instruction stringclasses 1
value | input stringlengths 6 8.98k | output stringlengths 5 3.11k |
|---|---|---|
Generate impression based on findings. | 64-year-old female with a history of COPD presents with shortness of breath. LUNGS AND PLEURA: Postsurgical changes of lung volume reduction surgery. Note is made of marked emphysematous changes with an upper lobe predominance. No pleural effusion or pneumothorax. Right upper lobe calcified nodule left upper lobe line... | Findings consistent with the stated history of COPD/ severe emphysema. Scattered bilateral pulmonary micronodules, statistically most likely granulomas. No suspicious pulmonary nodules or masses are identified. Signs of pulmonary hypertension.I personally reviewed the Images and/or procedure with the Resident/Fellow an... |
Generate impression based on findings. | History hepatocellular carcinoma now status post Therasphere treatment. ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic liver.*Hepatic segment 7 TACE defect now measures 2.2 cm (series 11, image 11), unchanged. *Previously described lesion lesion in the superior aspect of the the before mentioned defect has decreased in size c... | Interval regression of disease. No new lesions identified. Otherwise stable exam. |
Generate impression based on findings. | 77-year-old female with chest pain and shortness of breath. Evaluate for PE. The comparison chest radiograph performed on 5/7/2015 demonstrates a faint right upper lobe airspace opacity.The ventilation images show a uniform distribution of activity on single-breath and wash-in images. Mild abnormal Xe-133 retention dur... | Single moderate to large mismatched segmental perfusion defect in the left lower lobe. Intermediate probability for pulmonary embolism.Results text paged to 5019 at 3:00 PM on 5/8/2015. |
Generate impression based on findings. | Male; 60 years old. Reason: metastatic prostate cancer, radiographic evaluation to confirm disease progression per PCWG2 group History: prostate cancer Osseous metastases in the skull base, bilateral ribs, thoracolumbar spine, left proximal humerus, and pelvis are not significantly changed when compared to prior study.... | Multifocal osseous metastatic disease without significant interval change. |
Generate impression based on findings. | Left ankle pain Interval removal of splint or cast material. Additionally sideplate fixation and 2 screws the medial malleolus are also observed affixing in gross anatomic alignment the STIR for injury. Mortise intact and symmetric. Decreased soft tissue swelling | ORIF of distal fibular and medial malleolus fractures |
Generate impression based on findings. | Knee pain Hemiarthroplasty is again observed involving the medial compartment of the left knee. Similar superimposed tricompartmental degenerative changes with narrowing greater in the medial aspects unchanged. No evidence of hardware complication. No effusionMild progression of degenerative changes incompletely visual... | Unchanged left medial hemiarthroplasty. Progressing degenerative changes observed on the right knee |
Generate impression based on findings. | 14-year-old female with history of cerebral palsy, limb swelling and intermittent fevers. Evaluate for osteomyelitis.VIEWS: Right ankle AP, lateral and oblique (3 views) 5/8/2015 at 1126 Spastic equinovarus deformity affects the right lower extremity, with associated muscular atrophy and bone demineralization. Given th... | Chronic abnormalities as above, without convincing evidence of osteomyelitis. If there is high clinical suspicion of osteomyelitis, consider MRI with contrast. |
Generate impression based on findings. | 69-year-old male patient with history of tonsil cancer and bone metastases. Status post CRT, Compared to previous. CHEST:LUNGS AND PLEURA: A punctate left upper lobe pulmonary micronodule is unchanged. No suspicious pulmonary nodules are identified. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: No significa... | No significant interval change or evidence of metastatic disease. |
Generate impression based on findings. | 71 years old female. Reason: Solitary nodule on CT, undefined. History: RUL nodule on CT scan. RADIOPHARMACEUTICAL: 11.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates a mass in the left superior mediastinum, which compresses the trachea to the right and ap... | 1.Hypermetabolic nodule in the right upper lobe, highly suspicious for tumor.2.Intense FDG uptake in the left thyroid mass, suspicious for tumor.3.Increased activity in the mildly enlarged lymph nodes in the right axilla, suspicious for nodal metastasis.4.Increased activity in the sella turcica on right side, probably ... |
Generate impression based on findings. | Clavicle repair Distal left sideplate demonstrates continued healing of the underlying oblique fracture with minimal increased callus formation. No hardware complication. Left shoulder vascular stenting intact and unchanged | Continued interval healing of the distal clavicle fracture |
Generate impression based on findings. | Head and neck cancer (parotid). CRT. CHEST:LUNGS AND PLEURA: Mixed response in pulmonary metastases, while some have slightly increased in size, others have decreased in size and/or density (4/33, 4/46).Right upper lobe lesion (4/26) measures 9 mm, unchanged. Right costophrenic angle lesion measures 14 x 12 mm, previou... | Mixed response in pulmonary metastases, overall, there is no significant change in index lesions. |
Generate impression based on findings. | Lateral tibial plateau injury and fracture Minimally depressed left lateral tibial plateau remains unchanged in near-anatomic alignment with increased sclerosis and less well-visualized fracture planes. Appearance and changes compatible with continued healing. No significant effusion, interval resolution | Healing tibial plateau fracture |
Generate impression based on findings. | Pain with range of motion. More pronounced to the right Moderate to more pronounced degenerative changes extending from C3 through C7 and most pronounced C4-5. Alignment preserved without evidence of instability. Please note neural foramina and posterior elements are limited in evaluation without oblique projections | Moderate osteoarthritic changes most pronounced C4-5 with limitations described |
Generate impression based on findings. | 41-year-old with palpable right mass in the axillary region. Outside hospital recommended 6 month follow up of left breast cysts. Three standard views of both breasts and multiple right spot views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibrogland... | Right axillary skin cyst. 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: NS - Screening Mammogram. |
Generate impression based on findings. | Large volume emesis. Assess for source of obstruction including cervical cancer metastasis CHEST:LUNGS AND PLEURA: Bibasilar linear atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CORONARY ARTERY CALCIFICATION: None. CHEST WALL: Right-sided chest port with catheter terminating in the right atrium.ABD... | 1. Small bowel obstruction with transition point in the left lower quadrant.2. Cervical cancer with peritoneal carcinomatosis.Findings discussed with the clinical service (pager 3272) at the time of dictation |
Generate impression based on findings. | Female 12 years old Reason: 24 hours post trauma History: neck painVIEWS: Cervical spine AP and lateral 5/8/2015 (2 views) Vertebral body heights and disc spaces are maintained. No fracture or malalignment. No prevertebral soft tissue thickening. Mild adenoid hypertrophy is noted. Straightening of the cervical lordosis... | Straightening of the cervical lordosis, may be related to pain. |
Generate impression based on findings. | Female 12 years old Reason: s/p trauma and with left knee pain History: ttp, mild swellingVIEWS: Left knee AP, lateral and oblique 5/8/2015 (3 views) There is no evidence of fracture, malalignment, joint effusion or soft tissue swelling. | Normal examination. |
Generate impression based on findings. | Female 12 years old Reason: 24 hours post trauma History: back painVIEWS: Thoracic spine AP, lateral and swimmer's. Lumbar spine AP, lateral and lateral view of the sacrum. 5/8/2015 (6 views) Vertebral body heights and disc spaces are maintained. No evidence of fracture or malalignment. No spondylolysis or spondylolist... | Minimal straightening of the lumbar lordosis as described, otherwise normal examination. |
Generate impression based on findings. | 68 years Male Reason: restaging; 68M CLL s/p FCR cycle 2 last month History: transfusion-dependent cytopenias Lack of intravenous contrast limits evaluation of solid visceraCHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules. No focal consolidation or pleural effusion.MEDIASTINUM AND HILA: Heart size is normal with... | 1.Limited exam without significant interval change in diffuse mesenteric and retroperitoneal lymphadenopathy.2.New moderate volume ascites. |
Generate impression based on findings. | 62-year-old female with metastatic breast cancer. Multifocal osseous metastatic disease with small lesion in the right frontal bone of the calvarium, small lesion in the sternum, numerous segmental lesions in the bilateral ribs greater on the left, scattered small lesions in the thoracolumbar spine, and small lesion in... | Multifocal osseous metastatic disease. |
Generate impression based on findings. | 59-year-old female patient with extradural thickening of the C3-T6 spine suspicious for either a malignant or inflammatory process. Fatigue. CHEST:LUNGS AND PLEURA: Streaky bibasilar atelectasis/scarring. No suspicious pulmonary nodules are identified.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadeno... | 1. Cervical and upper thoracic posterior spinal fixation hardware; metal streak artifact limits the evaluation of the surrounding soft tissues.2. No specific evidence of malignancy within the chest, abdomen, and pelvis.3. Left thyroid nodule. |
Generate impression based on findings. | Unable to tolerate regular diet. Gastric liquid diet. Evaluate small bowel..EXAMINATION: MR enterography without and with IV contrast 05/08/15 ABDOMEN:LIVER, BILIARY TRACT: Normal in appearance.SPLEEN: Not enlarged. Normal in appearance.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality noted.KID... | Resolved right lower quadrant phlegmon. Abnormal appearance of the jejunal loops with thickening and enhancement. |
Generate impression based on findings. | 11-year-old male with history of medial joint line pain/tenderness to palpation. No joint effusion, fracture or dislocation. | Normal exam of the left knee. |
Generate impression based on findings. | 7-year-old male with history of ankle pain and gait abnormality. No joint effusion, significant swelling, fracture or dislocation. | No significant abnormality to explain the patient's symptoms. |
Generate impression based on findings. | Female, 70 years old.Left scapula cholecystectomy, converted to open. Surgical clips overlie the upper abdomen. Right abdominal drain. Pancreatic stent. Contrast material within the biliary tree. No unexpected radiopaque foreign object.Nonobstructive bowel gas pattern. Gas and stool seen within the colon. | No unexpected radiopaque foreign object identified.Findings were discussed via telephone with Dr. An, the attending surgeon, at 3:00 PM |
Generate impression based on findings. | 35-year-old female with dense breast tissue and a large mobile nontender mass in the left upper-outer quadrant (left axilla which was known hidradenitis for many years) presents for bilateral diagnostic mammogram. Strong family history of breast cancer. Three standard views of both breasts an additional left MLO view a... | No left axillary hidradenitis. 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: NS - Screening Mammogram. |
Generate impression based on findings. | 76-year-old female with a history of lung nodule. CHEST:LUNGS AND PLEURA:The reference right apical ground glass nodule measures 21 mm, previously 22 mm (series 5; image 14), unchanged allowing for scan variability.The reference right lower lobe partially marginated nodule measures 17 x 27 mm, previously 17 x 30 mm (se... | 1. No conclusive interval change in the 21 mm groundglass nodule in the right upper lobe which remains suspicious for adenocarcinoma in situ versus atypical adenomatous hyperplasia. Yearly follow-up examination is recommended.2. Indeterminate right lower lobe nodule is also unchanged, the appearance and presence of pro... |
Generate impression based on findings. | 59 years old female. Reason: evaluate for an FDG avid lesion amenable to biopsy, evaluate disease burden. History: 59 y/o F with extradural thickening of the C3-T6 spine suspicious for either a malignant for inflammatory process, please evaluate further. RADIOPHARMACEUTICAL: 8.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD ... | 1.Increased metabolic activity in the dura-based lesion extending to the epidural space at the level of the clivus and C1 vertebra, which can be due to tumor. The differential diagnosis including lymphoma, metastasis, benign tumor (likely meningioma) and sarcoidosis. Suggest correlate with the MRI examination, if clini... |
Generate impression based on findings. | Abnormality the pancreas in 2009 CT study. Follow-up. ABDOMEN:LUNG BASES: Tiny, sub centimeter nodule at the left lung base is stable and probably represents a granuloma.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Previously described side branch dilatation ve... | No substantial interval change compared to prior and no evidence of malignancy. Low-density nodule in the pancreas is stable. |
Generate impression based on findings. | Male, 67 years old, with history of melanoma and lymphoma and thyroid cancer. Head:Findings are again seen compatible with left parietal craniectomy and cranioplasty. Brain parenchyma subjacent to the calvarial defect shows hypoattenuation and encephalomalacia. The left lateral ventricle shows ex vacuo dilatation. Thes... | 1.A new soft tissue nodule has developed within the anterior subcutaneous tissues of the neck at the level of the cricothyroid junction.2.Superficial soft tissue thickening along the left lower neck has changed in appearance becoming somewhat smaller and less well-defined. A previously seen left supraclavicular nodule ... |
Generate impression based on findings. | History of MDS; pre-allo SCT evaluation. There is partial opacification of the frontoethmoid recesses and anterior and posterior ethmoid sinuses bilaterally with suggestion of fluid. There is mucosal thickening and bubbly secretions in the bilateral sphenoid sinuses. There is mild mucosal thickening within the bilatera... | Scattered paranasal sinus opacification in a sporadic pattern with signs of acute upon chronic sinusitis. |
Generate impression based on findings. | 54-year-old man with esophageal cancer. Chemotherapy completed 2 weeks ago. Weight loss and dysphagia. ABDOMEN:LUNG BASES: Presumed linear scarring medially at the right lung base. No effusions. Distal esophagus is concentrically thickened measuring 14 mm (image 12; series 4)LIVER, BILIARY TRACT: No significant abnorma... | Distal esophageal thickening compatible with history of esophageal carcinoma. No evidence of metastatic disease on CT. |
Generate impression based on findings. | Female, 70 years old. Reason: GERD History: dysphagia, esophageal spasms Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Right chest port, tip in the SVC.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnorm... | 1. No anatomic abnormality, significant esophageal dysmotility, or gastroesophageal reflux.2. Very small hiatal hernia. |
Generate impression based on findings. | Pain after fall.VIEWS: Right forearm AP/lateral (two views), right wrist PA/lateral/oblique (three views) 05/08/15, 1504, 1507, 1500, 1508 A transverse fracture of the distal radial diaphysis with anterior angulation is identified. A transverse fracture of the distal ulnar diaphysis, slightly distal to the radial fract... | Both bones fracture of distal forearm. |
Generate impression based on findings. | Reason: ha History: ha There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. Probable small pineal cyst. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unr... | No evidence of intracranial hemorrhage or mass effect. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Avascular necrosis, SCFE.VIEWS: Right hip AP and frog-leg 5/8/2015 (2 view/s) Round and smooth femoral head is well directed into a normally developed acetabulum. No evidence of AVN or slipped capital femoral epiphysis. No dislocation. | Normal examination. |
Generate impression based on findings. | 13-year-old female patient with history of loss of consciousness and fall 2 days prior with persistent headache. Evaluate for intracranial hemorrhage. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no mass effect or herniation. The image... | No evidence of intracranial hemorrhage, skull fracture, or mass effect. |
Generate impression based on findings. | 67-year-old male patient with melanoma and lymphoma. Please assess disease status. CHEST:LUNGS AND PLEURA: Redemonstration of a moderate right and small left pleural effusion with associated compressive atelectasis. There are innumerable new and enlarged subcentimeter pulmonary nodules compatible with pulmonary metasta... | 1. Pulmonary metastatic disease with a moderate right and small left pleural effusions.2. Decrease in size of mediastinal lymphadenopathy compared to the chest CT from 7/2014.3. Upper abdominal, mesenteric, and retroperitoneal lymphadenopathy.4. Multiple subcentimeter renal lesions are non-specific. |
Generate impression based on findings. | 55-year-old female with elevated alkaline phosphatase and pain. Evaluate for Paget's disease. No abnormal osseous foci are identified to indicate metastatic or Paget's disease. Increased focal uptake in the right maxillary molar region, most likely due to periodontal disease. Scattered degenerative arthritic changes in... | No evidence of bone metastases or Paget's disease. |
Generate impression based on findings. | Male 47 years old Reason: RUQ pain, critically ill with c/f acalculous cholecystitis History: above LIMITED ABDOMENLIVER: Increased echogenicity. Liver measures 25 cm in length. No obvious focal hepatic lesion.BILIARY TRACT: No biliary dilatation. Sludge-filled gallbladder without gallbladder wall thickening, perichole... | 1.Hepatomegaly and fatty infiltration of the liver.2.Sludge-filled gallbladder without acute sonographic signs of cholecystitis. |
Generate impression based on findings. | 65-year-old male with recurrent bacteremia of unclear source. Physiologic activity is present in the liver, spleen, and bone marrow. Faintly increased activity in the anterior right pelvis, suggestive of minimal inflammation involving right iliac fossa transplant kidney. No specific evidence of acute infection. | Findings suggestive of minimal inflammation involving right iliac fossa transplant kidney. No specific evidence of acute infection. |
Generate impression based on findings. | 23 month old male with history of neuroblastoma undergoing pretransplant evaluation. The patient’s weight of 10.8 kg and height of 82 cm were used for all calculations.Raw GFR = 34 mL/minBSA = 0.52199 m2Estimated GFR/m2 = 65 mL/min/m2Estimated GFR/m2 * 1.73 m2 (average adult BSA) = 113 mL/min (adult GFR equivalent) | GFR measurements as above. |
Generate impression based on findings. | 62-year-old female with dyspnea and Sjogren's syndrome. Evaluate for ILD. LUNGS AND PLEURA: Mild centrilobular emphysema with an upper lobe predominance. Biapical scarring/atelectasis. No focal consolidation, pleural effusion or pneumothorax. Probable intrapulmonary lymph node along the right major fissure. Scattered r... | 1. No evidence of interstitial lung disease, as clinically questioned. No suspicious pulmonary nodules or masses.2. Nonspecific right cervical lymphadenopathy is incompletely visualized but may be reactive.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Patient twisted foot today, pain laterally along with lump Mild calyx valgus deformity and bunion with degenerative changes. Associated comminuted asymmetry of the fifth metatarsal fracture with extension to the articular surface is observed in gross anatomic alignment. Mild overlying swelling. | Base of fifth metatarsal comminuted intra-articular fracture |
Generate impression based on findings. | Low back pain L-spine: Persistent moderate degenerative changes of L5-S1 with more mild to moderate degenerative changes involving the proximal lumbar levels. A grade 1 anterolisthesis of L4 on 5 is again observed and unchanged. Vertebral body heights otherwise preserved. Atherosclerotic changes. Incompletely visualize... | Unchanged degenerative changes of lower lumbar spine, mild anterolisthesis of L4 on 5 and left hip prosthetic |
Generate impression based on findings. | Patient fell, pain, check for fracture No radiographic abnormality observed. Specifically no findings to suggest acute rib fracture. Particular attention was placed in the area of markers. No underlying chest or cardiac abnormality within this limited view | Normal, however please consider serial imaging if suspicion remains high given relative decreased bone density and possibility of occult nondisplaced fractures |
Generate impression based on findings. | 11-year-old male with history of fall. Evaluate for fracture.VIEWS: Right wrist AP and lateral (2 views) 5/8/2015 at 1521Right forearm AP and lateral (2 views) 5/8/2015 at 1530 Distal metaphyseal both bones fracture with mild dorsal angulation of the distal fracture fragments. Soft tissue swelling is noted about the fr... | Distal both bones fracture as above. |
Generate impression based on findings. | Female 5 months old Reason: check NG placement VIEW: Chest and abdomen AP (2 views) 5/8/2015 at 1529 hours. NG tube terminates at the stomach. Cardiac silhouette size is top normal. Right upper lobe and bibasilar streaky opacities, likely atelectasis or pneumonia.Normal abdominal gas pattern. No evidence of obstruction... | NG tube positioning as described.Persistent multifocal opacities.Normal abdominal gas pattern. |
Generate impression based on findings. | Chronic knee pain Mild tricompartmental osteoarthritic changes including minimal narrowing, sclerosis and osteophytes are observed greater than medial compartments bilaterally.Small punctate calcifications are also observed in the lateral soft tissues on the right, possibly old healed post past trauma of the lateral co... | Mild tricompartmental osteoarthritis |
Generate impression based on findings. | 48-year-old male with neutropenic fever, new shortness of breath, and oxygen requirement. LUNGS AND PLEURA: Small groundglass nodules and tree-in-bud opacities most pronounced in the lower lobes, appearing similar to the previous study. Reference right middle lobe nodule measures 5 mm, previously 5 mm (154; series 5). ... | Persistent groundglass nodules and tree-in-bud opacities suspicious for infection, but not characteristic of fungal infection such as Aspergillus. Chronic aspiration could also be considered in the correct clinical setting.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this re... |
Generate impression based on findings. | 62-year-old female with endometrial cancer status post 3 cycles of Taxol/Carbo. ABDOMEN:LUNG BASES: No suspicious pulmonary nodules. No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Liver enhances homogenously without focal lesion. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PAN... | 1.Decreased retroperitoneal and pelvic lymphadenopathy. 2.Uterus decreased in size. 3.No evidence of disease progression. |
Generate impression based on findings. | 62-year-old with history of prior breast tenderness. History of Sjogren's syndrome. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant ma... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Headache There is no acute intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus. Mild ex-vacuo dilatation of left frontal horn of lateral ventricle secondary to a left caudate chronic lacunar infarct, unchanged. Small focus of low-attenuation in the left basal ganglia most like representing a chr... | 1. No evidence of intracranial hemorrhage or mass effect. Please note CT is insensitive for the detection of acute non-hemorrhagic infarcts, and MRI should be considered if there is continued clinical suspicion.2. Chronic small vessel ischemic disease with chronic lacunar infarcts as above. |
Generate impression based on findings. | History of trauma with foot pain ambulation overlies second metatarsal. Check for stress fracture Small focal periosteal reaction the mid second metatarsal diaphysis correlates with suspected stress fracture. Additional mild periosteal change observed in the third metatarsal, suggesting a stress reaction. Remaining foo... | Stress fracture second metatarsal and probable stress reaction of the adjacent third metatarsal |
Generate impression based on findings. | Pain, check for rheumatoid arthritis Hands: Questionable mild juxta-articular osteoporosis without additional acute hand abnormality. The radiocarpal joint demonstrates more moderate to severe degenerative changes with questionable fusion of the lunate triquetral articulation bilaterally. Specifically no specific findi... | Scattered degenerative changes most pronounced involving the knees without discrete findings to support an inflammatory or throat as. Nonspecific questionable hand juxta articular osteoporosis with congenital variants, see above |
Generate impression based on findings. | Aortic stenosis status post BAV; evaluate for possible bleeding. The following observations are made given the limitations of an unenhanced study.CHEST:LUNGS AND PLEURA: No significant abnormality noted.Calcified granuloma at the right lung base.MEDIASTINUM AND HILA: Ascending aorta measures 4.4 cm in diameter and desc... | No findings to suggest bleeding as clinically queried. Dilated fecal filled rectum; consider disimpaction. T11 compression fracture. |
Generate impression based on findings. | Lateral ankle swelling. Questionable mild diffuse swelling without distinct acute osseous abnormality. Moderate degenerative changes most pronounced involving the talonavicular articulation with bulky osteophytes dorsally and/or old prior healed fracture deformity. Soft tissues otherwise unremarkable | Mild swelling without acute osseous abnormality |
Generate impression based on findings. | Left orbit fracture after fall. Head: There is no evidence of acute intracranial hemorrhage or mass. There is mild patchy nonspecific cerebral white matter hypoattenuation, which may represent small vessel ischemic disease. The grey-white matter differentiation appears to be intact. The ventricles are normal in size an... | 1. Left facial contusion with associated left orbital floor fracture, extraconal and retrobulbar hemorrhage, and pneumo-orbit that result in proptosis, as well as fracture of the left maxillary walls with hemosinus, but no herniation of the orbital contents.2. No evidence of intracranial hemorrhage or calvarial fractur... |
Generate impression based on findings. | 63-year-old female with left hip pain status post remote fall Two views of the left hip show no acute fracture. Alignment is anatomic. Vascular calcifications are noted. Moderate osteoarthritis affects the left hip. | No acute fracture or malalignment is evident. |
Generate impression based on findings. | Nausea, vomiting, weight loss. Elevated inflammatory markers. Evaluate for small bowel Crohn's disease.EXAMINATION: MR enterography without and with IV contrast 05/08/15 ABDOMEN:LIVER, BILIARY TRACT: Normal in appearance.SPLEEN: Not enlarged. Normal signal intensity.PANCREAS: Normal in appearance.ADRENAL GLANDS: No sig... | No bowel abnormality identified. |
Generate impression based on findings. | Check for foreign bodies, from wooden rake Moderate scattered degenerative changes most involving the DIP and distal articulations, without evidence of superimposed acute abnormality. Significantly no radiopaque foreign object or bodies observed. These notes if specific site of concern was identified this may increase ... | Mild to moderate scattered degenerative changes largely involving distal articulations |
Generate impression based on findings. | 64-year-old male. Reason: Evaluation for hydronephrosis, infection, stones History: polyuria RIGHT KIDNEY: The right kidney measures 10.3 cm in length. There is no evidence of hydronephrosis or shadowing renal calculus. Renal cortical echogenicity is normal. There is an anechoic focus at the inferior aspect of the kidn... | 1. No evidence of hydronephrosis or shadowing renal calculus on the bilateral kidneys.2. Stable right inferior pole renal cyst. |
Generate impression based on findings. | Left breast pain. Family history of breast cancer in her mother. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcific... | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Check for rheumatoid arthritis and CPPD arthropathy. Joint pain. Knee: Pronounced severe tricompartmental degenerative changes with extensive subchondral cyst bone-on-bone narrowing and irregular cortical margins. No distinct erosions and a moderate small effusion, however the trochlear notch is wide which can be assoc... | Extensive erosive changes throughout both hands and knee concerning for pronounced rheumatoid arthritis, given distribution and secondary findings. Superimposed severe osteoarthritic changes and relative sparing of the more distal articulations, however only minimally. |
Generate impression based on findings. | 73 years Female Reason: 73F w/ ovarian cancer and hx of hernias p/w RLQ pain radiating to R flank. r/o diverticulitis vs appy vs hernia vs renal stone History: RLQ pain, n/v Lack of intravenous contrast limits evaluation of solid viscera.LUNGS BASES: Minimal scarring in the lung bases. No suspicious pulmonary nodules. ... | 1.No specific findings to account for right lower quadrant pain, though streak artifact from right hip prosthesis limits evaluation of the pelvis and therefore for distal ureteral stone. Normal appendix. No evidence of diverticulitis.2.Retrocrural and retroperitoneal lymphadenopathy not significantly changed from recen... |
Generate impression based on findings. | 43-year-old with known right breast cancer on neoadjuvant therapy. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The known right breast cancers are again... | Slight interval decrease in size of index right breast cancer since the prior mammograms from about a year ago and from the more recent ultrasound comparison from December. Satellite lesions are small and relatively difficult to visualize sonographically. If further characterization of the satellites is necessary, MRI ... |
Generate impression based on findings. | Closed Fracture, checking for instrument positioning Portable intraoperative imaging again demonstrates the total right hip arthroplasty in gross anatomic alignment. Surgical hemostat projects across the pelvis with tip projected towards the inferior and medial rim of the acetabular cup | Right total hip arthroplasty, intraoperative |
Generate impression based on findings. | Check positioning, arthroplasty placement Closed fracture repair, checking positioning Portable intraoperative imaging again demonstrates the total right hip arthroplasty in gross anatomic alignment. Surgical hemostat projects across the pelvis with tip projected over the femoral neck. Subsequent images interpreted | Right total hip arthroplasty, intraoperative |
Generate impression based on findings. | Female, 51 years old, with slurred speech and weakness. The cerebral and cerebellar hemispheres and brainstem are normal in attenuation and morphology. No intracranial hemorrhage or abnormal extra-axial fluid is seen. There is no evidence of mass effect or parenchymal edema. The ventricular system is normal in size and... | No acute intracranial abnormality. If clinical concern for acute ischemia persists, further evaluation with MRI would be appropriate. |
Generate impression based on findings. | 77 years Male with new dx pancreatic ca s/p ERCP; persistent bilirubin elevation ~ 17. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules. No focal consolidation. Small bilateral pleural effusions, right greater than left with associated compressive atelectasis.MEDIASTINUM AND HILA: Heart size is normal with no pe... | Marked pneumobilia status post ERCP with internal biliary drainage catheter and common bile duct stent.Gallbladder slightly hydropic in morphology but there are no specific findings of acute cholecystitis; if there is concern for acute cholecystitis, right upper quadrant ultrasound would be recommended.I personally rev... |
Generate impression based on findings. | 63 years Female Reason: LLQ abdominal pain/eval diverticulitis vs other History: LLq abdominal pain, constipation Lack of intravenous contrast limits evaluation of solid viscera.LUNGS BASES: Severe cardiomegaly and cardiac surgical changes redemonstrated. No suspicious pulmonary nodules. Nonspecific groundglass patchy ... | Findings compatible with mild uncomplicated acute diverticulitis of the distal descending/proximal sigmoid colon.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: Please confirm NG tube is in stomach History: NG tube Enteric tube tip projects over the mid gastric body. IVC filter again noted in the expected location. Nonobstructive bowel gas pattern. The low pelvis is excluded from the field-of-view. | Enteric tube tip projects over the mid gastric body.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: eval for free air History: worsened abdominal pain, prior heavy stool burden receiving bowel regimen Nonobstructive bowel gas pattern. Less than average colonic stool burden. Lung bases are clear. Sternotomy fixation again noted. Right total hip orthoplasty device partially imaged. | Nonobstructive bowel gas pattern. Supine radiographs are insensitive for free air.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 65 years Male Reason: HCC,THERASPHERE PROCEDURE History: HCC CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules. No focal consolidation. New trace left pleural effusion. Mild upper lobe predominant centrilobular emphysema redemonstrated.MEDIASTINUM AND HILA: Heart size is normal with no pericardial effusion. Calib... | 1.No significant interval change in right hepatic lobe lesion, compatible with known HCC. Other foci of hepatocellular carcinoma are also unchanged2.Mild interval increase in abdominopelvic ascites.3.Persistent occlusion of the anterior division of the right portal vein.I personally reviewed the Images and/or procedure... |
Generate impression based on findings. | 69-year-old male with history of metastatic pancreatic cancer. Please assess and provide index lesions measurements for RECIST. Additional history per EMR re: OSH course: On 7/7/14 he had open pancreatectomy with splenectomy and partial gastrectomy. Surveillance scans and repeat FNA/EUS demonstrated recurrence. Repeat ... | 1.Postsurgical findings related to distal pancreatectomy, splenectomy, and partial gastrectomy.2.Multiple subcentimeter hypodense lesions in the liver, too small to accurately characterize. MRI of the liver may be helpful if further characterization of these lesions is clinically indicated.3.Soft tissue mass in the exp... |
Generate impression based on findings. | 65-year-old female postop day 3, emesis. Evaluate SBO versus ileus. No frankly dilated bowel loops. Multiple mostly nondifferential air-fluid levels, suggestive of mild generalized ileus. No evidence of bowel obstruction.Venous catheter tip projects over the right atrium. Midline abdominal skin staples and JP drain ref... | Findings suggestive of mild generalized ileus.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 85-year-old female with abdominal pain. Evaluate for diverticulitis. LUNG BASES: Evaluation of lung bases is limited by rest from motion artifact. Subcentimeter nodule in the right middle lobe on image #4, series #4, nonspecific.. No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Subcentimeter hypodense ... | Significant amount of gas in the endometrial cavity and vagina. A fistulous communication between the rectum and vagina cannot be excluded. Correlation with clinical history and further evaluation with pelvic MRI is recommended, if clinically indicated.These findings were communicated with acknowledged by Dr. Subeh at ... |
Generate impression based on findings. | Female, 60 years old.Rule out foreign body. RFO trigger: Multiple surgical teams. Bilateral nephroureteral stents are present, terminating in the right lower quadrant, presumably within a pouch created for urinary diversion, per the attending surgeon. Also per the attending surgeon, 2 catheters are seen entering the ri... | No unexpected radiopaque foreign body.These findings were discussed by telephone with Dr. Lee, the attending surgeon, on 5/9/2015 at 0109 hours.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 55 years Male Reason: worsening abdominal pain, AKI, elevated LFTs, etiology? perforation? History: worsening abdominal pain Lack of intravenous contrast limits evaluation of solid viscera.LUNGS BASES: Tree-in-bud opacities in the right lung base may represent bronchiolitis secondary to aspiration or infection. No susp... | Small pericardial effusion.Right lung base small airways disease, likely either infectious or aspiration bronchiolitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 33 year old female with severe abdominal pain, signicant right lower quad pain. r/o intrabdominal etiology, r/o appendicitis. LUNG BASES: No suspicious pulmonary nodules. No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Liver enhances homogenously without focal lesion. High density intraluminal material... | 1.No specific findings to account for abdominal pain. Normal appendix.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 25 years Female Reason: eval for appendicitis History: RLQ abdominal pain, WBC LUNG BASES: No suspicious pulmonary nodules. No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Liver enhances homogenously without focal lesion. Gallbladder is unremarkable.SPLEEN: No significant abnormality noted.PANCREAS: Pa... | 1.Inflammatory changes in the right lower quadrant with focal areas of distal ileal wall thickening. Appendix not visualized. Although appendicitis cannot be entirely excluded, and its course of the less likely. Inflammatory changes in the small bowel loops may be secondary to the inflammation in the left adnexa versus... |
Generate impression based on findings. | 43-year-old male with CLL. Response assessment needed for clinical trial protocol IRB 14-0881. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. New cluster of nodules and micronodules in the right medial lung base. A subpleural nodule measures 1.2 x 1.3 cm (series 5, image 72). Given the distribution... | Mild interval decrease in size of axillary, mediastinal, retroperitoneal, and pelvic lymph nodes. Internal development of new lung nodules. These may be infectious, however, lymphoma involvement cannot be excluded.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 47-year-old female with abdominal pain. Assess for small bowel obstruction. LUNG BASES: No suspicious pulmonary nodules. No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Left hepatic lobe hypoattenuating lesion measures higher than water density is unchanged, likely representing a mildly complex cyst. G... | No evidence of bowel obstruction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 46-year-old female with right flank pain. Evaluate for stone. Lack of intravenous contrast limits evaluation of solid viscera. Lack of oral contrast limits evaluation for bowel pathology.LUNGS BASES: No suspicious pulmonary nodules. No focal consolidation or pleural effusion.LIVER, BILIARY TRACT: Liver is unremarkable.... | Cholelithiasis. Left renal stone. Right renal hypodense lesion likely representing a simple cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 62 years Female Reason: eval for distension History: hypotension Paucity of bowel gas. No specific evidence of obstruction. Calcified pelvic vasculature. | No specific evidence of bowel obstruction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 71 years Male Reason: ascites? History: abdominal distension Right upper quadrant surgical clips. Prostate radiation beads. Paucity of bowel gas without specific evidence of obstruction. No obvious centralization of loops to suggest ascites. | Nonobstructive bowel gas pattern.No obvious secondary signs of ascites, though sensitivity of radiographs is poor.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 35 years Male Reason: evaluate ng tube placement History: ng tube placement Enteric tube tip in the proximal jejunum. Multiple dilated loops of small bowel with relative decompression of the distal colon, compatible with small bowel obstruction. | Enteric tube tip in the proximal jejunum.Findings remain concerning for small bowel obstruction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 63 years Male Reason: DHT History: DHT Enteric tube tip in the mid gastric body. Nonobstructive bowel gas pattern. Cholecystectomy clips LVAD, midline skin staples noted. | Enteric tube tip in the mid gastric body.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 47 years Female Reason: NGT placment History: NGT placement Enteric tube tip in the distal gastric body. Cholecystectomy clips.Nondilated bowel loops. Contrast opacifies the renal collecting systems and ureters. | Enteric tube tip in the distal gastric body.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female 46 years old Reason: hematoma around liver area? other RUQ pathology History: RUQ and flank pain CHEST:LUNGS AND PLEURA: Right paramediastinal spiculated lesion measures 1.7 x 1.2 cm image #33, series #3, not significantly changed compared to CT dated 12/15/2014. Index left upper lobe lung nodule is also unchang... | Minimal interval increase in the size of the one of the liver lesions. This may be secondary to postablation changes, however, residual metastatic disease cannot the excluded. Further evaluation with liver MRI may be helpful, if clinically indicated.Chest findings are unchanged. |
Generate impression based on findings. | 28 years Male Reason: assess NGT position History: NGT position Tubing overlies the left hemiabdomen, which may represent a surgical drain. 2 chest tubes are partially imaged, projecting over the right upper abdomen. Enteric tube is not visualized. Nonobstructive bowel gas pattern. | Enteric tube is not visualized.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 45-year-old female with pain and swelling. Evaluate for fracture. 3 nonweightbearing views of the left foot reveal focal soft tissue swelling over the dorsum of the midfoot with no acute fracture or malalignment. Vascular calcifications noted. | Focal soft tissue swelling with no acute fracture or malalignment. |
Generate impression based on findings. | 31-year-old female with pain status post shoulder unit fall on her. Rule out fracture 3 views of the right wrist reveal mild soft tissue swelling of the wrist with no acute fracture or malalignment.3 views of the right shoulder reveal questionable increased distance between the coracoid process and the clavicle as well... | Findings are questionable for AC joint separation. Mild soft tissue swelling about the wrist. No acute fracture. |
Generate impression based on findings. | Male 59 years old Reason: h/o UC, s/p j pouch construction and subsequent removal with end ileostomy. admitted w/high output, please eval for crohns disease, adhesions, narrowing, or stranding. History: high stoma output ABDOMEN:LUNG BASES: Right-sided pleural effusion is resolved.LIVER, BILIARY TRACT: No significant a... | Interval resolution of right-sided pleural effusion. |
Generate impression based on findings. | 32 years Male Reason: dobhoff placed, eval for placement History: SOB Dobbhoff tube terminates in the mid gastric body and appears kinked 4 to 5 cm from its tip. Numerous mediastinal surgical clips and evidence of sternotomy. Central venous catheter tip in the low right atrium.Nonobstructive bowel gas pattern. | Dobbhoff tube terminates in the mid gastric body and appears kinked 4 to 5 cm from its tip.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 61 years old Reason: evaluate for biliary obstruction - 61 yo M h/o pancreatic CA w diffuse livery mets, Tbili 11. prior CT and MRCP 1 mo w no dilatation but now stark inc History: jaundice, hyperbilirubinemia ABDOMEN:LIVER, BILIARY TRACT: No again noted numerous bilobar liver metastases. Common bile duct is norma... | 1. Numerous bilobar metastatic lesions. Large, locally invasive pancreatic mass causing upstream pancreatic ductal dilatation.2.Although, there are multiple isolated focally dilated, peripheral bile ducts in the liver. None of them seems to be an amenable to percutaneous or endoscopic drainage. |
Generate impression based on findings. | 51-year-old male with digits one, 3, 4 necrosis. Evaluate for osteo. 3 nonweightbearing views of the left foot reveal amputations through the distal 3rd metatarsal, the 2nd digit MTP joint, as well as 1st midproximal phalanx. Cortical irregularity at the amputation line of the 1st digit as well as adjacent medial soft ... | Findings suspicious for osteomyelitis of the 1st digit as described above. |
Generate impression based on findings. | 52-year-old female with a history of PHT presents with hemoptysis. History of hypoplastic tricuspid valve and hypoplastic right ventricle. Status post SVC to right pulmonary artery shunt (Glenn Shunt) at age 11 years. She also has an ASD and a VSD per MRI report 3/16/2009. LUNGS AND PLEURA: Debris in the left lower lob... | 1. No conclusive findings to account for the patient's hemoptysis as clinically questioned. Debris in the left lower lobe bronchus with adjacent lymph node enlargement is nonspecific and could be secondary to infection or aspiration of blood products. Additionally, there is a questionable subcentimeter nodular density ... |
Generate impression based on findings. | 32-year-old female with tachycardia and left lower extremity pain. Rule out PE. PULMONARY ARTERIES: Suboptimal examination secondary to suboptimal opacification of the pulmonary arteries. There is no large saddle embolus identified within these limitations. No evidence of right heart strain. The main pulmonary artery m... | 1. Suboptimal examination secondary to inadequate opacification of the pulmonary arteries. No evidence of a large central pulmonary embolus, within the limitations of this examination. Segmental and subsegmental emboli cannot be ruled out.2. There is persistent mosaic attenuation which can be seen in small vessel or sm... |
Generate impression based on findings. | 66 year old female with pain/swelling. Rule out fracture 3 nonweightbearing views of the left foot reveal no acute fracture or malalignment. Mild soft tissue swelling about the dorsum of the foot. | Mild soft tissue swelling with no acute fracture or malalignment. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.