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Generate impression based on findings. | 19 year old female with dysphonia, dysphagia, and odynophagia for 2 days and a swollen right submandibular gland. There is borderline cervical lymphadenopathy bilaterally and mild tonsillar enlargement, left greater than right. There is no evidence of mass lesions. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Borderline cervical lymphadenopathy and mild tonsillar enlargement is likely reactive. No evidence of right submandibular pathology. |
Generate impression based on findings. | Female 33 years old ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Unremarkable CT. |
Generate impression based on findings. | 25-year-old female. Clinical history of Crohn's disease presenting with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Scattered punctate hypoattenuating hepatic foci, too small to characterize, unchanged and likely a cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post-surgical findings of ileocecectomy. Underdistention of small bowel limits evaluation. No evidence of bowel inflammation within this limitation. No abscess is identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Left adnexal cystic structure is 4.8 x 4 cm, may be a physiologic cyst, follow-up US is suggested in 3 months to confirm resolution. Cyst in the vaginal wall, unchanged and likely benign.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of abscess or bowel inflammation. Left adnexal cystic structure is 4.8 x 4 cm, may be a physiologic cyst, follow-up US is suggested in 3 months to confirm resolution. |
Generate impression based on findings. | Male 87 years old Reason: follicular lymphoma, followup scan. Increased nodes in lower neck, left groin. Also f/u pulmonary nodule History: increased adenopathy CHEST:LUNGS AND PLEURA: Focal scarring and bronchiectasis involving the peripheral aspect of the right upper lobe is unchanged. Scattered micronodules in bilateral small pleural effusions are unchanged.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst is unchanged. Left renal cysts unchanged.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. An index left aortic node measures 1.8 by 1 cm image number 130, series number 11.BOWEL, MESENTERY: Fat containing periumbilical hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Bilateral enlarged inguinal lymph nodes. An index left inguinal node measures 2.9 by 2.1-cm image number 196, series number 11. More inferior to this lymph node, there is another soft tissue density lesion in the left inguinal area measuring 3 x 2.6 cm on image number 213, series number 11. This lesion demonstrates less enhancement compared to the other lymph nodes and it may represent another enlarged lymph node, however, its etiology is unknown.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change in the chest from previous CT. there are significantly enlarged pelvic lymph nodes. Borderline retroperitoneal lymph nodes. |
Generate impression based on findings. | Female 16 years old Reason: 16 y F w/Crohn's ileitis, admitted for emesis and abdominal pain, evaluate disease course History: emesis, abdominal pain.EXAMINATION: MR enterography without and with IV contrast 3/20/15 ABDOMEN:LIVER, BILIARY TRACT: No intra-or extrahepatic B. dilatation. No liver focal lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is no evidence of bowel wall thickening, fat stranding or bowel dilatation. Specifically terminal ileum region looks normal..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please refer to the abdominal bowel and mesentery paragraph.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. No evidence of inflammatory bowel disease. |
Generate impression based on findings. | Clinical question: Concern for stroke. Signs and symptoms: Seizure, on anti-coagulation. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.BC cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal for patient's stated age of 24. There is contrast within the venous sinuses and arterial branches from the patient's enhanced CT of the abdomen performed at this date.Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells. | Unremarkable exam. |
Generate impression based on findings. | CT HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. CTV HEAD: There is no evidence of filling defect within the major dural venous sinuses. The bilateral cavernous sinuses are symmetric and enhance, as are the superior ophthalmic veins. | 1.No evidence of intracranial hemorrhage. 2.Unremarkable cavernous sinuses. |
Generate impression based on findings. | Female 70 years old Reason: renal mass enlargement? hepatic disease? mets? History: abd distention, elevated LFT's, hx renal mass ABDOMEN:LUNG BASES: Focal atelectasis at the lung bases. Cardiomegaly.LIVER, BILIARY TRACT: Liver is enlarged. Hepatic veins and IVC are dilated. These are secondary to heart failure. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again noted multiple enhancing masses involving the right kidney. Index anterior lesion now measures 3.3 by 3.7 cm on image number 51, series number 3, not significant change from previous study. A second index lesion is also unchanged and measures 2.5 by 2.2 cm on image number 45, series number 3. These lesions are suspicious for renal cell carcinoma. Other hypodense lesions which represent complex cysts are also grossly stable.RETROPERITONEUM, LYMPH NODES: Significant atherosclerotic changes throughout the abdominal aorta its major branches. Significant stenosis at the origin of bilateral renal arteries. Small infrarenal abdomen aortic aneurysm measuring 2.6 cm in largest AP dimension.BOWEL, MESENTERY: Interval increase in the amount of ascites.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: Interval increase in the amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Significant increase in the amount of ascites. Heart failure. Hepatomegaly.Right renal soft tissue masses suspicious for renal cell carcinoma another bilateral renal lesions are stable. |
Generate impression based on findings. | Status post allogenic bone marrow transplant. Central line placement.VIEW: Chest AP (one view) 3/21/15 at 830 hours. Right mainstem bronchus intubation. NG tube terminates in the stomach. Abdominal Central line unchanged. Interval placement of right IJ venous access , tip at the right atrium.Cardiac silhouette is non sizable due to a complete atelectases of the left lung, likely related to ET tube positioning. Small right apical pleural effusion noted. | Interval internal jugular vein central line placement.Left lung atelectases with mediastinal shift likely due to ET tube positioning.Interval development of small right apical pleural effusion. |
Generate impression based on findings. | 33-year-old female. Fevers, abdominal pain, nausea/vomiting, high output diarrhea. EPIC history: Crohn's s/p colectomy in 2088 and IAPP. ABDOMEN:LUNG BASES: Bilateral breast implants.LIVER, BILIARY TRACT: No focal hepatic mass. No biliary ductal dilatation. Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Findings of total colectomy with an ileal-pouch anal anastomosis. Diffuse dilatation of small bowel and ileal pouch measuring up to 5 cm with transition point at the anal anastomosis. Short segment of narrowing (~ 5 cm) with associated mild hyperenhancement and wall thickening of the most distal ileum just proximal to the pouch (series 3, image 98), suggestive of active inflammatory bowel disease.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered enlarged pelvic lymph nodes, likely reactive.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites. | Findings suggestive of a bowel obstruction due a ileal pouch-anal anastomosis stricture. Short segment of active inflammatory bowel disease just proximal to the ileal pouch. |
Generate impression based on findings. | Male 55 years old Reason: assess for urinary catheter placement and urine leak History: assess for urinary catheter placement and urine leak This study is limited the due to lack of intravenous contrastABDOMEN:LUNG BASES: Selective centra is bilateral pleural effusion.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: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Subcutaneous air is likely due to recent surgery.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post-prostatectomy. The balloon of Foley catheter is outside the bladder and appears to be posterior to the expected tract of the urethra. Round, tubular hyperdense material in the pelvis surrounding the bladder likely represents surgical packing materialBLADDER: Bladder is significantly distended. The tip of the surgical catheter is in the pelvis anterior to the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | The balloon of the Foley catheter is outside the bladder and possibly outside of the urethra. Bladder is significantly distended. |
Generate impression based on findings. | Female 13 years old Reason: MR urogram to rule out ectopic ureter History: 12yo F with urinary incontinence, suspected duplex kidneyEXAMINATION: MR of the upper abdomen without IV contrast pelvis with and without IV contrast (Multihance 10 ml) 3/20/15 ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: kidneys and uretersRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, Mesentery: no significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: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 | No evidence of ectopic ureter or duplicated system. Essentially normal examination. |
Generate impression based on findings. | Male 61 years old Reason: 61yo M h/o urothelial cancer, right lung met vs primary lung ca, s/p pleurx, eval right pleural effusion LUNGS AND PLEURA: Severe centrilobular emphysema. Right perihilar tumor with endobronchial invasion and associated post obstructive atelectasis of the right middle and right lower lobes. Exact measurement of the mass is difficult due to the adjacent atelectasis but is approximately 3.8 X 4.4 cm (series 4 image 63), previously 6.8 x 4.8 cm. Small right pleural effusion with a small bore chest tube in place in the right apex.MEDIASTINUM AND HILA: Heart is normal in size. No pericardial effusion. Mild coronary artery atherosclerotic calcifications. Reference right hilar lymph node is not signficantly changed in size measuring 1.7 cm in short axis (series 4 image 50), previously 1.9 cm. The reference precarinal lymph node is not significantly changed measuring 9 mm in short axis (series 4 image 43), previously 10 mm. Additional scattered enlarged mediastinal lymph nodes are not significantly changed from prior.CHEST WALL: Right-sided pleural-based mass with chest wall invasion and destructive changes in the adjacent rib measures 6.8 x 3.8 cm (series 4 image 63), previously 7.1 x 3.2 cm.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Large partially visualized mass in the region of the left kidney represent metastasis or synchronous primary tumor. | 1. Right perihilar mass with associated mediastinal/hilar lymphadenopathy and pleural-based metastases is overall not significantly changed from prior with measurements as described.2. Additional incompletely evaluated mass in the left renal fossa. |
Generate impression based on findings. | Left wrist pain. Three views of the left wrist show no acute fracture or malalignment. No soft tissue swelling is seen. | No specific radiographic findings to account for patient's pain. |
Generate impression based on findings. | Injured right knee yesterday while running. Four views of the right knee show no acute fracture or malalignment. Small osteophytes along the undersurface of the patella indicate minimal osteoarthritis. No knee joint effusion is seen. | Minimal osteoarthritis. |
Generate impression based on findings. | Pain in limb. Three views of the left ankle show no acute fracture or malalignment. No soft tissue swelling is seen. No ankle joint effusion is identified.Three views of the right ankle show no acute fracture or malalignment. No soft tissue swelling is seen. No ankle joint effusion is identified.Three views of the left foot show no acute fracture. There is hallux valgus deformity. No soft tissue swelling is seen.Three views of the right foot show no acute fracture. There is hallux valgus deformity. No soft tissue swelling is seen. | Hallux valgus deformity of the bilateral feet. |
Generate impression based on findings. | There is significant soft tissue stranding and edema surrounding the right eye. There is complete opacification of the right maxillary sinus, right ethmoid sinuses, and bilateral frontal sinuses with partial opacification of the left ethmoid sinuses. Mild mucosal thickening of the left maxillary sinus and right sphenoid sinus. Small osseous defects in the right lamina papyracea. Soft tissue density, likely phlegmon, is situated medial to the medial rectus muscle with associated thickening of the medial rectus muscle. Retro-orbital fat stranding on the medial side of the right orbit. The globe appears intact. No discrete abscess is identified. Thickening of the nasal mucosa. The left orbit is unremarkable. The middle ears and mastoid air cells are clear. Periosteal cavernous sinuses are within normal limits. The visualized intracranial structures are unremarkable. | Right ethmoid and maxillary sinus disease with extension through the lamina papyracea. Myositis of the right medial rectus muscle with adjacent phlegmonous collection and surrounding fat stranding in the medial aspect of the orbit. No distinct abscess formation. Follow-up is recommended. |
Generate impression based on findings. | Femoral neck fracture for preop evaluation. Evaluate alignment. AP view of the pelvis shows fracture of the superior cannulated screw. Two additional cannulated screws appear to have some surrounding lucency which may indicate loosening. There is deformity of the femoral neck with osteoarthritis of the hip.Surgical clips and coiled sutures noted in the abdomen. | Fractured hardware. |
Generate impression based on findings. | 82-year-old female. NGT. Nasogastric tube has been advanced, tip projects over the gastric body. Nonobstructive bowel gas pattern. Right upper quadrant surgical clips. | NGT tip projects over the gastric body. |
Generate impression based on findings. | Limited range of motion. Question of infection and effusion. Three views of the left shoulder show no acute fracture or malalignment.Two views of the left elbow show no acute fracture or malalignment. No joint effusion is seen.Two views of the left wrist show no acute fracture or malalignment. | No acute fracture or elbow joint effusion. |
Generate impression based on findings. | 82-year-old female. Nausea, vomiting, distention. Evaluate NGT. Interval placement of NGT, tip is in the distal esophagus. Nonobstructive bowel gas pattern. Right upper quadrant surgical clips. | NGT tip is in the distal esophagus. |
Generate impression based on findings. | 30 pleural female. Abdominal pain. Assess NGT placement for nausea/obstruction. Interval placement of NGT, which is coiled in the stomach with tip directed superiorly towards the fundus.Mildly dilated small bowel loops in the left hemiabdomen, possibly representing developing obstruction, similar to prior. | NGT coiled in the stomach with tip directed towards fundus. |
Generate impression based on findings. | Male, 17 years old. Reason: Evaluate change in perirectal fistulae, please compare to previous exam History: small amount perianal exudate. CrohnsEXAMINATION: MRI of the pelvis before and after IV administration of IV contrast. 10 mL of Multihance IV, were administered. 3/20/2015, 1854 PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is moderately distended and normal.LYMPH NODES: No evidence of pelvic lymphadenopathy.BOWEL, MESENTERY: No abnormal bowel wall thickening or evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A fistulous tract arising from the rectum at the 9 o'clock position (series 11, image 76) and coursing posteriorly appears similar to the prior exam.An additional tract arising from the anus at the 5 o'clock position (series 11, image 91) is similar in appearance to the prior exam.A previously described additional tract arising from the posterior aspect rectum is not clearly identified on this exam.No significant free peritoneal fluid is noted. | Two perirectal/perianal fistulas as detailed above, similar in appearance to the prior exam. |
Generate impression based on findings. | 62 years, Male. Reason: eval G tube position History: G tube came out, replaced NGT tip projects over the gastric body, sidehole is just proximal to the GE junction. Contrast injected through the G-tube opacifies stomach without evidence of extravasation on this single view.Nonobstructive bowel gas pattern. | Contrast injected through the G-tube opacifies the stomach without evidence of extravasation on this single view. |
Generate impression based on findings. | Male 16 years old Reason: assess stool load History: chronic constipationVIEW: Abdomen AP (one view) 3/21/15 902 hours Normal abdominal gas pattern. No evidence of obstruction or free air. Mild fecal accumulation. | M ejaculation with no bowel obstruction. |
Generate impression based on findings. | 83 years, Male. Reason: abdominal pain/distension History: abdominal pain Gastrostomy tube projects over a moderately gaseous distended stomach. Interval removal of enteric tube.Nonobstructive bowel gas pattern. Calcific density projecting over the bladder likely represents a bladder stone, unchanged. | Nonobstructive bowel gas pattern. Interval placement of G-tube which projects over the stomach. |
Generate impression based on findings. | 79 years, Female. Reason: cor pac History: cor pac Enteric tube projects over the first segment of the duodenum. Nonobstructive bowel gas pattern. Mild levoscoliosis with degenerative changes of the lumbar spine. | Enteric tube projects over the first segment of duodenum. No evidence of obstruction. |
Generate impression based on findings. | 25 years, Female. Reason: pt c/o abd pain with pressure, nausea, and constipation. Pt scheduled for lap rectopexy on 3/26 History: nausea, constipation, pain, rectal prolapse Nonobstructive bowel gas pattern. Multiple circular radiopaque foreign bodies in the stomach from the proximal body to the distal antrum for evaluation of transit time. | Nonobstructive bowel gas pattern. Markers for evaluating transit time located in distribution of the stomach. |
Generate impression based on findings. | 69-year-old male with left arm and left leg weakness and intermittent twitching. Previous stroke with left-sided weakness 4-5 months ago. 1. Normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The right vertebral artery origin is normal. Calcification at the origin of a hypoplastic and tortuous left vertebral artery.2. Severe atherosclerotic calcification of the carotid bifurcations bilaterally without significant stenosis. Mild to moderate calcified stenosis of the petrous segment of the right ICA. High grade stenosis of the cavernous segment of the right ICA. Mild stenosis of the right supraclinoid segment of the right ICA. Bilateral opthalmic arteries are patent.3. Hypoplastic left vertebral artery after the takeoff of the left PICA. Prominent left and small right PCOMs with generalized small caliber basilar artery, normal anatomic variation. 4. Normal superficial and deep intracranial venous drainage.Again demonstrated is a large area of encephalomalacia of the right parieto-occipital lobe with ex vacuo dilatation of the occipital horn of the right ventricle. Focal hypoattenuation in the body of the right caudate likely represents an old lacunar infarct. Focal hypoattenuation in the right cerebellar hemisphere likely reflects an old PICA infarct. Additional patchy periventricular white matter hypoattenuation is compatible with age indeterminate small vessel ischemic disease. Global cerebral volume loss is noted. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear, with the exception of mild mucosal thickening of the right frontal sinus. The visualized portions of the orbits are intact. The skull and extracranial soft tissues are unremarkable. Partially visualized metallic fragments within the left mandible.Dependent atelectasis and moderate centrilobular emphysema is present. No pneumothorax. Small left thyroid nodule. | 1.Encephalomalacia of the right parieto-occipital lobe with expected dilatation of the occipital horn of the right ventricle.2.Age indeterminate small vessel ischemic disease.3.Calcification at the origin of a hypoplastic and tortuous left vertebral artery.4.Mild to moderate calcified stenosis of the petrous segment, high grade stenosis of the cavernous segment, and mild stenosis of the right supraclinoid segment of the right ICA. |
Generate impression based on findings. | 69-year-old male for evaluation of CVA There is a large area of encephalomalacia of the right parieto-occipital lobe with ex vacuo dilatation of the occipital horn of the right ventricle. Focal hypoattenuation in the body of the right caudate likely represents an old lacunar infarct. Focal hypoattenuation in the right cerebellar hemisphere likely reflects an old PICA infarct. There are additional patchy periventricular white matter hypoattenuation compatible with age indeterminate small vessel ischemic disease. Global cerebral volume loss is noted. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear, with the exception of mild mucosal thickening of the right frontal sinus. The visualized portions of the orbits are intact. The skull and extracranial soft tissues are unremarkable. Partially visualized metallic fragments within the left mandible. | 1.Encephalomalacia of the right parieto-occipital lobe with expected dilatation of the occipital horn of the right ventricle compatible with a chronic infarct. Additional chronic infarcts as above.2.Age indeterminate small vessel ischemic disease.3.Globe cerebral volume loss.4.No evidence of acute intracranial hemorrhage, mass effect, or cerebral edema. Please note that CT is insensitive for the detection of early nonhemorrhagic stroke. If clinical suspicion remains high, further evaluation with MRI is recommended. |
Generate impression based on findings. | 76 years, Female. Reason: s/p SBFT, assess if contrast has reached colon History: EC fistula Contrast opacifies the colon to the level of the descending colon. Scattered colonic diverticula.Again seen are the left lower quadrant enterocutaneous fistula and abscess pocket projecting over the left ilium, similar to prior small-bowel follow-through.Nonobstructive bowel gas pattern. | Contrast has opacified the colon to the level of the descending colon. Abscess pocket and enterocutaneous fistula in the left lower quadrant, similar to prior. |
Generate impression based on findings. | Female 61 years old Reason: H/o Scleroderma UIP ILD, worsening shortness of breath and cough History: shortness of breath, cough LUNGS AND PLEURA: This interval change in basilar predominant articulation/honeycombing compatible to patient's known diagnosis of UIP. No significant airtrapping is noted on the expiratory images. Stable calcified micronodules compatible with a prior granulomatous infection. No suspicious pulmonary nodules or masses. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: New large pericardial effusion. Heart is normal in size. Severe coronary artery atherosclerotic calcification. Numerous enlarged lymph nodes throughout the mediastinum are slightly more prominent when compared to prior.CHEST WALL: Multilevel degenerative changes within the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1.No significant interval change in UIP pattern interstitial fibrosis.2.New large pericardial effusion.Findings were communicated with the ordering physician Mary Strek at 10:40 on 3/21/15. |
Generate impression based on findings. | Male 74 years old Reason: For restaging of mets, known small cell lung cancer CHEST:LUNGS AND PLEURA: Marked interval improvement in previously noted left upper lung pleural based mass which now measures 8.1 x 2.7 cm (series 3 image 35), previously 10.1 x 6.4 cm. Left upper lobe parenchymal nodule measures 2.7 x 2.1 (series 4 image 27). This may represent malignancy, post treatment changes, or aspiration. Marked interval decrease in size of left perihilar mass now measuring 1.7 x 0.9 cm (series 3 image 45), previously 5.6 x 5.6 cm. Small, intermediate density, left pleural effusion suggesting an exudative process. There are new pleural-based nodules in the left lower hemithorax measuring up to 1.4 x 1.0 cm (series 37 image 79).MEDIASTINUM AND HILA: Significant interval improvement in left perihilar mass as described above. No residual mediastinal or hilar lymphadenopathy.Right chest port with tip at the cavoatrial junction. Heart is normal in size. No pericardial effusion. Moderate coronary artery atherosclerotic calcification. Subacute to chronic pulmonary embolism in the right main pulmonary artery and extending into the right upper and middle pulmonary arteries is new compared to prior. Pulmonary artery is upper limit of normal in size measuring 3.0 cm in diameter. No radiographic evidence of right heart strain.CHEST WALL: Multilevel degenerative changes of the thoracolumbar spine without focal suspicious osseous lesion.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Multilevel degenerative changes without focal osseous lesion.OTHER: No significant abnormality noted. | 1.Marked interval improvement in left perihilar and left upper lung pleural-based masses as described.2.New pleural-based nodules in the left lower hemithorax compatible with new metastases. Associated small left pleural effusion.3.Subacute to chronic pulmonary embolus in the right main pulmonary artery without evidence of right heart strain.Findings were communicated with Michael Ramirez (p1208) of the clinical service at 10:40 on 3/21/15 |
Generate impression based on findings. | Status post fall Four views of the right knee reveals some small lateral osteophytes and osteophytes at the patellofemoral joint. No fractures or dislocations. The previous exam was weight-bearing and thus cannot be used for comparison. | Mild degenerative arthritis |
Generate impression based on findings. | 81 year-old male. GI bleeding. Evaluate for diverticular bleed. ABDOMEN:LUNG BASES: Severe coronary artery calcifications. Pacemaker leads and cardiomegaly.LIVER, BILIARY TRACT: Scattered hepatic hypodensities in the liver are too small to characterize but unchanged and likely cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Unchanged subcentimeter right adrenal nodule.KIDNEYS, URETERS: Nonobstructive bilateral renal stones. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Severe extensive atherosclerotic disease with mural thrombus of the abdominal aorta and its branch vessels. Left external iliac artery stent.BOWEL, MESENTERY: Focal of arterial contrast extravasation that pools on delayed images consistent with active GI bleeding in the right colon near the flexure, which may be due to angiodysplasia or a diverticular bleed.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Collapsed bladder with a Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above. BONES, SOFT TISSUES: Lumbar spine degenerative changes.OTHER: No significant abnormality noted | Active GI bleed in the right colon near the flexure, which may be due to angiodysplasia or a diverticular bleed. |
Generate impression based on findings. | CT HEAD: There are postoperative findings related to right pterional craniotomy for clipping of a right supraclinoid internal carotid artery aneurysm. Streak artifact in this region limits evaluation. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. CTA HEAD: There is an unchanged 2 mm millimeter neck by 3 mm in length superiorly directed left periophthalmic internal carotid artery aneurysm. Streak artifact from the right internal carotid clipping limits evaluation in this region, however, there is an unchanged 1 mm focal outpouching arising from the inferior aspect of the right cavernous carotid artery. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis. | 1.Unchanged 2 x 3 mm intradural left periopthalmic internal carotid artery aneurysm. 2.Streak artifact related to previous right supraclinoid internal carotid artery aneurysm clipping limits evaluation in this region, however, there is an unchanged 1 mm focal outpouching along the inferior aspect of the right cavernous carotid artery. |
Generate impression based on findings. | Male 87 years old Reason: weight loss rule out malignance History: as above ABDOMEN:LUNG BASES: Incidentally noted is thrombus in the right lower lobe pulmonary arteries.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts, unchanged.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic changes involving the abdominal aorta and its major branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Significantly enlarged prostate gland.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right lower lobe pulmonary artery embolus.Significantly enlarged prostate.Dr. Stern was not pageable. Dr. Kenigsberg (medicine resident on call) was notified and acknowledged about these findings at the time of the dictation. These findings were also communicated with patient's wife at 773 239-0190. |
Generate impression based on findings. | Male 7 months old Reason: interval change History: tachypneicVIEW: Chest AP (one view) 3/21/15 802 hours Tracheostomy tube terminates below the thoracic inlet. Left upper extremity central line tip is at the confluence of both innominate veins. Giant omphalocele again noted. Cardiac silhouette size is normal or mildly enlarged. Right upper lobe opacity likely atelectasis or pneumonia. No effusions or pneumothorax. | Right upper lobe opacity he had a disease or pneumonia |
Generate impression based on findings. | Male 68 years old Reason: pt with elevated LFT's please assess disease status and compare to previous imaging History: met melanoma CHEST:LUNGS AND PLEURA: Focal atelectasis at the lung bases. Wall in-laws of the left lung, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Bilateral axillary lymph node dissections. 2 by 1.6-cm hypodense lesion with rim enhancement in the region of the left anterior chest wall, best seen on image number 45, series number 3 likely represents a small collection.ABDOMEN:LIVER, BILIARY TRACT: Left lobe liver cyst is unchanged. 1 cm hypodense lesion in the right lobe of the liver on image number 71, series number 3. This lesion is unchanged from CT dated 1/5/2015.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node is unchanged measuring 1.9 by 1.3-cm image number 121, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Small left anterior chest wall hypodense lesion likely representing a collection. Exact etiology is unknown.Liver lesions and left retroperitoneal adenopathy, unchanged. |
Generate impression based on findings. | Metastatic breast cancer. Interval follow up exam. CHEST:LUNGS AND PLEURA: Persistent loculated right pleural effusion with associated atelectasis. Right apical reticulation/fibrosis compatible with prior radiation is also unchanged. Left basilar atelectasis is also not significant change.Multiple pleural based cystic metastases are again noted. The reference postero-inferior nodule measures 2.4 x 3.5 cm (series 4 image 56), previously 3.0 x 2.2 cm. The more superior right pleural based cystic metastasis is also slightly increased in size measuring 2.5 x 1.5 cm (series 4 image 45) previously 2.0 x 1.5 cm.MEDIASTINUM AND HILA: Left chest port with tip in the right atrium. Heart is normal in size. No coronary artery atherosclerotic calcification. No pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: Right anterior chest wall low density mass measures 8.3 x 3.9 cm (series 4 image 63) cannot previously 7.0 x 4.6 cm. Multiple old right-sided rib fractures. Mild scalloping/periostitis involving the posterior aspect of multiple right ribs adjacent to the above-mentioned pleural metastases is unchanged. No new suspicious osseous lesions.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Paracaval soft tissue nodule/lymph node measures 2.4 x 2.5 cm (series 4 image 73), previously 2.0 x 1.9 cm.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. | Slight interval increase in size of right chest wall mass and multiple pleural-based metastases with measurements as described. No new sites of disease identified. |
Generate impression based on findings. | Clinical question: Hemorrhagic transformation of CVA? Signs and symptoms: On heparin drip. Nonenhanced head CT:A previously noted subacute hemorrhage along the interhemispheric aspect of the left anterior cerebral artery in the frontal lobe demonstrates subtle interval increased size and extent indicating progression of stroke however without evidence of hemorrhagic conversion. The findings results in region mass effacement of cortical sulci.Findings the age indeterminate small vessel ischemic destruction of moderate to advanced degree is again noted.Ventricular system remain within normal size and with maintained midline. | 1.No evidence of hemorrhagic transformation.2.Interval increased size and extent of left ACA subacute ischemic stroke with regional mass-effect.3.Moderate to advanced age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question: Evaluate for hypodensity or other signs of evolving stroke. Signs and symptoms: Improving but persistent weakness. Unenhanced head CT:There is no detectable acute intracranial process. CT however it is insensitive for early detection of fracture nonhemorrhagic to small vessel ischemic strokes.Unremarkable cerebral cortex, cortical sulci, CSF spaces, and ventricular system with maintained midline. | No acute intracranial process and stable exam since prior study. |
Generate impression based on findings. | Metastatic breast cancer. Restaging exam. CHEST:LUNGS AND PLEURA: Right pleural effusion now with a small caliber chest tube in place. Interval increase in size of right upper lobe pleural-based nodular opacity which measures 1.7 x 1.7 cm (series 4 image 33), previously 1.0 x 0.6 cm. Additional focus of nodularity along the right major fissure is perhaps also increased compared to prior measuring 1.0 x 1.0 cm (series 4 image 42), previously 0.9 x 0.8 cm. Similarly additional pleural nodularity in the right hemithorax is minimally more prominent. Scattered nonspecific micronodules in the left lung are unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart is normal in size. No pericardial effusion.CHEST WALL: Post surgical changes from right mastectomy. A left breast prosthesis is in place. Expansile lytic lesion in the posterior aspect of the right 11th rib is not significantly changed. Additional lesion in the left sixth rib has increased in size compared to prior. T4 mixed sclerotic and lucent lesion also appears slightly enlarged compared to prior.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense, partially cystic metastasis within the dome of the liver is increased in size measuring 1.4 x 1.4 cm (series 3 image 63), previously 0.5 x 0.5 cm. There is also a new lesion within the inferior tip of the right lobe of the liver compatible with an additional new metastasis (series 3 image 107). Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No intra-abdominal lymphadenopathy.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No definite metastatic lesions in the lumbar spine.OTHER: No significant abnormality noted. | Interval increase in pleural nodularity in the right hemithorax, osseous metastatic disease, and hepatic metastatic disease. |
Generate impression based on findings. | Clinical question: History of laryngeal cancer status post laryngectomy now with concerns for stomal recurrence, evaluate vasculature to determine if appropriate for construction with free flap. Signs and symptoms: History of laryngeal cancer status post laryngectomy now with concern for stomal recurrence. Neck CTA:The visualized aortic arch is unremarkable.Brachiocephalic and bilateral leg and arteries demonstrate mild atherosclerotic disease without stenosis.Left common carotid artery demonstrate moderate vascular calcification along its trunk and at the level of the trifurcation without hemodynamically significant stenosis. Mild stenosis at the proximal left internal carotid artery however is detected.Left vertebral artery demonstrate short segmental high grade stenosis at its origin however remains patent throughout its course through the neck and the skull base otherwise.Moderate to severe stenosis at the origin of right vertebral artery is also detected. The right vertebral artery otherwise remains patent through the neck and across the skull base.Left external carotid arteries demonstrate significant stenosis at its origin.Right common carotid artery is occluded at its origin. The right internal carotid artery is also not identified and presumed completely occluded. There is however visualization of very small caliber a few of the external carotid artery branches likely secondary to retrograde filling. | Neck CTA demonstrate complete occlusion of right common, internal and external carotid arteries. Significant stenosis at the origin of left vertebral artery and patent otherwise. Moderate stenosis at the origin of right vertebral artery and patent otherwise. Atherosclerotic calcification at the origin of the left internal carotid artery with mild stenosis. |
Generate impression based on findings. | Female 70 years old Reason: lung CA, s/p RT to RUL primary in 8/2014. Radiation pneumonitis. Continued dyspnea. Status of pulmonary disease. History: shortness of breath and hypoxia LUNGS AND PLEURA: Redemonstration of paramediastinal, right apical, and right basilar reticulation and consolidation compatible with postradiation pneumonitis/fibrosis. This is associated with stable mild adjacent pleural thickening.Moderate to severe apical predominant centrilobular emphysema. Scattered unchanged pulmonary micronodules. The previously noted right upper lobe nodule is no longer clearly separable from the adjacent radiation changes. Previously noted right lower lobe nodule has resolved and may have been infectious or inflammatory in etiology.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Heart is normal in size. No pericardial effusion. Moderate coronary artery and aortic arch atherosclerotic calcifications.CHEST WALL: Healing right rib fractures. No new or suspicious osseous lesion. New T6 compression fracture.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hepatic calcifications compatible with prior granulomatous infection. | 1. Stable post treatment changes/radiation pneumonitis as described. The post radiation changes obscure the previously noted pulmonary nodule limiting evaluation. 2. New T6 compression fracture, possible metastasis.3. No other new sites of disease or radiologic evidence of progression. |
Generate impression based on findings. | 87 year old male with follicular lymphoma. There is a new right level IIb lymph node that measures 15 x 30 mm and a right level Ib lymph node measures 24 x 19 mm, previously 20 x 12 mm. There is a new ill defined enhancing lesion within the right parotid gland that measures 29 x 26 mm.There are several subcentimeter thyroid nodules. The major salivary glands are unremarkable. The major cervical vessels are patent, although, there is mild atherosclerotic calcification of the bilateral carotid bulbs as well as the intracranial internal carotid and vertebral arteries. There is a mild apex leftward curvature of the lower cervical and upper thoracic spine. There are degenerative changes of the cervical spine including multilevel facet arthropathy, mild superior endplate depression at C7, and mild grade 1 anterolisthesis at C4-C5, C5-C6, C6-C7, T1-T2, T2-T3. There is also a new 4-mm peripherally calcified rounded lesion within the posterolateral left aspect of the spinal canal at the C4 level adjacent to the left facet joint without evidence of spinal canal stenosis that likely represent a calcified synovial cyst. The osseous structures are otherwise unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are unchanged reticular opacities within the lateral portion of the right upper lobe that are likely radiation related. The imaged portions of the lungs are otherwise clear. There is a right globe prosthesis. There is a retention cyst within left maxillary sinus. | 1.New right level IIb enlarged lymph node and a right level Ib enlarged lymph node that has increased in size. 2.New ill defined enhancing lesion within the right parotid gland likely represents a lymphomatous lesion. |
Generate impression based on findings. | Male 78 years old Reason: Pleural mesothelioma please provide bi-dimensional measurements per RECIST 1.1 criteria and compare to prior exam. History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Redemonstrated circumferential pleural thickening in the left hemithorax with associated pleural effusion compatible with the history of mesothelioma. Measurements are as follows:Level of the aortic arch (series 3 image 34): Three oclock position measures 21 mm, previously 21 mm. 8 oclock position measures 14 mm, previously 11 mm. Nine o'clock position measures 30 mm, previously 30 mm.Level of the main pulmonary artery (series 3 image 50): 12 o'clock position measures 31 mm, previously 33 mm. Fissural measurement 40 mm, previously 42 mm. Eight o'clock position 9 mm, previously 31 mm.At the level of the cardiac apex (series 3 image 84): One o'clock position measures 20 mm, previously 22 mm. Two o'clock position measures 27 mm, previously 36 mm. Four o'clock position measures 7 mm, previously 9 mm.Anterior chest wall/pleural nodule (series 3 image 59) measures 20 mm, previously 19 mm.Numerous metastatic nodules in the right lung are slightly decreased compared to prior. The reference right upper lobe nodule measures 4 mm (series 5 image 145), previously 5 mm. The reference right lower lobe nodule measures 4 mm (series 5 image 153), previously 6 mm.MEDIASTINUM AND HILA: Unchanged hypodense thyroid nodules. Unchanged invasion of the mediastinal fat planes from the overlying pleural tumor as well as infiltration of the periaortic fat planes. Multifocal prominent mediastinal lymph nodes appear similar to prior. Stable pericardial thickening or nodularity. Small-moderate pericardial effusion is similar to prior.CHEST WALL: Stable left chest wall tumor invasion extending into the soft tissues of the left flank. Intramammary lymphadenopathy as well as a enhancing soft tissue nodule in the left pectoralis major muscle are similar to prior.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No evidence of peritoneal carcinomatosis.BONES, SOFT TISSUES: Stable thickening of the left diaphragmatic crus.OTHER: No significant abnormality noted. | 1.Stable extensive pleural nodularity in the left hemithorax with invasion of the left chest wall and the mediastinum.2.Interval improvement in pulmonary metastatic disease with measurements as described.3.No evidence of metastatic disease within the upper abdomen. |
Generate impression based on findings. | 32 year-old female with ataxia, evaluate for mass No mass lesions or areas of enhancement are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. The skull and extracranial soft tissues are unremarkable. | No evidence for acute intracranial hemorrhage, mass effect, or cerebral edema. |
Generate impression based on findings. | 42 year-old female with lumbago after a work-related injury. Alignment is anatomic. There are no fractures or subluxations. Hypodense lesion in the right kidney likely represents a benign cyst. Partially visualized left renal cyst. Punctate calcification in the left kidney may represent a non-obstructing renal stone. Degenerative changes at the sacroiliac joints with vacuum phenomenon. At T12-L1, there is no significant compromise to the spinal canal or neural foramina.At L1-L2, there is no significant compromise to the spinal canal or neural foramina.At L2-L3, there is no significant compromise to the spinal canal or neural foramina.At L3-L4, there is no significant compromise to the spinal canal or neural foramina.At L4-L5, there is mild central disk bulge with ligamentum flavum hypertrophy. No significant compromise to the spinal canal or neural foramina.At L5-S1, there is loss of disk space height, endplate degenerative changes with central disk bulge and ligamentum flavum hypertrophy. No significant compromise to the spinal canal or neural foramina. | 1.Lumbar spine spondylosis worst at L5-S1 as described above.2.Degenerative changes of the sacroiliac joints bilaterally. 3.Hypoattenuating renal lesions likely cysts as above. |
Generate impression based on findings. | Male 55 years old Reason: severe asthma, hx of mucous plugging History: cough LUNGS AND PLEURA: No significant bronchiectasis, bronchial wall thickening, mucous plugging, or associated parenchymal abnormalities. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart is normal in size. No pericardial effusion. Moderate to severe coronary artery atherosclerotic calcifications.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Essentially normal CT of the chest for the patient's age. No evidence of active reactive airway disease. |
Generate impression based on findings. | Clinical question: Possible dementia. Signs and symptoms: Memory impairment. Unenhanced head CT:No evidence of an acute intracranial process.Mild ventricular and subcortical low attenuation of white matter suggestive of age indeterminant small vessel ischemic stroke is noted.Unremarkable cerebral cortex, cortical sulci, ventricular system and the CSF spaces for patient's stated age of 86.Unremarkable calvarium and orbits. Paranasal sinuses demonstrate acute on chronic sinusitis. | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes. Unremarkable head CT otherwise.3.Acute on chronic sinusitis. |
Generate impression based on findings. | Weight loss and possible hemoptysis. Evaluate for malignancy. LUNGS AND PLEURA: 8 x 5 mm solid nodule in the basilar left lower lobe (series 5 image 211). The margins appear mildly spiculated. Additional sub-solid 4-mm nodule in the left lower lobe (series 5 image 170).No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. The heart is normal in size. No pericardial effusion. No significant coronary artery atherosclerotic calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Left lower lobe 8mm solid nodule. Although some imaging features suggest an intrapulmonary lymph node, continued close interval follow up in 3 to 6 months is recommended. |
Generate impression based on findings. | 28 year-old female with headache and neck pain, evaluate for bleed. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. The skull and extracranial soft tissues are unremarkable. | No evidence for acute intracranial hemorrhage, mass effect, or cerebral edema. |
Generate impression based on findings. | 24-year-old male with sudden onset of severe headache at 4 a.m. this morning followed by two seizures. Leftward gaze preference and right upper extremity twitching. Brain: No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The visualized portions of the orbits are intact. The skull and extracranial soft tissues are unremarkable. Head CTA: There are no intracranial arterial stenoses, occlusions or aneurysms identified. There is no evidence for cerebral vasculitis and no arteriovenous malformations are identified. Common PICA/AICA trunk is noted.Head CTV: No evidence of cerebral venous thrombosis. The cerebral veins and dural venous sinuses are patent. Dominant right transverse, sigmoid and jugular sinus. | 1. Negative noncontrast head CT2. Negative CTA and CTV of the head. |
Generate impression based on findings. | Clinical question: Evaluate subarachnoid hemorrhage. Signs and symptoms: Evaluate subarachnoid hemorrhage. Unenhanced head CT:Dilated 4th ventricle containing a small amount of hemorrhage remains is stable since prior exam.Dilated supratentorial ventricular system demonstrate no significant change in size. Intraventricular hemorrhage also remains nearly identical to the prior study. Residual blood within the third ventricle and lateral ventricles similar to prior study.Residual hematoma in the right frontal lobe and its surrounding vasogenic edema demonstrate no convincing evidence of change. Small foci of subarachnoid hemorrhage posteriorly in the occipital lobe remains stable.There is deviation of midline.Basal cistern remain patent. | 1.No convincing evidence of an acute or new finding since prior study.2.Stable residual acute blood product in the ventricular system since prior exam.3.Stable dilated ventricular system since prior exam without midline shift.4.Stable residual right frontal hematoma in this mild regions of bilateral occipital subarachnoid hemorrhage since prior study. |
Generate impression based on findings. | Clinical question: R$ule out intracranial abnormalities. Signs and symptoms: Status post Fall. Nonenhanced head CT:Suboptimal exam due to motion artifact. Within this limitation there is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp.Ventricular system remains within normal size and with maintained midline. Slight prominence of cortical sulci for patient's stated age. Correlate with history and risk factors.Unremarkable images through the paranasal sinuses, mastoid air cells and orbits.Nonenhanced cervical spine CT:Degraded images due to motion artifact. Within this limitation the examination demonstrates normal anatomic alignment the vertebral coronal. No convincing evidence of fracture. Mild to moderate degenerative changes abdomen is a normal terminal compromise at any level. CT is insensitive for assessment of spinal canal stenosis. The airway remains widely patent and no perispinal soft tissue abnormalities. There is an excessive amount of air within the esophagus which may represent reflux. | 1.Suboptimal motion degraded CT without evidence of acute or posttraumatic findings.2.Suboptimal motion degraded CT of cervical spine without evidence of acute posttraumatic changes. |
Generate impression based on findings. | Clinical question: Evaluate for evidence of infarction. Signs and symptoms: Slight left-sided facial droop. Nonenhanced head CT :No detectable acute intracranial process. CT however they is insensitive for early detection of acute nonhemorrhagic ischemic strokes. There are extensive periventricular and subcortical low attenuation are white matter which considering patient's stated age of 94 likely representing age indeterminate small vessel ischemic strokes. Cortical sulci remain within normal size. No detectable cerebral cortical abnormalities. Ventricular system are within normal size and with maintained midline.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process.2.Extensive age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Clinical question : Assess for evolution of subarachnoid hemorrhage. Signs and symptoms: Subarachnoid hemorrhage. Nonenhanced head CT:Examination demonstrates interval increased size of fourth ventricle and containing small amount of acute hemorrhage since prior exam.There is evidence of significant supratentorial ventriculomegaly since prior exam and consistent with hydrocephalus.There is a large new focus of edema involving the cortex and subcortical white matter of right frontal lobe with strands of acute blood product concerning for an acute to early subacute hemorrhagic stroke. There is evidence of significant mass effect on the adjacent cortical sulci and right frontal horn on lateral ventricle and trace midline shift to the left. Hemorrhage extends into the supratentorial ventricular system.In addition there is complete effacement of cortical sulci secondary to increased intracranial pressure. Small foci of subarachnoid or parenchymal hemorrhage in bilateral occipital lobes demonstrate no significant change. | 1.Interval in large new focus of edema in the right frontal lobe and containing acute blood product highly suggestive of acute to early subacute hemorrhagic ischemic stroke.2.Extensive intraventricular extension of hemorrhage and resultant significant interval increased size of ventricular system/hydrocephalus.3.Stable small foci of parenchymal or subarachnoid hemorrhage in bilateral occipital lobes without change. |
Generate impression based on findings. | Clinical question: Shunt malfunction. Signs and symptoms: Headache. Nonenhanced head CT:Shunt in left lateral ventricle demonstrate interval increased size since prior study. The and right lateral ventricle demonstrate very subtle interval increased size. There is a focus well-demarcated CSF like density consistent with encephalomalacia in the right basal ganglia and thalamus demonstrate no significant change.There is no detectable acute intracranial hemorrhage or edema.Unremarkable calvarium, orbits and mastoid air cells. Diffuse mucosal thickening in the left chamber sphenoid sinus and unremarkable paranasal sinuses otherwise. | 1.Interval increased size of left lateral ventricle and minimally of the right and the third ventricle.2.No change in the position of a left frontal approach ventricular catheter.3.Large focus of cystic encephalomalacia in the right basal ganglia/thalamus. |
Generate impression based on findings. | Clinical question: Evaluate for accurate bleed. Signs and symptoms: MVC and alcohol. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial or calvarial findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium.Hematoma and soft tissue thickening in the right supraorbital frontal region without underlying calvarial or frontal sinus abnormalities.Unremarkable images through the orbits. Unremarkable paranasal sinuses and mastoid air cells. Significant leftward nasal septum deviation and a large bony septal spur is noted. | 1.No acute posttraumatic intracranial or calvarial findings.2.Unremarkable intracranial content.3.Right supraorbital soft tissue hematoma and swelling.4.Unremarkable orbits, calvarium and paranasal sinuses with the exception of the sphenoid sinusitis.5. |
Generate impression based on findings. | Male; 56 years old. Reason: fx? History: Right hip pain after fall from bike Pelvis and right hip: Mild osteoarthritis affects the right hip. No acute fracture or dislocation. | No acute fracture or dislocation. |
Generate impression based on findings. | Clinical question: Rule out mass. Signs and symptoms: New seizure. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, edema, hydrocephalus, mass or mass effect. Mild prominence of cortical sulci could be at the upper limits of normal for age. Prominence of cerebellar and vermian folia for age. Ventricular system and CSF cisterns are unremarkable.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process and no evidence of mass.2.Prominence of cerebellar and vermian folia for stated age of 40. Correlate with history and risk factors. |
Generate impression based on findings. | Male; 30 years old. Reason: rule out fracture History: pt was hit by large piece of steel on right elbow at work yesterday. Posterior elbow pain. No joint effusion. No acute fracture or dislocation. | No acute fracture or dislocation. |
Generate impression based on findings. | Clinical question: Subarachnoid hemorrhage. Signs and symptoms:Sudden onset of severe left-sided headache. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation. There is a punctate focus of increased density within the right sylvian fissure which is visible only on axial image 11. Finding could represent calcific right MCA branch or thrombosis.Unremarkable calvarial, paranasal sinuses and mastoid air cells as well as images through the orbits.Head CTA:Bilateral vertebral arteries, clinical branches, basilar artery and its distal branches are within normal limits.Bilateral internal carotid arteries across the skull base and in the supraclinoid segments are unremarkable. There are patent bilateral small posterior communicating arteries and demonstrating small infundibuli. Bilateral anterior cerebral arteries and anterior communicating artery is unremarkable. There is hypoplastic right A1 segment of anterior sagittal artery which is a normal anatomical variation. Bilateral middle cerebral arteries are patent and unremarkable. | 1.Nonenhanced head CT demonstrate a tiny focus of high density within the right sylvian fissure visible on axial image 11 and could represent a vascular calcification or thrombus in the right MCA. Unremarkable exam otherwise.2.Unremarkable enhanced head CTA. |
Generate impression based on findings. | Female; 25 years old. Reason: Wrist pain and swelling History: pain/swelling after someone fell onto the patient's wrist last night Questionable cortical disruption along the lateral aspect of the mid scaphoid is seen only on one projection. There is no overlying soft tissue swelling. | Questionable cortical disruption of the scaphoid but no definite fracture. If suspicion for fracture remains high, follow-up radiographs in 7 to 10 days are recommended. |
Generate impression based on findings. | Female 4 days old Reason: where is the umbilical venous catheter and ETT and are lungs re-expanded. History: lines and tube adjustedVIEW: Chest abdomen AP (two views) 3/21/15 at 1034 hrs. ET tube tip is at the thoracic inlet. NG tube terminates at the stomach. UVC tip is at the RA/SVC junction. UAC terminates at T6.Cardiac silhouette size is normal. Bilateral diffuse lung haziness with no focal opacity, effusion or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Interval retraction of ET tube and UVC.Resolution of focal opacities with persistent diffuse lung haziness consistent with RDS.Disorganized, nonspecific abdominal gas pattern. |
Generate impression based on findings. | Male 23 months old Reason: fx History: swelling and painVIEWS: Left foot AP, lateral and oblique 3/21/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Clinical question : Rule out hemorrhage, CVA. Signs and symptoms: Confusion and dizziness. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are extensive periventricular and subcortical parenchyma low-attenuation consistent with extensive age indeterminate small vessel ischemic strokes. In addition there is a focus of left frontal encephalomalacia involving the cortex and consistent with a chronic left MCA territory frontal lobe stroke.Mild ex vacuo dilatation of the lateral ventricles and the cortical sulci for patient's stated age.Unremarkable barium and images through the orbits.Extensive bilateral maxillary and ethmoid sinus disease. | 1.No acute intracranial process.2.Extensive age indeterminate small vessel ischemic stroke and chronic left frontal cortical stroke.3.Extensive bilateral maxillary and ethmoid sinus disease |
Generate impression based on findings. | Male 2 years old Reason: Rule out SBO, intussusception History: Abd pain, emesis, possible bloody emesisVIEWS: Abdomen AP supine and left lateral decubitus 3/21/15 (two views) Normal abdominal gas pattern. No evidence of obstruction or free air. | Normal examination. |
Generate impression based on findings. | Female 78 years old; Reason: 78F w schizophrenia, s/p TAH w altered mental status/catatonia, possible paraneoplastic syndrome, OSH showing adnexal mass, repeat pelvic US here reports cystic mass superior of bladder History: cystic mass superior to bladder PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Cystic mass associated with the right ovary measures 7.9 x 7.0 cm (image 42/series 3). This has increased since prior. There is a soft tissue component that is exophytic toward midline which may represent the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Thrombosis of the right superficial femoral artery. Classic arterial sclerotic disease affects the remainder of the pelvic vasculature. | 1.Cystic right adnexal mass differential considerations include benign and malignant neoplasms. |
Generate impression based on findings. | Female 7 days old Reason: Eval bowel loops History: Intolerance to feeds, sump in at LISVIEW: Abdomen AP (one view) 3/22/15 at 517 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. | Clinical question: Evaluate for new metastases. Edema or shift. Signs and symptoms: Seizure, and lung cancer with metastases. Unenhanced head CT:Multiple supratentorial foci of vasogenic edema with resultant regional mass-effect and without midline shift are again identified and consistent with peritumoral edema from patient's known multiple metastatic lesions. There is however interval decreased density of metastatic lesions since prior exam and likely representing decreased hemorrhage in the tumor. Ventricular system remains within normal size and without deviation of midline. There is a very dense well demarcated focus of parenchymal calcification without surrounding edema along the medial aspect of the right anterior temporal lobe similar to prior the study and suspicious for a cavernoma. | 1.No significant change in the extensive foci of vasogenic edema ventricles and regional mass-effect consistent with peritumoral edema.2.Decreased density of previously noted high density metastatic lesions since prior exam.3.Stable normal size of ventricular system and without deviation of midline.4.Stable well-demarcated calcified parenchymal lesion along the medial right temporal lobe which is a nonspecific finding however cavernoma is suspected. |
Generate impression based on findings. | Female 66 years old; Reason: any focus of infection History: sepsis, ascites ABDOMEN:LUNG BASES: Bilateral pleural effusions, left greater than right. Bilateral areas of atelectasis.: Glass changes in both lungs likely represents palmar edema.Epicardial pacer leads are present.LIVER, BILIARY TRACT: Liver has a nodular contour and slightly widened fissures suggestive of chronic liver disease. The hepatic and portal veins are patent.Tiny hypodensities in the liver are too small to characterize. The gallbladder is distended.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Poor perfusion involving the superolateral aspect of the left kidney most suggestive of a focal infarction.RETROPERITONEUM, LYMPH NODES: Abdominal aortic dissection extending thoracic area to the level of the iliac vessels. Celiac and SMA originates adjacent to the flap. The right renal artery originates from the false lumen the left renal artery is poorly perfused as the portion of the dissection flap likely extends into the origin of the left artery.BOWEL, MESENTERY: Small bowel is normal in caliber and course. Contrast has reached the ascending colon the transverse colon wall appears thickened which may represent debris. There is scattered mesenteric edema. No loculated ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urinary bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Surgical changes in the left femur.Degenerative changes affect the lower lumbar spine and hips.Left body wall electronic device with lead terminating adjacent to the right sacrum.OTHER: Small amount of pelvic free fluid. Diffuse body wall anasarca. | 1.New abdominal aortic dissection with patchy perfusional changes of the left kidney is compatible with ischemia.2.Mesenteric edema and body wall anasarca.3.No evidence of bowel obstruction.4.Thickening of the transverse colonic wall is suboptimally evaluated but may be due to debris.5.Correlation with lactic acid recommended to exclude bowel ischemia. |
Generate impression based on findings. | Female 8 days old Reason: Concern for NEC History: Bloody Stools, Abdomen DistensionVIEWS: Abdomen AP supine and left lateral decubitus 3/22/15 (two views) NG tube terminates in the stomach, however side port is above GE junction. 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 8 days old Reason: Eval bowel loops History: Feeding intoleranceVIEW: Abdomen AP (one view) 3/21/15 at 2142 hrs NG tube terminates in the stomach. Disorganized, persistently distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Disorganized, persistently distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | Female 8 days old Reason: is there evidence of obstruction or NEC History: DistentionVIEW: Abdomen AP (one view) 3/21/15 at 1522 hrs NG tube terminates in the stomach. Disorganized, mildly distended and nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | NG tube placement.Disorganized, mildly distended and nonspecific abdominal gas pattern. |
Generate impression based on findings. | Clinical question: ICH. Signs and symptoms: ICH Nonenhanced head CT:Acute product within the normal sized fourth ventricle stable since prior exam.Stable acute product casting the left lateral ventricle this exam and the mild edition across the midline to the right. Stable acute hematoma and left posterior parietal lobe since prior exam.Stable small amount of blood in the dependent right occipital horn since prior exam. This very extensive right hemispheric encephalomalacia and ex vacuo dilatation ofright lateral ventricle. Stable right frontal approach ventricular catheter with the tip in right foramen of Monro. | 1.Stable large left posterior parietal hematoma and extensive intraventricular hemorrhage since prior study.2.Stable enlarged ventricular system and right frontal approach ventricular catheter. |
Generate impression based on findings. | Male; 38 years old. Reason: r/o abnormality History: pain, worse at medial aspect for two weeks Calcified opacity in the joint space seen on oblique and lateral views likely represents an intraarticular loose body. No donor site is identified. No acute fracture or dislocation. No joint effusion.Old fracture deformity of the proximal tibia and metallic densities projecting over the tibia are seen on the frontal view. | Right knee intraarticular loose body, no donor site is identified. |
Generate impression based on findings. | Clinical question: Persistent fever. Signs and symptoms: Persistent fever status post transplant. Unenhanced maxillofacial CT:Minimal mucosal thickening of bilateral frontal sinuses, bilateral ethmoid and bilateral maxillary sinuses are noted. There is frothy in bilateral posterior ethmoid air cells which could represent acute sinusitis. Patent bilateral ostiomeatal units of maxillary sinuses and moderate bilateral sphenoethmoidal recesses. Unremarkable images through the nasal passage.Minimal bilateral mastoid air cells and middle ear cavities. Unremarkable orbits. | 1.Frothy contents of bilateral posterior ethmoid air cells could represent acute sinusitis.2.Minimal mucosal thickening of all paranasal sinuses.3.Well pneumatized mastoid air cells and middle ear cavities. |
Generate impression based on findings. | Female; 66 years old. Reason: HIT, 10 d post cardiac surgery, any evidence of clot, any intrathoracic focus of infection History: sepsis, ventilator dependence, HIT PULMONARY ARTERIES: Good quality study with no evidence of pulmonary embolism.LUNGS AND PLEURA: ET tube approximately 6 cm above the carina.Moderate bilateral pleural effusions with compressive atelectasis. Diffuse intralobular septal thickening and groundglass opacities.MEDIASTINUM AND HILA: Median sternotomy with intact hardware.Central venous catheter with tip in the SVC. Swan-Ganz catheter, tip in the main pulmonary artery. Transcutaneous cardiac pacing wires are seen.Aortic dissection originating in the distal ascending aorta, extending into the brachiocephalic artery superiorly and inferiorly below the most inferior image. The celiac and superior mesenteric arteries originate adjacent to the flap.No pleural effusion. Heart size within normal limits.Prominent mediastinal lymph nodes.CHEST WALL: Bilateral breast implants.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathologyNG tube within the gastric body as seen on the scout view.Small amount of ascites. | 1.Aortic dissection originating in the distal ascending aorta, extending superiorly into the brachiocephalic artery and inferiorly past the last image. Please correlate with the same day abdominal CT for further details regarding dissection in the abdomen.2.Moderate bilateral pleural effusions and compressive atelectasis.3.Interlobular septal thickening and ground glass opacities likely represent edema, however superimposed infection cannot be excluded.Findings discussed with Dr. Dodick via phone at 2:50 pm on 3/21/2015 by the resident on call.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 38 years old; Reason: neutropenic fever with no known source. Hx of multiple abdominal surgeries and chronic abdominal pain. History: above CHEST:LUNGS AND PLEURA: The previous right pulmonary nodules have decreased in size. There are new right pulmonary lesions adjacent to the fissure. The largest measuring 1.3 x 1.1 cm (image 43/series 4). No pleural effusion. There are scattered ground-glass opacities.Left upper lobe opacity is also new.MEDIASTINUM AND HILA: Heart size is normal. Trace pericardial effusion. No mediastinal lymphadenopathy.Right chest wall port terminates the cavoatrial junction.Left central venous catheter terminates in the subclavian vein.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is enlarged. Gallbladder is without diagnostic abnormality.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Suboptimal evaluation of the small bowel without oral contrast. Inflammatory changes adjacent to loop of bowel in the pelvis where there is a surgical resection margin. There is also a resection margin in the proximal sigmoid colon. There are enlarged mesenteric lymph nodes in the vicinity, the largest measuring 1.4 x 1.0 cm (image 166/series 3). BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy. Thickening of the residual vagina.BLADDER: No significant abnormality noted.LYMPH NODES: Please see aboveBOWEL, MESENTERY: Postsurgical changes in the sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Trace pelvic fluid | 1.Abnormal CT scan with thickened loop of bowel in the pelvis with adjacent mesenteric lymphadenopathy. It's unclear if the loop of bowel represent a portion of sigmoid colon or distal small bowel. Correlation with patient's prior surgical record is recommended.2.Lack of oral contrast limits evaluation for focal bowel obstruction or bowel ischemia.3.Nodular lung opacities may represent infection in the appropriate clinical setting.4.Splenomegaly and hepatomegaly |
Generate impression based on findings. | Clinical question: 45-year-old male with metastatic lung cancer now with concern for septic emboli or MRI. Assess aortic arch for evidence of plaques/thromboembolic disease. Signs and symptoms: Brain septic emboli. Nonenhanced head CT:There is no evidence of an acute intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Multiple previously seen tiny foci of embolic strokes are not identified on this exam.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter the initiation is unremarkable.Unremarkable calvarium, soft tissues of the scalp and orbits.Neck CTA:The visualized aortic arch is unremarkable other than minute vascular calcification. There disease normal origins of major vessels. The right brachial cephalic and bilateral subclavian arteries are unremarkable. Right common carotid artery, right internal and external carotid arteries are unremarkable.The left common carotid artery, left internal and external carotid arteries are unremarkable.Bilateral vertebral arteries are well visualized and unremarkable.Head CTA:Unremarkable bilateral vertebral arteries, bilateral pica branches, basilar artery and all its distal branches.Left internal carotid artery demonstrates a small aneurysm arising from the cavernous portion of left internal carotid artery anteriorly. There is any left paraophthalmic aneurysm measuring approximately 1.7 mm in length and 1.5-mm at the base and neck. The finding is best appreciated on sagittal reformatted series 80793 on images 98 through 102. The left ophthalmic artery is identified and unremarkable. There is a left posterior communicating artery present. The left anterior and middle cerebral arteries are well-visualized and unremarkable. The left carotid artery is unremarkable. No detectable abnormality at the level of anterior communicating artery.Right internal carotid artery is unremarkable across the skull base and in its supraclinoid segment. Right ophthalmic artery is visualized and unremarkable. A small right posterior communicating artery with a tiny infundibulum is identified.Right anterior and middle cerebral arteries are better visualized and without evidence of disease. | 1.Nonenhanced head CT is unremarkable. Previously reported and moderate strokes on prior MRI are not identified on this nonenhanced head CT.2.Neck CTA is unremarkable.3.Head CTA demonstrates a left paraophthalmic aneurysm measuring at 1.7-mm in length and 1.5-mm in transverse axis and neck. Unremarkable head CTA otherwise. |
Generate impression based on findings. | RIGHT TEMPORAL BONE: The external auditory canal is patent. The middle ear and mastoid air cells are well-pneumatized and clear. The ossicular chain is intact. The inner ear structures are unremarkable. The facial nerve describes a normal course.LEFT TEMPORAL BONE: There are postoperative findings related to left mastoidectomy and ossicular chain reconstruction. There is nonspecific soft tissue lining the external ear canal extending to the neo-tympanic membrane. The external ear canal remains patent. The ossicular prostheses appear intact. There is minimal nonspecific tissue within the epitympanum. There is no fluid collection within the superficial soft tissues. There is also minimal fluid within the left mastoid air cells. The inner ear structures are unremarkable. The facial nerve describes a normal course although there may be mild dehiscence of the tympanic portion wall. | Postoperative findings related to left mastoidectomy, ossicular chain and tympanic membrane reconstruction with minimal non-specific tissue in the epitympanum. If there is continued concern for infection, a contrast enhanced MRI may be beneficial. |
Generate impression based on findings. | Pain involving undersurface of the first MTP, no history of trauma No distinct acute osseous abnormality, however incomplete visualization of the medial sesamoid underlying the first MTP is noted. This may be a congenital variant however given patient's symptoms and specific comment in this area, a fracture cannot entirely be excluded. No definite superimposed overlying soft tissue changes to suggest an acute process. Please correlate with specific changes related infection. | Nonspecific changes underlying the medial first digit sesamoid, described above. Correlation with patient's specific site of concern and follow -up imaging may be indicated |
Generate impression based on findings. | Female 3 years old Reason: ETT placement History: Skull fracture and seizures.VIEW: Chest AP (one view) 3/21/15 at 2234 hrs. ET tube terminates below thoracic inlet. NG tube is generously coiled in the distended stomach. Cardiac silhouette size is normal. Streaky left lower lobe opacity, likely subsegmental atelectasis is again noted. | Left lower lobe subsegmental atelectasis. |
Generate impression based on findings. | Pediatric trauma. Rule out pneumothorax.VIEW: Chest AP (one view) 3/21/15 at 2124 hrs. ET tube terminates below the thoracic inlet. NG tube is generously coiled in a distended stomach. Aortic arch, cardiac apex and stomach are left-sided. Cardiac silhouette is normal in size and shape. Left lower lobe atelectases. No effusions or pneumothorax. | ET tube and NG tube positioning as described.Left lower lobe atelectases. |
Generate impression based on findings. | Female 3 years old Reason: R/O Fracture History: Pediatric TraumaVIEWS: Pelvis AP and 3/21/15 (one views) There is no evidence of fracture, malalignment or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Male 55 years old; Reason: thrombocytopenic w/ hematuria after LP and with abd pain WITH PO CONTRAST PLEASE History: abd pain, hematuria ABDOMEN:LUNG BASES: Bilateral lower lobe pulmonary consolidation with air bronchograms. Hypoattenuation of the cardiac blood pool compatible with anemia.LIVER, BILIARY TRACT: Hyperdense hepatic parenchyma without focal lesion. Portal vein and splenic vein are enlarged.Gallbladder has sludge and calculi.SPLEEN: Spleen is enlarged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber and course; contrast has reached the ascending colon.There is abdominal ascites and nodularity.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Extensive sclerotic changes in the osseous structures compatible with patient's history of myelofibrosisOTHER: Pelvic ascites. | 1.Lower lobe pneumonia2.No bowel obstruction3.Abdominal pelvic ascites, mesenteric edema and nodularity4.No hydronephrosis |
Generate impression based on findings. | Male 9 years old Reason: pain s/p trauma History: painVIEWS: Right uncal AP, lateral and oblique. Right foot AP, lateral and oblique. Right tibia-fibula AP and lateral and left knee AP, lateral and oblique on 3/21/15 (11 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Check for osteomyelitis. Limited due to the lack of prior imaging for comparison and marked demineralization. The patient is status post amputation through the midfoot with only the talus and calcaneus remaining. Overlying moderate soft tissue swelling and inflammation throughout the soft tissues, however no distinct definite focal osseous changes to support osteomyelitis. Cortical margins appear intact. No distinct deep ulcerations observed. | Middle and distal foot amputation without evidence of current osteomyelitis within the limitations described. See detail |
Generate impression based on findings. | Female 47 years old; Reason: rule out abscess post robotic surgery History: L sided pain and umbilical drainage ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Liver morphology is normal. No focal hepatic lesions. Hepatic and portal veins are patent. Gallbladder is without diagnostic abnormality.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis in either kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Suboptimal evaluation of the small bowel to the poor opacification.BONES, SOFT TISSUES: Nonspecific mild soft tissue thickening at the umbilicus. It extends to the left rectus muscle. There is also scattered areas of skin thickening along the anterior bowel wall. No drainable fluid collections. No intra-abdominal abscess.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Focus of gas within the urinary bladder of unclear etiology.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine at L5 and S1 with endplate sclerotic changes.OTHER: No significant abnormality noted. | 1.Soft tissue thickening at the umbilicus and skin. |
Generate impression based on findings. | Male 9 years old Reason: r/o fx History: pain, swellingVIEWS: Right ankle AP, lateral and oblique on 3/21/15 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Pain and swelling Marked diffuse soft tissue swelling without evidence of underlying osseous acute abnormality. Irregularity along the dorsal aspect of the distal talus represent suspected old chronic degenerative change. Minimal irregularity underlying the medial malleolus also represent suspected old remote trauma | Mild osteoarthritic changes and diffuse soft tissue swelling without acute distinct osseous abnormality |
Generate impression based on findings. | Male 17 years old Reason: r/o fx History: deformityVIEWS: Right wrist AP, lateral and oblique 3/21/15 (3 views) There is a nondisplaced, oblique fracture of the distal epiphyses of the right radius with extension to the articular surface. | Oblique fracture of the distal epiphyses of the right radius as described. |
Generate impression based on findings. | Clinical question: Rule out stroke. Signs and symptoms: Slurred speech, headache and elevated blood pressure. Nonenhanced head CT:There is no of an acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and grade I white matter differentiation.Unremarkable calvarial, paranasal sinuses and mastoid air cells.Atrophic/calcific left globe and unremarkable right orbit. | 1.No acute intracranial process.2.Atrophic/ calcific left globe.3.Unremarkable exam otherwise. |
Generate impression based on findings. | Patient states she has rib fracture. Right-sided. Patient fell 2 weeks ago Subacute right fifth and sixth lateral rib fractures, essentially nondisplaced and best observed on oblique imaging. Old healed rib fractures observed in the right seventh and eighth ribs. Left ribs are otherwise unremarkable | Subacute right fifth and sixth rib fractures |
Generate impression based on findings. | Female 77 years old; Reason: r/o abdominal abscess History: abdominal discomfort, constipation, strep bacteremia ABDOMEN:LUNG BASES: Trace bilateral pleural effusions.LIVER, BILIARY TRACT: Liver is normal in morphology. Well marginated hypodense lesions in the liver likely represent cysts. Other lesions which are subcentimeter and too small to characterize.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: Moderate calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Small bowel is normal in caliber and course. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse colonic wall thickening involving the sigmoid colon in the setting of severe diverticulosis. There is a perirectal multiloculated cystic collection it measures 4.4 x 3.6 cm and is most suspicious for an abscess. There are foci of gas outside the colon indicating a perforation.BONES, SOFT TISSUES: Degenerative changes affects the right hip.OTHER: No significant abnormality noted. | 1.Multiloculated collection in the pelvis near the sigmoid/rectum with foci of extramural gas most compatible with a perirectal abscess likely from a complicated diverticulitis.2.Evaluation and as we follow the acute phase of illness is recommended to exclude underlying neoplasm.3.Findings discussed with Dr. Deboer at 8.10pm on 3/21/2015 |
Generate impression based on findings. | Male 54 years old; Reason: WBC 15, N/V, no PO tolerating, weight loss History: N/V ABDOMEN:LUNG BASES: Lower lobe scattered areas of airspace opacities and bronchiectasis, bronchial wall thickening most compatible with infection.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction. Contrast has reached the ascending colon. There are scattered mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Etiology for the patient's nausea and vomiting is not evident.2.Further evaluation of the colon with colonoscopy is recommended.3.Lower lobe bronchiectasis and airspace opacities compatible with infection. Atypical infections should be considered. |
Generate impression based on findings. | Female 63 years old; Reason: SBO, volvulus History: pmh of ESRD s/p renal transplant p/w generalized abd pain, obstipation x 1 day ABDOMEN:LUNG BASES: Basilar linear atelectasis.LIVER, BILIARY TRACT: Liver is unremarkable unenhanced technique. There is trace amount of perihepatic fluid.SPLEEN: No significant abnormality noted.PANCREAS: Fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: The kidneys are atrophic.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is dilated measuring up to 5 cm. The distal loops of ileum are collapsed. There is interloop ascites. There is mild bowel wall thickening. No extraluminal air is identified. The transition point is in the mid abdomen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Urinary bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Right iliac fossa renal allograft without hydronephrosis or perinephric fluid collections.Trace amount of pelvic free fluid with hyperdense layering debris. | 1.Findings of a severe small bowel obstruction with bowel wall thickening and interloop fluid. Bowel ischemia is not excluded. |
Generate impression based on findings. | Male; 87 years old. Reason: r/o clot burden History: hx of pulmonary embolism PULMONARY ARTERIES: Good quality study with pulmonary embolism in the right lower lobe lobar pulmonary artery extending into the segmental branches.The right atrium is enlarged which could represent early right heart strain, however stability compared to 2011 argues for a more chronic process.LUNGS AND PLEURA: No pleural effusion or evidence of infection or infarct. Scattered pulmonary micronodules but no suspicious pulmonary nodule.Atelectasis/scarring is seen at the left lung base.Moderate centrilobular emphysema.MEDIASTINUM AND HILA: The heart size is normal, no pericardial effusion.Moderate coronary artery and aortic 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. Right renal cyst is partially imaged.Small hiatal hernia. | Right lower lobe pulmonary embolism without evidence of infarct. No definite evidence of acute right heart strain.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Single.Most Proximal: Lobar.RV Strain: Negative. |
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