubationVIEW: Chest and abdomen AP (two views) 3/21/15 at 437 hours. Right bronchus intermedius intubation. UVC terminates at the right atrium. UAC tip is at T6. NG tube tip is at the stomach.Cardiac silhouette is none sizable due to a complete atelectasis of the left lung and right upper lobe.Normal abdominal gas pattern. | ET tube displaced with consequent atelectasis of the right upper lobe the whole left lung.Normal abdomen gas pattern.Findings were communicated to and acknowledged by Dr. BOREN, MARY on 3/21/15 at 849 hours. |
Generate impression based on findings. | Swelling, inability to ambulate. Question of sprain or fracture. Three views of the right ankle show soft tissue swelling most notably about the lateral malleolus. No acute fracture or malalignment is evident. No ankle joint effusion is identified. | Soft tissue swelling without acute fracture. |
Generate impression based on findings. | Knee laceration from broken glass. Evaluate for foreign body/glass. Four views of the right knee show no acute fracture or malalignment. A small round opacity along the posterior aspect of the knee is likely artifact. No radiopaque foreign body is identified. No knee joint effusion is seen. | No radiopaque foreign body is identified. |
Generate impression based on findings. | Male 2 days old Reason: evaluate umbilical line placement History: Desaturation and blood per NG tube.VIEWS: Chest and abdomen AP, abdomen cross table lateral (3 views) 3/21/15 at 451 hours. ET tube tip is below the thoracic inlet. Esophageal temperature probe terminates at the lower third of the esophagus. Proximal side-port of NG tube is above GE junction. UVC tip is at the ductus venosus or optic vein. UAC terminates at the left iliac artery. Persistence of tissue edema.Cardiac silhouette size is normal. Small lung volumes with no focal opacities, effusions or pneumothorax.No change in complete paucity of abdominal gas. | Misplaced NG tube and UAC.Small lung volumes with no focal opacities.No change in complete paucity of abdominal gas. |
Generate impression based on findings. | Male 26 years old Reason: 26yo w/CF, admitted for MSSA PNA c/b parapneumonic effusion, appears exudative. Now with L chest tube w/o significant change in XR. Considering intrapleural TPA,, need CT for further eval History: left chest tube LUNGS AND PLEURA: Diffuse bronchiectasis, mucous plugging, bronchial wall thickening with associated multifocal peripheral opacities compatible with the history of cystic fibrosis with superimposed infection.Moderate to large left hydropneumothorax with a small diameter chest tube adjacent to the left lung base. In the mid to upper left hemithorax there is a focal pleural pocket of air and fluid with bulging convex contour suggesting a component of loculation (series 4 image 45). In addition, within the pleural fluid in the left lower hemithorax, there are multiple foci of gas distributed throughout the effusion raising the possibility of additional loculations. No right-sided pleural effusion.MEDIASTINUM AND HILA: Prominent left hilar lymph nodes are likely reactive in etiology. Heart is normal in size. No coronary atherosclerotic calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cirrhotic morphology liver. Splenomegaly. Trace perihepatic ascites. Innumerable upper abdominal enlarged lymph nodes versus varices are partially visualized. | 1.Large left hydropneumothorax with findings suggestive of multiple loculations as described.2.Sequela of cystic fibrosis with multiple peripheral opacities suggestive of superimposed infection.3.Cirrhotic morphology liver with evidence of portal hypertension. Numerous enlarged lymph nodes versus varices are only partially visualized in the upper abdomen. If there is clinical concern for malignancy, dedicated contrast enhanced CT of the abdomen and pelvis is recommended for further evaluation of the possible adenopathy. |
Generate impression based on findings. | Hypertension and foot pain. Three views of the left foot show no acute fracture. There are degenerative changes at the calcaneocuboid articulation with osteophyte formation and sclerosis. There appears to be pes planus deformity but this is a nonweightbearing study. | Degenerative changes as above. |
Generate impression based on findings. | 55-year-old female with IVH 1. Normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal, with the right vertebral artery slightly hypoplastic relative to the left.2. Right ICA is occluded shortly after the ECA/ICA bifurcation. There is retrograde reconstitution of the supraclinoid segment of the ICA via the right opthalmic artery or right posterior communicating artery. Normal contrast opacification through the left common carotid artery, carotid bifurcation, cervical internal/external carotid, and vertebral artery. Small caliber supraclinoid segment of the right ICA, MCA and distal branches.3. The A1 segment of the right anterior cerebral artery is hypoplastic. Prominent A1 segment of the left anterior cerebral artery. Otherwise, normal contrast opacification through a complete circle-of-Willis with a patent anterior communicating artery and bilateral posterior communicating arteries. 4. Normal superficial and deep intracranial venous drainage.Again seen is a large left parietal lobe hemorrhage extending into the left ventricle, third ventricle, and fourth ventricle with a small amount in the right ventricle. The left parietal hematoma measures 5.8 x 3.5 cm, previously 5.5 x 3.5 cm, not significantly changed. There is a slight decrease in degree of ventricular dilatation. Surrounding edema bilaterally and right sided encephalomalacia is again noted. There is approximately 10 mm of rightward midline shift, previously 8 mm.A right trans-frontal approach ventriculostomy catheter tip terminates in the right ventricle near the foramen of Monroe. Small amount of subcutaneous air is noted which may reflect recent insertion. No significant change in small extra-axial hemorrhage over the left frontal convexity. Left nasogastric tube is partially visualized. Air-fluid levels are noted within the sphenoid sinuses and nasopharynx likely related to NG tube insertion and intubation. No depressed calvarial fractures. Postsurgical changes of a prior right frontal craniotomy. | 1.No significant change in left parietal hematoma as described above.2.Slight interval decrease in degree of intraventricular hemorrhage and dilation with increased rightward midline shift.3.Right trans-frontal ventriculostomy catheter tip is in the right ventricle near the foramen of Monroe.4.Complete occlusion of the right ICA from its origin to the supraclinoid segment with retrograde reconstitution as described above. |
Generate impression based on findings. | Clinical question: Evaluate status-post CSF drainage. Signs and symptoms: Headache. Unenhanced head CT:There is no evidence of any acute or new finding since prior exam.Stable mildly enlarged left lateral ventricle since prior study.Extensive encephalomalacia of right hemisphere identical to prior study. No change in the position of a left posterior parietal approach catheter since prior examEpidural collection along the inner table of craniotomy flap containing small amount of post procedural air demonstrate no change. | 1.No convincing evidence of any acute or new finding since prior study.2.Mildly prominent left lateral ventricle remains similar to prior study.3.No change in the position of a left sided ventricular catheter.4.Epidural thickening and with small amount of air under the right craniotomy flap similar to prior exam. |
Generate impression based on findings. | Hemoptysis. Evaluate for source of bleeding or infection ANGIOGRAPHY: The thoracic aorta is normal in size. Conventional aortic arch anatomy. No aneurysm or evidence of dissection. No significant atherosclerotic calcification. Origins of the celiac, superior mesenteric, and bilateral renal arteries are widely patent. No active contrast extravasation is noted associated with the patient's known mycetoma. No extravasated contrast or other debris is noted within the airway.LUNGS AND PLEURA: Redemonstrated postsurgical changes from right upper lobectomy. Extensive traction bronchiectasis in the right middle and superior segment right lower lobe it is also not significantly changed.Cavitary lesion within the superior segment of the right lower lobe now contains more defined internal debris compatible with a mycetoma. Cavitary lesion in the left upper lobe with findings of an additional smaller mycetoma are unchanged.MEDIASTINUM AND HILA: The heart is normal in size. No pericardial effusion. No significant coronary atherosclerotic calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: Unchanged right breast parenchymal nodule with adjacent biopsy clip. Stable post surgical changes in the right chest wall.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter focus of early arterial enhancement in the right lobe of the liver likely represents a small flash filling hemangioma. | 1.Negative CT angiogram of the chest for active hemorrhage, however conventional angiography is more sensitive and can be considered as clinically significant hemoptysis. Otherwise, small volume hemoptysis may be secondary to either the mycetomas or bronchiectasis.2.Stable left upper lobe cavitary lesion with findings compatible with a small aspergilloma. Additional cavitary lesion in the superior segment of the right lower lobe is overall not significantly changed in size, however it now contains more defined internal debris raising the possibility of an additional aspergilloma.3.Stable post surgical changes in the right hemithorax and chest wall. |
Generate impression based on findings. | Clinical question: History of CVA/evaluate for new lesions. Signs and symptoms: Frequent falls. Nonenhanced head CT:There are no prior exams for comparison as is requested by the clinical service as. Small wedge shaped low density defect along the inferior aspect of right cerebellum is consistent with a chronic right pica territory stroke.Images through the supratentorial space demonstrate findings of age indeterminant small muscle ischemic strokes of moderate degree. There is mild prominence of lateral ventricles. The cortical sulci remain patent and no detectable cortical abnormality.Very mild large arterial vascular calcification is noted.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. CT is insensitive for early detection of acute nonhemorrhagic ischemic strokes.2.Moderate age indeterminate small vessel ischemic strokes.3.No prior exams for comparison. |
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