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Generate impression based on findings. | 49 year old female status post left lumpectomy for invasive ductal carcinoma grade 2 with lymphovascular invasion and associated DCIS, presents today for routine follow up. Patient received radiation, chemotherapy, and hormonal therapy with Femara. History of benign right breast biopsy. No current breast complaints. Fa... | Postsurgical changes of the left breast. Stable right breast calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.Additionally, the patient ... |
Generate impression based on findings. | Female 48 years old; Reason: 48F h/o cervical cancer, hematuria, lung nodule History: h/o cervical cancer ABDOMEN:LUNGS BASES: Left lower lobe pulmonary nodularity, reference nodule is the largest and measures 7 x 5 mm. Additional left sided nodules stable to mildly more pronounced, another 3-mm lung nodule seen more s... | 1. Moderate degree, stable to mildly increased, right-sided hydronephrosis with mild interval increase in soft tissue thickening and stranding at level of the ureteropelvic junction. Findings may again reflect stent dysfunction or chronic obstruction. 2. Small pelvic free fluid, new from earlier exam. Stable circumfere... |
Generate impression based on findings. | Male; 61 years old. Reason: eval for infectious, new AML History: eval for infectious, new AML LUNGS AND PLEURA: No focal airspace consolidation. Scarlike subpleural opacity of the right middle lobe (coronal image 59).MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal heart size without pericardial e... | No evidence of pneumonia or other acute cardiopulmonary abnormality. |
Generate impression based on findings. | 51 year old male with history of sigmoid diverticulitis complicated by colovesical fistula and abscess, s/p sigmoidectomy with diverting loop ileostomy in September 2014. Please assess bowel prior to ileostomy takedown. The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. ... | 1.Expected postoperative changes with normal opacification of the rectum, colon, and postsurgical distal ileum as described above.2.No evidence of colovesical fistula as clinically questioned. |
Generate impression based on findings. | 41 year old female with history of ulcerative colitis s/p colectomy with J pouch creation. Now presents with new gradual periumbilical discomfort and cramping. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time through the small bowel was 35 minutes. Fluoroscopic evaluation demonstrated postsurgic... | Subtle nonobstructive adhesions involving left lower quadrant bowel loops as described above, but otherwise unremarkable exam. |
Generate impression based on findings. | 62 year-old female with knee osteoarthritis and limp Right knee: The bones are demineralized suggesting osteopenia. Poorly defined sclerosis within the lateral femoral condyle could conceivably represent osteonecrosis, but this is equivocal. There is no fracture or subchondral collapse.Left knee: The bones are deminera... | Severe osteoarthritis of the right hip and other findings as described above. |
Generate impression based on findings. | 58-year-old male with history of bladder cancer, status post cystectomy and neobladder formation. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver without evidence of focal hepatic lesions.SPLEEN: Splenule is noted.PANCREAS: No significant abnor... | 1.Postoperative changes of cystoprostatectomy and formation of neobladder without evidence of disease recurrence.2.Diffuse fatty liver. |
Generate impression based on findings. | 16-year-old male, evaluate for compression fracture, history of T4, T5 compression fractures There is a compression fracture of the T5 vertebral body with approximately 50% loss of vertebral body height. There is also relatively mild anterior wedging of the T4 vertebral body, indicating an additional compression fractu... | Compression fractures and other findings as described above. |
Generate impression based on findings. | 59-year-old female status post left THA Hardware components of a left total hip arthroplasty are situated in near-anatomic alignment without evidence of complication. Foci of gas and drains in the soft tissues reflect recent surgery. Moderate to severe osteoarthritis affects the right hip as seen on the AP view. | Postoperative changes of total hip arthroplasty as described above. |
Generate impression based on findings. | 12-year-old male with swelling of dorsum of the right hand, ulnar aspectVIEWS: Right hand AP, oblique, lateral (3 views) 01/13/15 Predominantly transverse fracture through the neck of the fifth metacarpal with apex dorsal angulation. Overlying soft tissue swelling is noted. | Boxer's fracture of the fifth metacarpal. |
Generate impression based on findings. | Colon is well distended and well cleansed. There is a moderate amount of retained fluid is extremely well and oral contrast.No significant size polyps masses are seen anywhere in the colon. No evidence of diverticulosis.Note: CT colonography is not intended for the detection of diminutive colonic polyps (i.e., tiny po... | Normal exam. Extracolonic findings as above.*OPTIONAL C-RADS CLASSIFICATION:C-1E-2*(see full definitions in: Zalis et al. CT Colonography reporting and data system: a consensus proposal. Radiology 2005;236:3-9)C1: Normal or benign lesions (no polyps > 6mm). Continue routine screening.C2: Intermediate polyp (less than t... |
Generate impression based on findings. | 62-year-old female with history of metastatic breast cancer, pathologic fracture now with right proximal femur endoprosthesis. Femur: The previously seen hemi-hip arthroplasty and proximal femur have been removed and reconstructed with a long stem endoprosthesis. We see no evidence of hardware complication. There is os... | Reconstruction of right proximal femur with endoprosthesis and other findings as above. |
Generate impression based on findings. | 23 years, Female. Reason: assess for obstructive gas pattern and stool burden History: n/v/abdominal pain, constipation Non obstructive gas pattern. Above average stool burden. No evidence of free air. Lung bases are clear. | Non obstructive gas pattern. Above average stool burden. No evidence of free air. Lung bases are clear. |
Generate impression based on findings. | 44-year-old male with history of fracture Four views of the right foot again show diffuse demineralization as well as multiple fractures which have been previously described. There is deformity of the mid third metatarsal consistent with healed/healing fracture. Healing/healed fractures of the bases of the third, fourt... | Multiple healed/healing fractures as described above. |
Generate impression based on findings. | 60 year-old female with history of colon cancer. Patient is on chemotherapy. Evaluate disease burden. CHEST:LUNGS AND PLEURA: Index left lower lobe nodule measures 0.2 cm (series 5, image 82), previously measuring 0.3 cm. No new lung nodules noted. No pleural effusions or pneumothorax.MEDIASTINUM AND HILA: Heart is nor... | 1.Interval worsening of metastatic disease, specifically hepatic.2.Interval worsening of thickening of the cecum and the inflammatory changes affecting the adjacent terminal ileum and small bowel and underlying fistulous formation not entirely excluded as above. Interval decrease in size of the right lower quadrant flu... |
Generate impression based on findings. | 40-year old male with history of bilateral foot pain. Evaluate for bunion formation. Left foot: There is a moderate hallux valgus deformity. Mild osteoarthritis affects the first MTP joint and midfoot. No acute fractures or dislocations.Right foot: There is a moderate hallux valgus deformity. Mild osteoarthritis affect... | Bilateral hallux valgus deformities and osteoarthritis as described above. |
Generate impression based on findings. | 33 years, Female. Reason: see if contrast still in colon History: see if contrast still in colon There is persistent large amount of residual contrast material in the colon, presumably from recent upper GI examination. Nonobstructive bowel gas pattern. Cholecystectomy clips. | Persistent large amount of residual contrast material in the colon. |
Generate impression based on findings. | 74-year-old female with history of fall approximately 8 weeks ago. Evaluate for occult fracture. No evidence of acute fracture or dislocation. Moderate to severe osteoarthritis affects the AC joint. Mild to moderate osteoarthritis affects the glenohumeral joint. | Osteoarthritis as above without evidence of acute fracture. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this re... |
Generate impression based on findings. | 12 year old male status-post cochlear implant.VIEW: Skull AP (one view) 1/13/2015 Interval placement of a right cochlear implant, with the implant evident along the lateral aspect of the skull, and with the cochlear lead making the curl of the cochlea in this single plane. Endotracheal tube in place with the distal tip... | Right cochlear implant. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of heart failure. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymme... | Focal asymmetry in the left inferior breast. Additional imaging, including spot compression views and possible ultrasound, is recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 64-year-old female with history of right knee pain. No acute fracture or malalignment. There is a moderate to large joint effusion. Moderate osteoarthritis affects the knee. Mild osteoarthritis affects the left knee as seen on the frontal view. | Osteoarthritis as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast benign biopsy. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. New super... | New superficially located right retroareolar mass for which spot compression and possible ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 78 year old woman with history of right breast lumpectomy for IDC in Jan 2014. Patient received radiation and is on Femara. Left breast reduction in Dec 2014 incidentally revealed ALH. No new breast complaints. History of breast cancer in maternal aunt and sister. Three standard views of both breasts, 2 right spot magn... | Expected postsurgical changes of both breasts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mam... |
Generate impression based on findings. | Reason: eval for bleed, other intracranial process History: ams, recent mca stroke, now on apixaban The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hypodense focus measuring 40 x 24 mm axial dimensions located in the right middle frontal gyrus which contains a mildly hyperd... | 1.Findings are compatible with subacute infarctions involving the right middle frontal gyrus and small foci in the right medial frontal lobe. Some of somewhat hyperdense components in the right middle frontal gyrus may represent petechial blood products.2.Lacunar infarct in the left thalamus.3.Findings suggest a small ... |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measurements pls History: none LUNGS AND PLEURA: Mild basilar scarring.No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Status post neck dissection with a phonation device.There is no mediastinal or hilar lymphadenopathy.Severe coronary calcifications, or a... | No evidence of metastases. Severe coronary calcifications are present. |
Generate impression based on findings. | 64-year-old female with history of first MTP joint fusion. There is a plate and screw device affixing the first metatarsophalangeal joint in anatomic alignment. There is no evidence of hardware complication. Parts of the joint are indistinct suggesting early fusion. Mild osteoarthritis affects the interphalangeal joint... | Orthopedic fixation of the first MTP joint as above. |
Generate impression based on findings. | Metastatic melanoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Stable right breast skin thickening.ABDOMEN:LIVER, BILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatation.SPLEEN: No significant abnormality noted... | Stable negative examination. No evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Reason: Hx tonsil CA, pls compare to previous and measure History: none LUNGS AND PLEURA: No sign of pulmonary or pleural metastases, or other significant abnormality.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Mild coronary artery calcifications are present, the heart and pericardium otherwi... | 1. No evidence of metastatic disease or change.2. Cholelithiasis. |
Generate impression based on findings. | 12-year-old male with worsening genu varumVIEWS: Standing lower extremities/mechanical axis 01/13/15 14 degrees of varus alignment of the right knee is present with respect in neutral mechanical axis. 16 degrees of varus alignment of the left knee is noted with respect to neutral mechanical axis. | Bilateral genu varus as described above. |
Generate impression based on findings. | 72 year old woman with history of left lumpectomy in 2006 for IDC. Status post radiation and hormone therapy. No new breast complaints. History of breast cancer in maternal aunt. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of s... | Stable right breast focal asymmetry and post-surgical left breast changes, without mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign find... |
Generate impression based on findings. | Female 63 years old; Reason: Colon cancer with hx of PET positive mesenteric nodule. Following since '12. Evaluate for interval change CHEST:LUNGS AND PLEURA: Stable 4 mm right lower lobe lung nodule, image 150 series 5. MEDIASTINUM, HILA AND AXILLA: Incompletely imaged right humeral prosthesis with associated beam har... | 1. Interval decrease in size of reference lymph nodes as described. 2. Unchanged 4 mm right lower lobe lung nodule, of uncertain etiology. |
Generate impression based on findings. | Reason: s/p left orbital / nasal recon History: postop The patient is status post repair for left orbital floor fracture. A mesh is present along the left orbital floor. The posterior aspect of the mesh droops approximately 5 mm below the osseous margins of the left orbital floor along with some intraorbital contents. ... | 1.Status post left orbital floor a mesh placement as described above. Please correlate with clinical exam findings.2.Bilateral nasal bone fractures as described above.3.Partial opacification the maxillary sinuses may be related to blood products in this clinical context. |
Generate impression based on findings. | 17 year old male with cerebral palsy and question of aspiration pneumonia. Coughing with thin liquids.EXAMINATION: Oropharyngeal motility study 1/13/2015 Julie Ecclestone, speech and language therapist, supervised the examination.PRESENTATION: The patient was presented thin liquids via a spoon and an open cup, nectar t... | Aspiration without cough with all consistencies tested.Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Postoperative changes are again seen from previous posterior cervical fusion of L5 and S1, with bilateral pedicle screws at these levels and bilateral connecting rods. There is associated extensive streak artifact, limiting evaluation of surrounding structures. There is no evidence of acute fracture or instrumentation... | 1. Essentially stable postoperative changes following previous decompressive laminectomy and posterior surgical fusion of L5 and S1. No acute fracture or instrumentation complication. Degree of posterior element fusion appears slightly progressed.2. Stable degree of grade 3 anterolisthesis with slightly progressed L5-S... |
Generate impression based on findings. | 84-year-old male with history of parotid mucoepidermoid carcinoma, status post chemoradiation. Per chart, pT4aN0 high grade carcinoma ex pleomorphic adenoma of the R parotid with R auditory canal recurrence in 6/2014. Radiation to R parotid bed in 9/2013, R auditory canal/pinna in 12/2014 Again seen are postoperative c... | 1. Posttreatment changes in the right head and neck including radical parotidectomy and lateral temporal bone reconstruction. Mild diffuse interval increase in soft tissue thickening is seen in the deep aspect of the surgical bed extending to the masticator space which likely represents evolving treatment changes. No n... |
Generate impression based on findings. | Female; 66 years old. Reason: small cell lung CA, s/p resection, chemo and RT. Followup History: none LUNGS AND PLEURA: Stable posttreatment changes of the right hemithorax with volume loss and apical/paramediastinal consolidation, fibrosis, and traction bronchiectasis. Surgical clips in the right hilum. No new pulmona... | No evidence of recurrent or metastatic disease in the chest. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of prior right breast benign biopsy in 1995. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribu... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Bladder carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Fatty infiltration of the liver and cholelithiasis again noted.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic right ki... | Stable examination. |
Generate impression based on findings. | Reason: Abscess vs. fistula History: draining subcutaneous nodule LUNGS AND PLEURA: Mild upper lung centrilobular and paraseptal emphysema.No suspicious nodules and no sign of infection.MEDIASTINUM AND HILA: No significant lymphadenopathy.Mild coronary arterial calcification.No pericardial effusion.CHEST WALL: Abnormal... | Abscess confined to the soft tissues of the upper back, extending into the subcutaneous fat to a depth of 2.5 cm. |
Generate impression based on findings. | Reason: dysphagia History: dysphagia Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Penetration and trace aspiration was noted during exam. Prominent cricopharyngeal muscles were noted during terminal swallowing, of questionable clinical significance. Th... | 1.Possible anterior web at the cervical esophagus.2.Sharp angulation of the GE junction with transient holdup of the barium pill. This may have implication on swallowing solid food.3.Prominent cricopharyngeal muscle noted at terminal swallowing, of questionable clinical significance.4.No evidence of reflux. |
Generate impression based on findings. | 64 years, Male. Reason: evaluate NGT position History: see above NGT tip projects over distal third duodenum. Decreased gas in the bowel loops. | NGT tip projects over distal third duodenum. Decreased gas in the bowel loops. |
Generate impression based on findings. | 84 years, Female. Reason: Assess stool burden History: Abdominal pain, constipation, abdominal distension Non obstructive gas pattern. Average stool burden.Mild scoliosis and degenerative disc disease of spine and hips. | Non obstructive gas pattern. Average stool burden. |
Generate impression based on findings. | 17-month-old female with history of gastroschisis and short gut on total parenteral nutrition, with elevated LFTs, evaluate for biliary sludge. LIVER: No significant abnormality noted. The liver measures 10 cm.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN... | No evidence of biliary sludge. Splenomegaly. |
Generate impression based on findings. | Male 39 years old; Reason: right testicle pain and swelling, eval for torsion vs orchitis History: pain and swelling to testicle RIGHT TESTIS: 4.1 x 2.8 x 2.2 cm. No focal lesions.LEFT TESTIS: 4.4 by 3.1 x 1.8 cm. No focal lesions.RIGHT EPIDIDYMIS: Right epididymis is enlarged with slightly increased vascularity.LEFT E... | Mildly thickened right epididymis with mildly increased vasculature suggestive of acute right epididymitis. Bilateral small varicoceles. |
Generate impression based on findings. | Male 67 years old; Reason: GIST - restaging CHEST:LUNGS AND PLEURA: Biapical pleural nodularity/scarring. MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes, for example, prevascular lymph node measuring 9 x 8 mm, image 29 series 7. Asymmetric dilatation of left jugular vein.CHEST WALL: No significant abnor... | 1. Diffuse circumferential thickening of stomach, particularly gastric body, appearance may be exacerbated by underdistention. Improving hepatic metastatic disease. Interval decrease in size of right lower quadrant mass as described, suspicious for metastatic adenopathy. 2. Mildly prominent mediastinal lymph nodes, non... |
Generate impression based on findings. | Male 49 years old Reason: pt with a history of met renal cell cancer, pelase assess for disease progression History: met RCC CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, more on the right side compared to the left. Bilateral dependent atelectasis. Stable left lower lobe nodule on image number 76 on series numbe... | Mostly stable metastatic disease other than minimal interval increase in one of the left paraortic lymph nodes.New small amount of ascites. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in her cousin. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. ... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Prior benign right breast surgical biopsy. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No s... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of cervical cancer diagnosed at age of 49 treated by hysterectomy, chemotherapy, radiation. Family history breast cancer in mother with age in the 80s. Two standard digital views of both breasts were performed and reviewed with the aid of ... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 32 year old male who has a complaint of bilateral breast enlargement and tenderness. Palpable areas in the upper/outer periareolar region on the left and left retroareolar breast. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts and two left spot compression views were performed digitally an... | Bilateral gynecomastia, left greater than right. The patient should consult his physician for management. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Previous left breast aspiration. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious ... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 59 years old Reason: GE junction carcinoma please compare to most recent imaging and provide index lesions for RECIST as required per study History: As study CHEST:LUNGS AND PLEURA: Interval decrease in the amount of bilateral pleural effusions.MEDIASTINUM AND HILA: As a fascial stent is in place. Wall thickening ... | Interval decrease in the amount of bilateral pleural effusions, otherwise no significant change from previous study. |
Generate impression based on findings. | The frontal sinus and frontoethmoidal recesses are clear. The anterior ethmoid air cells are clear. The posterior ethmoid air cells are clear. There is trace mucosal thickening involving the bilateral maxillary sinuses inferiorly. Maxillary molar roots are noted projecting into the maxillary antrum. The maxillary sinu... | No significant paranasal sinus disease. |
Generate impression based on findings. | 51 year old female status post right lumpectomy 1/2013 for invasive ductal carcinoma grade 1 with tubular features, presents today for routine follow up. Patient received breast radiation and is currently on tamoxifen. No current breast complaints. Family history of breast carcinoma in her maternal grandmother. Three s... | Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagno... |
Generate impression based on findings. | Female, 67 years old, status-post orbital and maxillary reconstruction with a free fibular flap on 1/5. Evidence of prior extensive left maxillectomy is seen with resection of the entire left maxillary sinus, the inferior orbital wall, the left heart palate and alveolar ridge and the left sided nasal structures.The cur... | Findings are seen related to recent extensive left maxillofacial reconstruction with placement of bone and soft tissue graft across the previously seen left maxillary defects, as as well as a mesh plate along the left orbital floor. |
Generate impression based on findings. | There is redemonstration of extensive post operative changes of right frontal and anterior temporal craniotomy for resection of a meningioma. Right greater than left anterior/inferior frontal encephalomalacia and bilateral trace right greater than left subfrontal extra-axial CSF collections remain unchanged. There is ... | 1. No significant interval change in appearance of residual enhancing meningioma along the dorsal planum sphenoidale extending along the diaphragmatic sella, comparing back to 10/16/2013. Redemonstration of intimate relationship with slightly elevated optic chiasm and proximal left optic nerve as well as the proximal a... |
Generate impression based on findings. | Male 87 years old Reason: colon cancer restaging History: colon cancer restaging CHEST:LUNGS AND PLEURA: Right lower lobe dependent atelectasis, some of which are new from previous CT.MEDIASTINUM AND HILA: Index precarinal lymph node measures 10 x 7 mm on image number 33, series number 3.CHEST WALL: No significant abno... | No significant change from previous study. |
Generate impression based on findings. | The frontal sinuses are clear. There is mild opacification of the anterior ethmoid air cells with minimal extension into the right frontal recess. There is right medial orbital wall defect with herniation of fat medially. The posterior ethmoid air cells are clear. There is trace mucosal thickening involving the bilate... | 1. Minimal mucosal thickening in the paranasal sinuses.2. Right medial orbital wall defect with herniation of fat medially. Finding may be related to prior trauma.3. Opacification of the left mastoid air cells and middle ear cavity including the epitympanum. |
Generate impression based on findings. | Male 75 years old Reason: s/p 4 cycles of treatment for prostate cancer History: s/s associated with metastatic prostate cancer CHEST:LUNGS AND PLEURA: Left upper lobe nodule measures 8-mm in diameter image number 27, series number 5, not significantly changed from previous study. Elevation of the left hemidiaphragm is... | Diffuse bone metastases. No significant change from previous study. |
Generate impression based on findings. | Male 45 years old Reason: Pt is a 44 y/o male with RCC, s/p nephrectomy, evaluate for recurrence, attention to lung nodules History: RCC CHEST:LUNGS AND PLEURA: Scattered subcentimeter nodules, unchanged.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BIL... | No significant change from prior study. |
Generate impression based on findings. | 12-year-old male status post reduction of right fifth digit boxer's fracture.VIEWS: Right hand PA and lateral (two views) 1/13/2015, 12:02 Overlying splint material obscures fine bone detail. Interval reduction of the transverse fracture of the neck of the fifth metacarpal, with residual anterior angulation. | Reduction and splinting of the fifth metacarpal boxer's fracture with residual anterior angulation. |
Generate impression based on findings. | 50 year-old male with history of pancreatic cancer who presents for surveillance after 3 cycles. ABDOMEN:LUNG BASES: Mild to moderate bibasilar atelectasis. No suspicious pulmonary nodule or mass. No pleural effusion or pneumothorax.LIVER, BILIARY TRACT: Few scattered subcentimeter hypoattenuating hepatic lesions too s... | 1.Interval decrease in size of the pancreatic head mass with persistent pancreatic ductal dilatation and distal atrophy.2.Interval decreased size of peripancreatic lymphadenopathy. |
Generate impression based on findings. | 61-year-old female with history of pancreatic cancer. Surveillance study, evaluate for liver lesions. CHEST:LUNGS AND PLEURA: Scattered pleura micronodules, and calcified left lung base granuloma, unchanged. No pleural effusion or consolidation, and no suspicious nodule or masses.MEDIASTINUM AND HILA: Heart size within... | 1.Small focus of hypoattenuation in the anterior left hepatic lobe, unchanged from prior. Nonspecific, and may be followed on subsequent imaging.2.Postoperative findings of Whipple procedure, without findings of disease recurrence, unchanged. |
Generate impression based on findings. | 78 year-old male with metastatic prostate cancer after 6 cycles of investigational therapy. Stable foci of increased radiotracer uptake are again seen, including L5 vertebral body/left transverse process, left sacrum, left iliac wing, and left hip, compatible with metastatic disease. Increased activity in the cervical ... | Stable osseus metastatic disease without evidence of progression. |
Generate impression based on findings. | 68 years, Male. Reason: OG tube placement History: OG tube placement NGT tip projected over the gastric antrum. Gaseous distention of the colon similar to prior studies. Rectal tube in place. | NGT tip projected over the gastric antrum. Gaseous distention of the colon similar to prior studies. |
Generate impression based on findings. | 74 years, Male. Reason: Rule out obstruction. Mild diffuse bowel loop dilatation with some air fluid levels on upright views, suggestive of ileus. No free air. Surgical and skin staples project over the pelvis. Right hip arthroplasty hardware. Surgical drain in the pelvis. Cardiomegaly. | Findings compatible with ileus as described above. No free air. |
Generate impression based on findings. | CT HEAD:No intracranial mass or mass effect. The ventricles and sulci are within normal limits. There is no midline. There is no intracranial hemorrhage. Minimal periventricular white matter hypoattenuation is nonspecific but unchanged from the prior exam and likely represents age indeterminate small vessel ischemic d... | 1.Postoperative findings related to total thyroidectomy. No evidence of tumor progression in the neck or lymphadenopathy.2.Mild focal area of esophageal thickening at the level of the surgical bed is unchanged. Endoscopy may be considered if clinically indicated.3.For findings in the chest, please see dedicated chest C... |
Generate impression based on findings. | 46 years old female with a history of cervical adenocarcinoma s/p surgery and chemoRT. This is a post-treatment scan for restaging and evaluating of therapeutic response. RADIOPHARMACEUTICAL: 12.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates a soft tissue... | 1.Soft tissue density with mild FDG uptake and surgical clips in the right breast, which is nonspecific. However tumor cannot be excluded. Suggest clinical correlation.2.Stable normal sized lymph nodes in the bilateral inguinal regions, which are most likely due to inflammatory change.3.Multiple new normal-sized lymph ... |
Generate impression based on findings. | 78-year-old male with history of bilateral knee pain. Right knee: There is medial compartment joint space narrowing and tricompartmental osteophytes compatible with moderate osteoarthritis which has progressed when compared to prior. There is a slight varus deformity of the knee. Scattered arterial calcifications are p... | Osteoarthritis and other findings as above. |
Generate impression based on findings. | Male 85 years old; Reason: 85 yo M with HCC, please evaluate extent of disease prior to planned radioembolization procedure. CHEST:LUNGS AND PLEURA: Mild biapical nodularity/scarring. Nonspecific mild asymmetric airspace disease in left upper lobe, image 15 series 3. Emphysematous changes seen. Biapical pleural nodular... | 1. Multifocal hepatocellular carcinoma with dominant right hepatic lesion as described.2. Endovascular aortic repair with type II endoleak seen.3. Nonspecific mild asymmetric airspace disease in left upper lobe, of uncertain clinical significance, correlation with patient's clinical history recommended, may be re-asses... |
Generate impression based on findings. | 56-year-old female with history of right knee pain. There is narrowing of the lateral compartment particularly on the skiers view compatible with moderate osteoarthritis. Minimal osteoarthritis affects the left knee as seen on the frontal view. | Osteoarthritis as above. |
Generate impression based on findings. | 60 year-old female with shoulder pain, joint pain, evaluate for RA Left hand: There is marked soft tissue swelling about the dorsum of the wrist. There is a questionable erosion of the ulnar styloid. No additional erosions or significant arthritic changes are identified.Right hand: A small ossicle adjacent to the ulnar... | Marked soft tissue swelling about the left wrist and questionable ulnar styloid erosion without other findings to suggest inflammatory arthritis. |
Generate impression based on findings. | Findings compatible with recent Le Fort I surgical maxillary osteotomy and biparietal halo placement, including a band-like fixation device along the anterior maxilla, and screws within the paramedian and bilateral anterior rami of the mandible. ADA number 7 and 10 are absent. The distractor has not yet been deployed.... | 1. Postsurgical changes related to recent Le Fort I osteotomy and halo placement, without definitive distractor device deployed. Extensive soft tissue swelling in the anterior facial soft tissues, right greater than left.2. Blood products are present within the posterior nasal cavity as well as the maxillary sinuses. 3... |
Generate impression based on findings. | 84 female with history of lumbar diskitis, osteomyelitis There is loss of the L1/2 intervertebral disk space with destruction of the adjacent vertebral body endplates consistent with the history of diskitis osteomyelitis. There is minimal kyphosis at this level. The remaining lumbar spine appears unremarkable. | Findings consistent with L1/2 diskitis osteomyelitis as described above. |
Generate impression based on findings. | 27-day-old male with desaturationVIEW: Chest AP (one view) 01/13/15, 1126 ET tube tip is below thoracic inlet and just above carina. Nasogastric tube tip is in the stomach, unchanged. There are now 3 chest tubes on the right. The left upper extremity PICC with tip in the superior vena cava is unchanged.Interval decreas... | Interval decrease in size of large right pneumothorax with leftward mediastinal shift. Atelectatic left lung. |
Generate impression based on findings. | 69-year-old female with heel ulcers, bacteremia. Evaluate for osteomyelitis. There remains increased blood flow to the right foot and ankle, particularly at the right heel, which does not appear significantly changed. Mildly increased flow in the left heel is new from the prior exam. Blood pool images show persistent i... | Cellulitis and inflammatory soft tissue changes. Stable uptake in the right heel and new uptake in the left heel on delayed phase imaging may involve the cortex, and therefore osteomyelitis of both/either calcanei remains a differential consideration. |
Generate impression based on findings. | Female 51 years old; Reason: History of metastatic breast cancer on treatment. Compare to previous scans and evaluate for response and extent of disease. Abnormal uptake in the L4 vertebral body consistent with metastatic disease is unchanged.Scattered uptake in the shoulders, hips and knees consistent with degenerativ... | L4 vertebral body metastasis not significantly changed. |
Generate impression based on findings. | 75-year-old male status post fusion. Posterior stabilization rods with transpedicular screws entering the vertebral bodies of L5, L4, L2 and L1 in near-anatomic alignment without evidence of hardware complication. There is disk space narrowing and endplate destruction at L2-L3, appearing similar to the prior exam, cons... | Orthopedic fixation and other findings as described above without evidence of hardware complication. |
Generate impression based on findings. | 84-year-old male, evaluate hardware and fusion Posterior stabilization rods with transpedicular screws enter T5, T4, T3 and C4, C5 and C6 without evidence of hardware complication. Sclerosis of the T1 vertebral body is consistent with prostate metastasis. Multilevel degenerative disk disease affects the lower cervical ... | Orthopedic fixation of the cervical and thoracic spine as well as other findings as described above. |
Generate impression based on findings. | Colon and cervical carcinoma CHEST:LUNGS AND PLEURA: Stable biapical bullae and emphysematous findings.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post wedge resection of previously noted segment 6 metastatic focus. No new worr... | Status post wedge resection of segment 6 metastatic hepatic lesion. No new mass lesion or metastatic focus appreciated. |
Generate impression based on findings. | 84-year-old male, preoperative evaluation There is 8 degrees valgus deformity of the knee relative to the neutral mechanical axis. Severe osteoarthritis affects the knee with lateral greater than medial joint space narrowing. Hardware components of a right total hip arthroplasty are situated in near-anatomic alignment. | Valgus deformity and severe osteoarthritis of the knee as described above. |
Generate impression based on findings. | 40 year-old male with metastatic thymic cancer. Evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Right paramediastinal ground glass and fibrotic changes have increased compared to previous examination and may be related to previous treatment. Interval resolution of the previously noted opacity at the left lung ... | 1.Interval decrease in size of anterior mediastinal mass. 2.Interval increase in right paramediastinal ground glass opacity/fibrotic changes which may be related to treatment.3.Stable osseous metastases. 4.Interval resolution of tree in bud opacity at the left lung base. |
Generate impression based on findings. | 52-year-old female status post ACDF 3 months prior. Evaluate for bony fusion. An anterior plate with screws affixes C4 and C5 with interposed bone graft material. We see no frank intervertebral fusion. No evidence of instability. Moderate degenerative disk disease affects C5-6 and C6-7. The prevertebral soft tissue swe... | Postoperative changes of ACDF and degenerative disc disease as described above. |
Generate impression based on findings. | Female; 58 years old. Reason: Pt w/ extensive stage small cell lung cancer. Not on therapy. Eval for progression. History: Pt w/ extensive stage small cell lung cancer. Not on therapy. Eval for progression. CHEST:LUNGS AND PLEURA: Large left hydropneumothorax has slightly improved since prior study with mildly increase... | 1. Large left hydropneumothorax has slightly improved. Again, this may be related to a bronchopleural fistula.2. Marked bronchiectasis of the residual left lung and moderate emphysema of the right lung, similar to prior study. No suspicious pulmonary nodules or masses.3. No evidence of metastatic disease in the abdomen... |
Generate impression based on findings. | Ms. Gill is a 45 year old female with screen-detected asymmetry in the left lower inner breast. US showed possible cluster of cysts vs solid mass. She presents today for US-guided aspiration of cyst vs biopsy. Left ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a cluster of two hypo... | Successful aspiration of two cysts in the left lower inner breast. No fluid was sent for cytology based on the typically benign appearance. A short term follow-up ultrasound of the left breast is recommended in 6 months to confirm stability of these findings.BIRADS: 3 - Probably benign findingRECOMMENDATION: X - No Let... |
Generate impression based on findings. | 65-year-old female with history of osteoarthritis and worsening right knee pain. The bones are demineralized suggesting osteopenia/osteoporosis. There is severe osteoarthritis affecting the right knee with bone on bone apposition medially which has progressed slightly when compared to prior. There are small tricompartm... | Severe osteoarthritis as above. |
Generate impression based on findings. | There is been a left frontotemporal craniectomy and cranioplasty with small fixation plates and microscrews. Multiple patchy areas of bone graft appears similar to the with large areas of uncovered dura. There is irregularity and mild overlap along the inferior cranioplasty margin. The dura in this region as thickened... | 1.Left frontotemporal cranioplasty is unchanged in appearance. Small underlying extra-axial CSF fluid collection is unchanged. 2.Mild stable irregularity along the cranioplasty margins as described above, possibly corresponding to palpable abnormality. |
Generate impression based on findings. | 55-year-old female with left lower quadrant pain. Evaluate for diverticulitis. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Unchanged peripherally calcified hypoattenuating subcentimeter lesion in the lateral right hepatic lobe; apparent macroscopic fat in lesion. SPLEEN: Splenule noted.PAN... | 1.Findings consistent with descending colitis.2.Indeterminate right hepatic lobe lesion is unchanged, favor benign lesion.3.Incompletely characterized right renal lesion. |
Generate impression based on findings. | 45-year-old female with history of head and neck cancer and chemoradiation therapy.RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 80 mg/dL. Today's CT portion grossly demonstrates right chest wall port catheter tip common terminating in the right atrium, cholelithiasis without evid... | 1.No evidence of FDG avid tumor in the head and neck.2.Focal intense FDG avidity in the left upper quadrant may represent colonic adenoma or carcinoma versus less likely metastasis. Correlation with endoscopic findings is recommended.3.Endometrial/adnexal increased activity may be physiologic, and correlation with last... |
Generate impression based on findings. | Male 42 years old; Reason: right hydronephrosis History: hydronephrosis The posterior abdominal radionuclide angiogram demonstrates decreased perfusion in the left kidney at the level of the renal sinus likely due to mild hydronephrosis. Sequential images of the left kidney is significant for an area of indentation alo... | 1. Bilateral hydronephrosis, right greater than left. 2. Delayed washout of radiotracer after administration of diuretic from the right kidney may represent obstruction. Suggest follow-up in one month to determine change in renal function if clinically indicated. 3. Indentation along the superolateral aspect of the lef... |
Generate impression based on findings. | 66 years, Male. Reason: Dobbhoff tube placement History: Dobbhoff tube placement Dobbhoff tube tip projecting over gastric fundus. Decreased bowel gas compared to prior study. | Dobbhoff tube tip projecting over gastric fundus. Decreased bowel gas compared to prior study. |
Generate impression based on findings. | 53-year-old female status post right wrist fusion. There has been prior resection of the proximal carpal row with the exception of the distal pole of the scaphoid. There is now a plate and screw device affixing the radius and third metacarpal. The articulation between the distal radius and capitate is indistinct which ... | Postoperative changes of wrist fusion as described above. |
Generate impression based on findings. | 67-year-old woman with a history of a right breast lumpectomy in 2002 for IDC, status post chemoradiation. Recent history of left breast lumpectomy in Jan 2014 for IDC, status post chemoradiation. Today complains of medial left breast "thickness." Three standard views of both breasts were performed digitally with addit... | Post-surgical changes with medial left breast skin thickening and edema, likely secondary to radiation. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDAT... |
Generate impression based on findings. | Female; 64 years old. Reason: h/o sarcoma History: sarcoma LUNGS AND PLEURA: 5-mm left apical ground glass nodule (image 14, series 5). Additional smaller ground glass nodule in the right lower lobe (image 61). Very small nodular opacities along both major fissures, most compatible with intrapulmonary lymph nodes.MEDIA... | Ground glass nodules which could represent atypical adenomatous hyperplasia (AAH) or adenocarcinoma in situ (ACIS) and for which annual follow-up is recommended. No specific evidence of sarcoma metastasis. |
Generate impression based on findings. | 44-year-old male with history of known aortic aneurysm, proximally 4 cm at the level of the sinus of Valsalva and outside MRI, evaluate current size. VASCULAR: Proximal ascending aorta measures approximately 3 cm in diameter just superior to the sinus of Valsalva. Descending aorta measures approximately 2.2 cm at the l... | Mild dilation of the ascending thoracic aorta to approximately 3 cm, without additional abnormality. |
Generate impression based on findings. | BRAIN:There is redemonstration of tonsillar herniation below the foramen magnum approximately 14 mm, unchanged. Evaluation of CSF flow at the foramen magnum shows near complete absence of flow dorsally and mild attenuation of biphasic flow ventrally, similar to the prior exam. The ventricles and sulci are within norma... | 1.Chiari 1 malformation is not significantly changed.2.No evidence of syrinx or tethered cord. Trace prominence of the central canal at the C6 level is unchanged |
Generate impression based on findings. | Male; 78 years old. Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Interval resolution of patchy groundglass and nodular opacities in the posterior right upper lobe, most compatible with prior infection or aspiration. Stable scattered micronodules, some of which are calc... | Interval resolution of patchy opacities in the posterior right upper lobe, most compatible with prior infection or aspiration. No evidence of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or ar... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in maternal grandmother and paternal first cousin. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unc... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
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