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Generate impression based on findings.
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48-year-old female with adrenal mass. Evaluate. ABDOMEN:LUNG BASES: Previously noted small right inferior breast nodularity is not as conspicuous on the current examination. Previously noted 3-mm peri-fissural right middle lobe nodule is not in the field of imaging.LIVER, BILIARY TRACT: Cholelithiasis. Few scattered subcentimeter hepatic hypoattenuating foci are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.7 x 1.5 cm left adrenal nodule measures approximately 2 Hounsfield units on the noncontrast, 56 Hounsfield units on the portal venous phase, and 20 Hounsfield units on the delayed imaging. Findings consistent with a lipid rich adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Markedly enlarged fibroid uterus measuring up to 19 cm in the transverse dimension and 17 cm in the craniocaudal dimension, not significantly changed. Small amount of fluid within the endocervical canal is noted; correlation with menstrual history is recommended.BLADDER: Moderate mass effect upon the bladder from the fibroid uterus.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Left adrenal nodule most consistent with a lipid rich adenoma. 2.Stable enlarged fibroid uterus with mass effect on the bladder. 3.Small amount of fluid in the endocervical canal. Correlation with menstrual history is recommended.4.Cholelithiasis.
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Generate impression based on findings.
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Clinical concern for pneumatosis intestinalis or pneumoperitoneum.VIEWS: Abdomen AP and crosstable lateral (two views) 1/21/2015, 19:40 Nasogastric tube terminates in the body of the stomach, with the side port below the GE junction.Increased gaseous distention of multiple loops of bowel, with a paucity of distal bowel gas, which is nonspecific, but worrisome for distal obstruction. No pneumoperitoneum or portal venous gas is evident. Pneumatosis intestinalis cannot be not excluded on this image.
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Increased gaseous distention of multiple loops of bowel, worrisome for distal obstruction.
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Generate impression based on findings.
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59-year-old male with question of gout There is mild soft tissue swelling about the PIP joints bilaterally without erosions or visualized tophi. Mild osteoarthritis affects scattered interphalangeal joints.
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Soft tissue swelling and mild osteoarthritic changes without radiographic evidence of gout.
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Generate impression based on findings.
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33-year-old male, rule out signs of infection or malignancy The teeth appear grossly intact with one mandibular molar filling noted. The mandible appears unremarkable with no evidence of erosion to indicate infection or malignancy.
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No specific radiographic evidence of infection or malignancy.
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Generate impression based on findings.
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Multiple small osseous lesions are again seen in the cervical spine consistent with known multiple myeloma. Lesions involving the anteroinferior C2 and posterolateral and anteroinferior C5 demonstrate evolution compared to 6/4/2012 with decrease in size and STIR signal abnormality. No compression fractures. Lack of contrast somewhat limits evaluation. However, no evidence of epidural mass or cord compression related to tumor is seen. There is moderate spinal canal stenosis at C4-5 and C5-6 and mild canal narrowing at C3-4 and C6-7 related to degenerative disease with disc-osteophyte complexes and ligamentum flavum buckling. Appearance is stable to minimally worse since prior. There is questionable T2 signal abnormality from C4 to C6. Moderate to severe left C6-7 neural foramen narrowing is similar to prior.THORACIC SPINE
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1. Multiple myeloma with small scattered osseous lesions in the cervical and thoracic cord. No large destructive osseous lesions or compression fractures.2. Extensive epidural tumor in the lower thoracic spine with the superior epidural extent to T9 suspected and can be further delineated with postcontrast imaging for treatment planning if clinically indicated. There is edema in the conus with extensive epidural tumor at L1 extending into the right neural foramen and paraspinous soft tissues. Please refer to separate report for findings in the lumbar spine. Although there may some hemorrhage associated with the tumor, particularly involving the right psoas muscle, epidural soft tissue is most consistent with neoplasm. 3. Moderate spinal canal stenosis in the cervical spine on a degenerative basis which is stable to minimally progressed since 2012. There is questionable T2 signal abnormality at C4 to C6.Findings of epidural tumor at the thoracolumbar junction were discussed with Dr. Ramos at 10 am on 1/22/2015.
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Generate impression based on findings.
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Respiratory distress, rule out pneumonia.VIEW: Chest AP (one view) 1/22/2015 Previously seen left upper lobe opacity is not identified on today's examination and may have been related to rotational artifact or possibly atelectasis. Interval improvement of the right lower lobe opacity, likely reflecting resolved atelectasis. The cardiothymic silhouette is normal.
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Previously seen left upper lobe opacity may have related to rotational artifact or atelectasis, and is not seen on today's exam.
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Generate impression based on findings.
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Premature infant with clinical concern for necrotizing enterocolitis.VIEWS: Abdomen AP and crosstable lateral (two views) 1/22/2015, 08:38 The nasogastric tube has been retracted with the tip at the level of the GE junction and the side port above the GE junction. Significant interval improvement of the previously seen diffuse gaseous bowel distention. No pneumatosis intestinalis, pneumoperitoneum or portal venous gas seen.
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Misplaced NG tube, with interval improvement of the diffuse generalized bowel distention.
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Generate impression based on findings.
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61-year-old male, evaluate for elbow injury Alignment is anatomic. No joint effusion is noted. We see no fracture or radiographic evidence of gout.
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No fracture or malalignment.
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Generate impression based on findings.
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58-year-old female with pain and limited mobility A well corticated ossicle is again noted along the medial aspect of the humeral neck, which may represent a loose body, appearing similar to the prior exam. Amorphous ossification along the medial humeral neck at the level of the inferior glenohumeral ligament may represent prior injury. We see no fracture. Moderate osteoarthritis affects the glenohumeral joint.
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1. Findings suggestive of a loose body within the joint as well as possible old injury to the inferior glenohumeral ligament. Further evaluation with MRI may be considered if clinically warranted.2. Moderate glenohumeral osteoarthritis.
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Generate impression based on findings.
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History of subdural hematoma and right meningioma. The right cerebral convexity subdural fluid collection has resolved. There is an unchanged mildly hyperattenuating extra-axial right temporal convexity mass that measures up to approximately 10 mm in width. There is no evidence of intracranial hemorrhage. There is mild nonspecific patchy cerebral white matter, which may represent small vessel ischemic disease. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are carotid siphon and vertebral artery calcifications. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. The right cerebral convexity subdural fluid collection has resolved and there is no evidence of acute intracranial hemorrhage.2. A right temporal convexity mass is compatible with a meningioma, but it better delineated on the prior MRI.
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Generate impression based on findings.
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44 year-old female with left knee pain. Three non weight bearing and one weight-bearing views of the left knee are provided. Normal appearing left knee. No acute fracture or dislocation. No joint effusion. The right knee also appears normal as seen on the frontal view.
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Normal left knee.
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Generate impression based on findings.
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49-year-old male with metastatic renal cell carcinoma, needs new surveillance scan. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules, some of which are calcified and most likely related to prior inflammatory disease are unchanged. No new nodules or masses are seen to suggest metastatic disease. No pleural abnormalities seen. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No change in the lytic lesion in the proximal left rib. No new skeletal metastatic lesions are seen, however nuclear medicine bone scintigraphy is a more accurate indicator of extent of metastatic disease.ABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma is of higher attenuation compared with prior examinations that showed clearly demonstrable fatty infiltration. Because only postcontrast images were obtained, whether hepatic steatosis persists cannot be ascertained at this time. Again seen are scattered predominately 1 cm or smaller hypodensities unchanged dating back to 2012 and most likely hepatic cysts. No new parenchymal abnormalities are seen to suggest metastatic disease. Gallbladder and biliary tractSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Multiple enhancing adrenal gland nodules bilaterally are again seen which have increased in size. Superior right adrenal posterior nodule (series 80212, image 99) measures 1.8 x 1 .4 cm, previously 0.8 x 0.8 cm. More inferiorly on the right and none are medially at apex of glands, another nodules increased in size (image 104) to 1.8 x 1.5 cm, previously 1.0 x 0.9 cm. Smaller nodules in right and show no significant change. The solitary left adrenal gland nodule (image 104) now measures 1.6 x 1 .4 cm, previously 1.1 x 0.7 cm.KIDNEYS, URETERS: Prior left nephrectomy without evidence of residual or recurrent tumor in surgical bed. Right kidney shows no significant abnormalities.RETROPERITONEUM, LYMPH NODES: Again seen are small scattered subcentimeter lymph nodes without change and without any enlarged lymph nodes to suggest lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lytic lesions are again seen in the T9 and L1 vertebral bodies consistent with metastatic disease. T9 lesion appears similar on CT and the L1 lesion appears slightly larger extending more into the posterior elements. However, nuclear medicine bone scintigraphy is a more accurate indicator of extent of metastatic bone disease. No new foci elsewhere of metastatic bone disease are suggested on CT examination.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted in the bilateral iliac lymph node chains or elsewhere in the internal pelvis. Small profoundly subcentimeter enhancing inguinal lymph nodes are seen bilaterally of uncertain significance and stable in appearance.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable benign calcifications in the gluteal region unchanged.OTHER: No significant abnormality noted
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1. Increasing size of multiple adrenal gland nodules with measurements provided above. 2. Minimal change in scattered lytic skeletal lesions -- nuclear medicine bone scintigraphy is a more accurate indicator of extent of metastatic disease. 3. No new foci of metastatic disease identified.
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 122 cm/sec.Right internal carotid artery: 111 cm/sec.Left middle cerebral artery: 134 cm/sec.Left internal carotid artery: 101 cm/sec.
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Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec).
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Generate impression based on findings.
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88 year old female with history of C.diff and abdominal pain, evaluate for free air. Interval resolution of rectal fecal impaction. Nonspecific rectangular radiodensity is noted which projects over the rectum. Nonobstructive bowel gas pattern. Spinal degenerative disease and vascular calcifications again seen. No free air on decubitus view. Bilateral pleural effusions, left greater than right.
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1.Nonobstructive bowel gas pattern with interval resolution of rectal fecal impaction. No free air. 2.Rectangular radiodensity of uncertain etiology and clinical significance projects over the rectum. Please correlate with patient's history.
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Generate impression based on findings.
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NHL and GVHD. Follow up on fungal sinusitis and cough. There are postoperative findings related endoscopic sinonasal debridement. There is near-complete opacification of the left frontal sinus. There is apparent thinning of portions of the porsterior wall of the left frontal sinus. There is diffuse partial opacification of the bilateral ethmoid air cells and sphenoid sinuses with suggestion of air-fluid levels and bubbly secretions. There is extensive left maxillary sinus and moderate right maxillary sinus mucosal thickening. There is opacification of the inferior nasal cavity, bilaterally. There is mild nasal septal deviation and spur directed to the left. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There is bilateral tympanomastoid opacification, right greater than left.
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1. Postoperative findings related to sinonasal debridement with pansinus opacification that may represent acute upon chronic rhinosinusitis and apparent thinning of portions of the posterior wall of the left frontal sinus, which may represent inflammatory erosions. A brain MRI may be useful for further evaluation if clinically warranted.2. Bilateral tympanomastoid opacification, right greater than left, may represent otomastoiditis.
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 120 cm/sec.Right internal carotid artery: 94 cm/sec.Left middle cerebral artery: 126 cm/sec.Left internal carotid artery: 97 cm/sec.
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1.Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec).2.Occasional heart rate irregularities with sporadic slightly increased diastolic times.
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Generate impression based on findings.
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Ms. Hibbs is a 60 year old female with a personal history of left breast lumpectomy for breast cancer in 1997 followed by chemoradiation therapy. BRCA1 positive. Family history of breast cancer in sister and niece. Three standard views of both breasts along with a cleavage view 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. Linear marker was placed on a scar overlying the left breast. Stable postsurgical changes including minimal architectural distortion and increased density are present within the left lumpectomy site. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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Stable postsurgical changes of the left 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 - Diagnostic Mammogram.
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Generate impression based on findings.
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CT HEAD: Right medullary infarct better seen on MRI. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is a left lens implant.CTA HEAD: There are atherosclerotic calcifications with moderate narrowing of the bilateral cavernous carotid arteries. There is mild narrowing of the right M1 segment. The right A1 segment is mildly hypoplastic. The left middle and left anterior cerebral arteries are unremarkable. There is also narrowing of the right V4 segment beyond the PICA origin. The left vertebral artery is within normal limits. There is moderate narrowing of the right P1 segment with patent right PCOM artery. The basilar artery and left posterior cerebral artery are normal in course and caliber. A left PCOM artery is not definitively identified. Proximal visualized PICA's are patent. There is no evidence of aneurysm. CTA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is mild narrowing of the origin of the bilateral internal carotid arteries with less than 50 percent stenosis per NASCET criteria. There is moderate stenosis at the right proximal vertebral artery at its origin and just beyond its origin. There is also short segment narrowing at the V1 segment of the left vertebral artery beyond the origin. OTHER: Cervical spondylosis with disc bulge at C3/4, C4/5 and C5/6. Mild right C5/6 foraminal narrowing. There is a 14 x 8 mm right intraparotid nodule.
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1. Atherosclerotic disease involving the intra- and extracranial vessels. Moderate multifocal stenoses is seen involving the V1 and V4 segments of the right vertebral artery. There is also short segment narrowing at the V1 segment of the left vertebral artery. 2. Moderate narrowing of the right P1 segment with patent right posterior communicating artery. Mild narrowing of the right M1 segment. 3. Less than 50 percent stenosis at the origins of the bilateral internal carotid arteries. 4. 14x8 mm nodule in the right parotid gland which is favored to represent a benign salivary gland neoplasm versus pathologic lymph node.
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Generate impression based on findings.
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64-year-old male -- pre-kidney transplant evaluation, patient with severe peripheral vascular disease. Within the limits of a non-IV contrast-enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made:ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted in liver parenchyma on limited non-IV contrast enhanced examination. Gallstones are seen without other biliary complication.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted -- morphology of kidneys appears normal with only mild cortical thinning. No hydronephrosis. No abnormal calcifications.RETROPERITONEUM, LYMPH NODES: No adenopathy or retroperitoneal mass is seen. The aorta shows scattered mild aortic wall calcification. Left common iliac and left external iliac artery show no significant calcifications. Right common iliac artery shows no calcifications proximally and only mild calcifications along the posterior medial just proximal to the bifurcation with a normal appearing external iliac artery without calcifications.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Anterior umbilical hernia containing only mesenteric fat.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No calcification seen in the left common or external iliac artery. Mild calcification seen along the distal posterior/medial wall of the right common iliac artery with no calcification seen in the right external iliac artery.
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1. Gallstones without other biliary tract complication. 2. Minimal calcifications in the aorta and right common iliac artery with detailed descriptions above.
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Generate impression based on findings.
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History of altered mental status, weakness, and speech disturbance. Remote history of left CVA with residual right-sided weakness. There is no evidence of intracranial hemorrhage. There is encephalomalacia and volume loss involving the left frontal, parietal, and occipital lobes, as well as ex vacuo dilatation of the left lateral ventricle, most prominent in the trigone and occipital horn, which suggests chronic infarct with addition confluent surrounding hypoattenuation. The gray-white matter differentiation is maintained on the right. There is mild prominence of the sulci and ventricles on the right, which may be related to mild age-related atrophy. There is no mass or significant midline shift. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable.
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1. Findings suggestive of chronic left middle cerebral artery territory infarction and perhaps the left posterior cerebral artery territory, although superimposed acute or subacute infarction in this region cannot be excluded. 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. 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.
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Generate impression based on findings.
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74 year old male with progressive dysphagia to solids who reports history of similar episodes and esophageal dilation at outside hospital in 2010 and 2011. Scout radiograph of the chest unremarkable.Single contrast evaluation of the esophagus and gastric cardia/fundus demonstrated significant retention of ingested material within the esophagus, with impaired transit across a focally narrowed GE junction, "bird beak" configuration seen, appearance consistent with achalasia. During the exam, spontaneous gastroesophageal reflux was observed to the level of the mid esophagus. Fluoroscopic evaluation of esophageal peristalsis demonstrated breakup of the primary peristaltic wave with significantly delayed transit of material from the esophagus into the stomach due to resultant dysmotility. TOTAL FLUOROSCOPY TIME: 5:18 mm:ss
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1.Imaging findings compatible with achalasia as described above, also consistent with patient's reported history. If clinically indicated, further evaluation with endoscopy to assess for stricture or underlying partially obstructing lesion may be considered. 2.Moderate to marked esophageal motility disorder.3.Spontaneous gastroesophageal reflux to the level of the mid esophagus.
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Generate impression based on findings.
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Status post grand mal seizure, now intubated.VIEW: Chest AP (one view) 1/22/2015 Endotracheal tube tip is just above the carina. The right upper extremity PICC is in the high right atrium. A gastrostomy tube is in place. Slightly increased bibasilar airspace opacities likely reflecting atelectasis.
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Bibasilar atelectasis. Endotracheal tube tip just above the carina.
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Generate impression based on findings.
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BRAIN: There is extensive encephalomalacia involving the right frontal lobe, right basal ganglia, right thalamus and to a lesser extent the right temporal and parietal lobes with associated ex vacuo dilatation of the right lateral ventricle, consistent with chronic infarct. There is also evidence of chronic infarct involving the right posterior cerebellar hemisphere. Signal abnormality extending into the right centrum frontal centrum semi-ovale and volume loss along the right cerebral peduncle is compatible with Wallerian degeneration. The ventricles and sulci are prominent, consistent with moderate parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. MRA HEAD: There is irregularity/up to moderate focal stenoses of the right M1 segment with attenuation of the distal right MCA branches. There is atherosclerotic disease involving the bilateral cavernous internal carotid artery segments with mild to moderate stenosis, worse on the left The left middle and bilateral anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of aneurysm.MRA NECK: Absence of contrast slightly limits evaluation. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries demonstrate no significant stenosis. There is mild narrowing at the bilateral internal carotid artery origins. Both vertebral artery origins are patent. There is moderate to severe stenosis at the origin of the left external carotid artery. There is no other evidence of flow-limiting stenosis or occlusion.
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1. No acute infarct. 2. Chronic large right frontotemporoparietal infarct including the right basal ganglia and thalamus. Chronic right cerebellar infarct also seen. 3. Evidence of intracranial and extracranial atherosclerotic disease with irregularity and up to moderate stenosis of the right M1 segment. There is attenuation of the distal right MCA branches which may be in part due to decreased demand. 4. No high-grade stenosis of the bilateral internal carotid arteries. Moderate to severe stenosis at the origin of the left external carotid artery.
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Generate impression based on findings.
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Status post right upper extremity PICC placement. Evaluate location.VIEW: Chest AP (one view) 1/21/2015, 19:25 Endotracheal tube tip is below the thoracic inlet and above the carina. New right upper extremity PICC is in the high right atrium. A gastrostomy tube is in place and the epidural catheter has been removed. Unchanged bibasilar airspace opacities likely reflecting atelectasis.
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Bibasilar atelectasis. New right upper extremity PICC with tip in the right atrium.
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Generate impression based on findings.
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Male 63 years old Reason: evaluate hepatic vasculature, evaluate for lesions History: Cirrhosis, pre liver transplant eval, hx splenorenal embolization. LIMITED ABDOMENLIVER: 12.6 cm in length. Extremely echogenic limiting sensitivity for focal lesions in limiting the Doppler exam as well.BILIARY TRACT: Gallbladder surgically absent. No intrahepatic or extrahepatic biliary dilatation. Common bile duct could not be identified.PANCREAS: Limited visualization.SPLEEN: 14.2 cm in length. RIGHT KIDNEY: 13 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.OTHER: Left kidney 15 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.No evidence of ascites.
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Exam limited by markedly echogenic liver. Right portal vein and hepatic veins could not be visualized on this exam or on the prior exam. Other vessels a patent.
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Generate impression based on findings.
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Lower back pain for one year, evaluate for spondylolysis.VIEWS: Lumbar spine AP oblique and lateral (4 views) 1/21/2015 No acute fracture, malalignment or spondylolysis is evident. A large stool burden is distributed throughout the colon.
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No findings seen to account for the patient's lower back pain.
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Generate impression based on findings.
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Status post PICC placement, evaluate location.VIEW: Chest AP (one view) 1/21/2015, 18:35 Interval placement of a right upper extremity PICC with the tip terminating in the right atrium. New bibasilar opacities suggestive of atelectasis. Previously seen contrast within the renal collecting systems is no longer evident.
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Basilar atelectasis. Right upper extremity PICC terminates in the right atrium.
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Generate impression based on findings.
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58 year old female with inflammatory pain right hand, family history of RA. Evaluate for RA, inflammatory arthritis, crystalline arthritis. Left hand:Three views of the left hand are provided. Osteoarthritis affects the DIP joints. No evidence of erosions.Right foot:Three weight bearing views of the right are provided. Minimal degenerative changes affect the first MTP joint. No evidence of erosions. Enthesophyte formation along the base of the fifth metatarsal and at the insertion of the Achilles tendon. Fusiform thickening of the Achilles tendon.Left foot:Three weight bearing views of the left are provided. Mild degenerative changes affect the first MTP joint. No evidence of erosions. Enthesophyte formation along the base of the fifth metatarsal and insertion of the Achilles tendon. Fusiform thickening of the Achilles tendon with ossific densities at the distal tendon attachment.
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No specific evidence of inflammatory arthritis. Additional findings as above.
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Generate impression based on findings.
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11-year-old male with cough/chest painVIEWS: Chest PA/lateral (two views) 01/21/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Minimal peribronchial cuffing suggestive of reactive airway disease/bronchiolitis pattern.
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Mild reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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Reason: rule out pneumonia as well as evaluating back pain History: wheezing, back painVIEW: Chest AP (one view) 01/21/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild to moderate peribronchial cuffing compatible with reactive disease/bronchiolitis pattern.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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Dysphagia and 90 pound weight loss. There is apparent mild asymmetric thickening of the left palatine tonsil, extending slightly into the left soft palate. However, the pterygoid muscles are intact and there is no evidence of significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is mild multilevel degenerative spondylosis of the cervical spine. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.
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Apparent mild asymmetric thickening of the left palatine tonsil, extending slightly into the left soft palate is nonspecific and may represent anatomic variation or inflammatory process, although neoplasm cannot be entirely excluded. Endoscopy may be useful for further evaluation.
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Generate impression based on findings.
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Reason: obstruction History: nausea vomitingVIEW: Abdomen AP (one view) 01/21/15 Gastrostomy tube, surgical sutures, and surgical clips are present and unchanged. Ascending colonic enema catheter is unchanged.Moderate to large amount of amorphous stool throughout the rectum and colon, increased since the prior exam. Nonobstructive bowel gas pattern. Segmentation anomaly of the sacrum is again seen.
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Moderate to large stool burden. Nonobstructive bowel gas pattern.
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Generate impression based on findings.
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CLINICAL DATA: Age: 70 years. Sex : Male. Indication: Reason: eval for progression History: metastatic RCC, on bevacizumab. CHEST:LUNGS AND PLEURA Right middle lobe nodule (6/60) is unchanged in size, at 4 mm. No additional suspicious nodules or masses are seen.Right hilar reference lymph node (80410/68) measures 27 x 41 mm, previously measured 28 x 42 mm.Reference subcarinal lymph node (80410/59) measures 50 x 34 mm, unchanged from prior.MEDIASTINUM:Heart is normal in size. Severe coronary artery calcifications. No significant pericardial effusion.CHEST WALL: No significant abnormalityAbdomen:LIVER, BILIARY TRACT: Multiple hypoattenuating liver foci, unchanged and likely benign cysts. Cholelithiasis, without findings of cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule (80410/103) measures 20 x 16 mm, previously 19 x 15 mm.Heterogeneous left adrenal nodule (80410/103) measures approximately 69 x 65 mm, previously 65 x 62 mm.KIDNEYS, URETERS: Postoperative findings of right nephrectomy, unchanged. Left renal hypoattenuating foci, most likely cysts, are unchanged.RETROPERITONEUM/LYMPH NODES: Reference periportal lymph node (80410/102) measures 10 mm, unchanged. Moderate atherosclerosis affects the visualized aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER:No significant abnormality noted.PELVIS:PROSTATE: Prostate enlargement, similar to prior.BLADDER: Left posterolateral bladder diverticulum, stable.LYMPH NODES: Right external iliac lymph node measures 8 x 15 mm (80410/182), unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Adrenal metastases are similar in size to prior.2.Mediastinal and hilar lymphadenopathy, similar in size to prior.
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Generate impression based on findings.
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History of chronic constipation and anal duplication, evaluate stool burden status post clean-out.VIEW: Abdomen AP (one view) 1/22/2015 An average stool burden is distributed predominantly throughout the right colon, improved from the prior examination. The bowel gas pattern is nonobstructive. No portal venous gas, pneumatosis intestinalis or pneumoperitoneum is seen.
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Average stool burden distributed predominantly throughout the right colon, improved from the prior exam.
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Generate impression based on findings.
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Reason: Assess for cecal bleeding source/mass History: GI bleed; incomplete colonoscopy due to tortuosity The scout film shows a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. There is no evidence of an obstructing or constricting lesion. Scattered colonic diverticula, including in the right colon. Few diverticula seen in sigmoid colon, consistent with prior endoscopy findings. Small amounts of barium and air refluxed into the terminal ileum. Spot films of the terminal ileum were normal. The appendix was visualized and is normal in appearance. Significant tortuosity and redundancy of the colon is noted.
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1.Multiple colonic diverticula as above.2.No cecal mass is noted. 3.Significant tortuosity and redundancy of the colon.
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Generate impression based on findings.
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Fever, cough, hypoxia, L-sided chest painVIEWS: Chest PA/lateral (two views) 01/21/15 Cardiothymic silhouette is normal. No pleural effusion or pneumothorax. No focal pulmonary opacities. Mild to moderate peribronchial cuffing suggestive of reactive airway disease/bronchiolitis pattern. Left-sided aortic arch, cardiac apex, and stomach.
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Bronchiolitis/reactive airway disease pattern.
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Generate impression based on findings.
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Ms. Roginski is a 75 year old female with a personal history of right breast lumpectomy 1997 for DCIS followed by radiation. Personal history of benign right breast biopsy in 2001. Family history of breast cancer in mother and 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 scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on a scar overlying the right breast. Stable postsurgical changes, including minimal architectural distortion and increased density, are present in the right lumpectomy bed. Scattered benign calcifications, including arterial calcifications, are present. Biopsy marker clip is unchanged in the right central breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast.
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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 - Diagnostic Mammogram.
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Generate impression based on findings.
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History of large T waves on EKG, concerning for hemorrhagic conversion of CVA. There has been interval appearance of small patchy areas of hypoattenuation and loss of gray-white differentiation in the right middle cerebral artery territory, including the right postcentral gyrus, suggests edema related to evolving acute infarction. There is no evidence of hemorrhagic transformation. There is redemonstration of encephalomalacia involving the right occipital lobe with associated ex vacuo dilatation of the occipital horn of the right lateral ventricle, compatible with chronic infarct. There is also a subcentimeter defect in the right subinsular region, which is compatible with a chronic lacunar infarct. There is no intracranial mass or midline shift. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The periventricular and subcortical white matter hypodensities elsewhere are otherwise not significantly changed. There is mucosal thickening of the maxillary sinuses, right greater than left. The mastoid air cells are clear. The skull and orbits are unremarkable.
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Findings consistent with evolving acute infarcts in the right middle cerebral artery territory superimposed upon chronic infarct in the right occipital lobe and chronic small vessel ischemic disease, without evidence of hemorrhagic transformation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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A patient submitted outside study for review. Submitted for review are digital mammographic images (12/15/14) performed at Jackson Park Hospital. For comparison, mammographic images (11/6/12) are available. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A linear scar marker is placed at 12 o'clock position in the right breast. Coarse calcifications are seen in the left retroareolar region and left axillary region.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in either breast.
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No mammographic evidence of malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.
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Generate impression based on findings.
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16-year-old female with right knee patellar dislocation. Four views of the right knee are provided. No joint effusion. No acute fracture or dislocation. The trochlea appears shallow.
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The trochlea appears shallow, otherwise, normal appearing knee.
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Generate impression based on findings.
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91-year-old female left week and landed on her wrist; now with pain and swelling. Three views of the left wrist are provided. The bones appear demineralized. Arterial calcifications. Complete fracture through the distal radial metaphysis with slight dorsal displacement of the distal fracture fragment. Tiny fragment distal to the ulnar styloid also likely represents a fracture. Associated moderate soft tissue swelling about the wrist.
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Distal radial metaphyseal and ulnar styloid fractures as described above. Findings discussed with Dr. Zmuda at 10:45 AM.
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Generate impression based on findings.
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32 year-old female with right knee pain. Three nonweightbearing and one weight-bearing views of the right knee are provided. No joint effusion. No acute fracture or malalignment.
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Normal appearing right knee.
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Generate impression based on findings.
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Ankle pain, evaluate for fracture.VIEWS: Left ankle AP lateral and oblique (3 views) 1/22/2015 Moderate soft tissue swelling is seen about the ankle, and there is a small joint effusion, but no underlying fracture or malalignment is evident.
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Moderate soft tissue swelling and joint effusion without underlying fracture or malalignment.
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Generate impression based on findings.
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Male; 76 years old. Reason: nature of right upper lobe mass on CT scan History: weakness, weight loss, failure to thrive. LUNGS AND PLEURA: Right apical mass compatible with primary lung cancer measuring 4.8 x 2.9 cm (series 4/18). The mass is largely contiguous with the pleural surface, which raises the question of pleural invasion. No underlying bone destruction. Severe centrilobular emphysema. Bibasilar subsegmental atelectasis and/or scarring. Small amount of tracheal debris. No pleural effusions. MEDIASTINUM AND HILA: Marked mediastinal lymphadenopathy. For future reference, an enlarged prevascular node or conglomerate of nodes measures 3 cm (series 3/30) and an enlarged right paratracheal node or conglomerate of nodes measures 5.3-cm (series 3/32).Moderate cardiac enlargement. Moderate calcifications of the coronary arteries.CHEST WALL: Marked bilateral supraclavicular lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. Subcentimeter right hepatic lobe hypoattenuating focus is too small to characterize but likely a benign cyst (series 3/78). Moderate elevation of the right hemidiaphragm.
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Right apical mass compatible with primary lung cancer with possible pleural invasion and marked mediastinal and bilateral supraclavicular lymphadenopathy.
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Generate impression based on findings.
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62-year-old male with increased abdominal girth. Evaluate for cirrhosis. LIVER: The liver measures 18.5 cm in length with mild nonspecific coarse hepatic echotexture. No evidence of nodularity of the liver capsule or asymmetric left hepatic lobe enlargement to suggest cirrhosis. Again noted is an anechoic lesion in the left lobe of the liver measuring 1.9 x 1.2 x 1.0 cm, not significantly changed and consistent with a simple cyst. GALLBLADDER, BILIARY TRACT: No significant abnormality noted. Gallbladder wall measures 0.2 cm in thickness. The common bile duct measures 0.3 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT AND LEFT KIDNEY: Right kidney measures 11.6 cm in length and left kidney measures 12.1 cm in length without evidence of hydronephrosis. There is an anechoic lesion in right kidney measuring 2.9 x 2.4 x 3.1 cm, not significantly changed and compatible with a simple cyst.SPLEEN: The spleen is normal in echotexture and measures 9.6 cm in length.OTHER: No significant abnormalities noted.
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1.No sonographic evidence of cirrhosis as clinically questioned.2.Stable cyst in the liver and the right kidney.
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Generate impression based on findings.
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There is a focal oval low-density structure within the right lateral retropharyngeal space, measuring 1.3 x 1.5 cm in greatest axial dimensions. This measures 37 Hounsfield units. There is additional extensive abnormal low density, right greater the left side. Along the retropharyngeal space, extending from the clivus down to the C7-T1 level. This measures up to 1.4 cm in greatest thickness. There is localized mass effect with anterior displacement of the right posterior pharyngeal wall. The palatine tonsils are enlarged bilaterally but demonstrate homogeneous enhancement. The airway is somewhat deviated and rotated to the left due to the mass effect and is somewhat narrowed at the level of the oropharynx.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are numerous enlarged cervical lymph nodes bilaterally, especially along the jugular chains at level 2 and level 3. The largest on the right measures 2.2 cm in length at the right level 2a nodal station. A left level 2b/5 lymph node measures 1.7 cm in length.OTHER: There is moderate mucosal thickening throughout the paranasal sinuses with partial opacification of the right frontal sinus.
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1. Focal right lateral retropharyngeal low density collections suspicious for abscess versus phlegmon, with adjacent extensive retropharyngeal fluid and edema, extending from clivus to C7-T1 level. Associate localized mass effect upon adjacent structures including slight rotation and displacement of the airway, which is somewhat narrowed along the oropharynx.2. Cervical lymphadenopathy, greater on the right side, which is nonspecific but most likely reactive.Dr. Adam Sanchez discussed these findings over the telephone with Dr. Huang on 1/22/2015 1:00 am.
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Generate impression based on findings.
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Redemonstrated are postoperative changes related to a left frontal craniotomy for tumor resection and hematoma evacuation from the left frontal lobe. There is an unchanged mixed density extra-axial collection underlying the craniotomy flap, representing postoperative fluid and blood products. There are residual scattered hyperdense areas in the left frontal lobe grossly unchanged in size. There are scattered foci of pneumocephalus as well as more prominent extra-axial air overlying the anterior left frontal lobe with mild-moderate local mass effect. There remains edema within the left frontal white matter. There is slight mass effect upon the left lateral ventricle. There is unchanged mild left to right midline shift measuring 5 mm. There remains diffuse left cerebral sulcal effacement, especially anteriorly. Partially visualized remote postoperative changes are seen along the posterior arch of C1.
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Postoperative changes related to evacuation of left frontal lobe metastatic lesion. No significant change in residual blood products and edema in the left frontal lobe. Unchanged mass effect including 5 mm left to right midline shift.
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Generate impression based on findings.
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42 year-old female with a strong family history of breast cancer, including breast cancer in her mother, maternal grandmother, and maternal and paternal great grandmothers. Prior questionable left breast skin lesion seen. 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. Benign calcifications are seen bilaterally.No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast.
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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 Mammogram.
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 132 cm/sec.Right internal carotid artery: 130 cm/sec.Left middle cerebral artery: 142 cm/sec.Left internal carotid artery: 115 cm/sec.
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Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec).
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Generate impression based on findings.
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Left true vocal cord lesion at the anterior commissure and persistent hoarseness, path consistent with SCCA, s/p microlaryngoscopy with re- excision of left true cord lesion in December 2014. There is no discernible vocal cord tumor. The paraglottic fat and laryngeal framework appear to be intact. There is no evidence of significant cervical lymphadenopathy based on size criteria or other tumors in the neck. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. There is a small posterior disc-osteophyte complex at C3-4. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. There is a carious tooth # 29 with periodontal lucency. The imaged paranasal sinuses are clear.
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1. No discernible vocal cord tumor. 2. No evidence of significant cervical lymphadenopathy based on size criteria or other tumors in the neck3. Carious tooth # 29 with periodontal disease.
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Generate impression based on findings.
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Patient with tibia and fibular fractures, evaluate healing.VIEWS: Left knee AP and lateral (two views) 1/22/2015 The lines of the proximal tibial and fibular diaphyseal fractures appear less distinct. Callus formation and periosteal reaction is seen, increased from the prior exam. Alignment is near anatomic.
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Healing tibial and fibular fractures as above.
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Generate impression based on findings.
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History of rhinorrhea, decreased sense of smell and taste. Assess for chronic sinusitis. There is minimal scattered ethmoid sinus mucosal thickening. The other paranasal sinuses are clear. There are minimal secretions within the nasal cavity. There is no significant nasal septal deviation. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is midline. The orbits and the posterior nasopharynx appear unremarkable.
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minimal scattered ethmoid sinus mucosal thickening. The other paranasal sinuses are clear. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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Altered mental status. DM, HTN, CAD, diastolic heart failure, paroxysmal AF, asthma, and treated breast cancer, childhood epilepsy, and shaking spells of unclear etiology. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebellar volume loss. The ventricles are otherwise normal in size and configuration. There is mild patchy cerebral white matter hypoattenuation, which may represent small vessel ischemic disease. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable.
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1. No evidence of intracranial hemorrhage or mass. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct.2. Nonspecific diffuse cerebellar volume loss, which may be a manifestation of paraneoplastic syndromes, for example. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.
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Generate impression based on findings.
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62-year-old female with bilateral adrenal hyperplasia or adrenal nodule. Evaluate. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Too small to characterize segment 7 hypoattenuating focus. Cholelithiasis without associated inflammatory changes.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The adrenal glands are mildly thickened bilaterally measuring up to 6 mm without evidence of hyperplasia by CT criteria or a discrete nodule.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1.Nonspecific mild adrenal gland thickening without evidence of hyperplasia by CT criteria or discrete nodule as clinically questioned.2.Cholelithiasis
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 82 cm/sec.Right internal carotid artery: Could not obtain because the patient was unable to cooperate fully for the entire examination.Left middle cerebral artery: 107 cm/sec.Left internal carotid artery: 85 cm/sec.
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Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec). However, the right internal carotid artery time average mean velocity could not be obtained because the patient was unable to cooperate fully for the entire examination.
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Generate impression based on findings.
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History of colon cancer, pulmonary nodules, and cough. LUNGS AND PLEURA: Several pulmonary micronodules are present in both lungs, some of which are new since the prior study. For reference, a 4 mm micronodule in the right lower lobe (series 5 image 72) is new, as is a 4 mm subpleural nodule in the left lower lobe (image 81). However, it appears that some micronodules seen on the two prior exams from 3/13/14 and 11/12/13 have resolved on the current study. No nodules seen previously have definitively increased in size. Mild centrilobular upper lobe predominant emphysema. MEDIASTINUM AND HILA: Left hypoattenuating thyroid nodule unchanged. Stable small mediastinal lymph nodes and mild coronary calcifications. Normal cardiac size without pericardial effusion. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenic granulomata
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Pulmonary micronodules which have waxed and waned since 2013 as described above would be an atypical presentation for metastatic disease and may be post-infectious or post-inflammatory in etiology. However continued follow up is recommended given the history of malignancy.
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Generate impression based on findings.
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Ms. Greene is a 43 year old female with a personal history of left breast mastectomy in May 2011 for ILC/LCIS, followed by chemoradiation and hormonal therapy. Additional history of benign right breast biopsy in 2010. Family history of breast cancer in paternal grandmother and paternal aunt. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. Two biopsy marker clips are identified in the right upper outer breast, at site of prior benign breast biopsy. Scattered benign calcifications are present.
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No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.
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Generate impression based on findings.
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Female; 64 years old. Reason: 64 y/o F with PMHx of OHT on immunosuppresion here with cough sob, concern for infection vs asthma History: sob, cough, sputum, chills LUNGS AND PLEURA: Interval improvement left lower lobe consolidation. Minimal bibasilar streaky subsegmental atelectasis persists. Mild right lower lobe bronchiectasis. Stable scattered pulmonary micronodules, some of which are calcified. No suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: Post operative findings from heart transplant. Heart size is normal without pericardial effusion. No visible coronary artery calcifications. Stable small mediastinal lymph nodes.CHEST WALL: Healed sternotomy with intact fixation hardware.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted.
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Interval improvement in left lower lobe consolidation. No specific evidence of pneumonia on the current exam.
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Generate impression based on findings.
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72-year-old female with history of endometrial cancer. Evaluate extent.Per pathology, endometrial adenocarcinoma. ABDOMEN:LUNG BASES: Nonspecific micronodule at right lung base (series 3, image 20)LIVER, BILIARY TRACT: No focal hepatic lesions. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: Nonspecific hypoattenuating focus at the lateral aspect of the spleen measuring 1.9 x 1.3 cm (he series 4, image 23).PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole hypoattenuating focus consistent with a cyst. Additional subcentimeter hypoattenuating foci within the kidneys bilaterally are too small to characterize. Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes are nonspecific.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Mildly heterogeneous appearance of the uterus, most likely secondary to stated history of endometrial carcinoma.BLADDER: No significant abnormality notedLYMPH NODES: Mildly prominent iliac chain and inguinal lymph nodes are nonspecific.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild compression deformity of T10 and scattered degenerative joint disease.OTHER: No significant abnormality noted
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1.Mild heterogeneity of the uterus, most likely secondary to stated history of endometrial carcinoma.2.Nonspecific mildly prominent retroperitoneal, iliac chain, and inguinal lymph nodes.3.Mild T10 compression deformity.
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Generate impression based on findings.
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There is no intracranial hemorrhage. The ventricles and sulci are mildly prominent, greater than expected for age. Volume loss also includes the cerebellum which may be related to chronic alcohol use. There is no midline shift or mass effect. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. Paranasal sinus disease is improved since 1/18/2015. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear.
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1. No acute intracranial hemorrhage.2. Mild global parenchymal volume loss, greater than expected for age
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Generate impression based on findings.
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Reason: difficulty swallowing in pt with hx of smoking. evaluate for obstruction, reflux History: difficulty swallowing Scout radiograph of the chest demonstrated mild diffuse increased interstitial markings and atherosclerotic calcification of the aortic knob. Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no abnormality of the mucosal surfaces. Prominent cricopharyngeus muscle and aortic knob impression noted without functional obstruction. Fluoroscopic evaluation of esophageal peristalsis demonstrated moderate dysmotility with proximal escape and tertiary waves, appearance consistent with presbyesophagus. There was transient hold up of the barium pill near the gastroesophageal junction, which passed small amount of liquid wash. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. No significant hiatal hernia. TOTAL FLUOROSCOPY TIME: 4:25 minutes
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1.Moderate dysmotility, appearance consistent with presbyesophagus. 2.Prominent cricopharyngeus muscle and aortic knob impression without functional obstruction.3.No evidence of gastroesophageal reflux, no hiatal hernia.4.Transient hold up of pill near the gastroesophageal junction, which passed with liquid wash.
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Generate impression based on findings.
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24 year-old female with laceration over palmer PIP, evaluate for foreign body Soft tissue swelling about the PIP joint and mild soft tissue irregularity without evidence of radiopaque foreign body. No fracture is evident.
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Mild soft tissue swelling without radiopaque foreign body visualized.
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Generate impression based on findings.
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71-year-old female with ankle pain along lateral malleolus There is deformity of the distal fibula consistent with old fracture. Moderate osteoarthritis affects the tibiotalar joint. No acute fracture is visualized.
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Osteoarthritis and old fracture deformity of the distal fibula.
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Generate impression based on findings.
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The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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No acute abnormality. Mild chronic small vessel ischemic changes.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. Hypodensities within the right basal ganglia identified on the prior CT correspond to prominent peri-vascular spaces. There are a few scattered T2 hyperintensities within the periventricular and subcortical white matter which are nonspecific but likely reflect mild chronic small vessel ischemic disease. Focal T2 hyperintensities are seen within the pons without diffusion restriction which likely represent prominent perivascular spaces. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
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1.No evidence of acute infarct.2.Mild chronic small vessel ischemic disease.3.T2 hyperintensities within the right basal ganglia and pons likely represent prominent perivascular spaces, with chronic lacunar infarcts considered much less likely.
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Generate impression based on findings.
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Evaluate stool burden. Abdominal distention.VIEW: Abdomen AP (one view) 1/22/2015 A ventriculoperitoneal shunt catheter is in place, with the tip terminating in the right upper quadrant. A cecostomy tube is in place. There is a moderate/large stool burden distributed throughout the colon, predominantly affecting the descending and rectosigmoid colon, where a moderate/large amount of desiccated stool is present. No portal venous gas, pneumatosis intestinalis or pneumoperitoneum is evident. Lumbosacral dysraphism is present.
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Moderate/large stool burden, with desiccated stool in the descending and rectosigmoid colon.
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Generate impression based on findings.
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64 years, Male. Reason: re-evaluate line placement History: as above Limited view of the abdomen with motion artifact. Pelvis is excluded from view. Enteric tube tip coiled in the gastric body.
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Enteric tube tip coiled in the gastric body.
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Generate impression based on findings.
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64-year-old male with change in exam. Evaluate for changes in ICH. Re-demonstrated is an intraparenchymal hematoma centered at the left thalamus measuring 2.9 x 4.1 cm and approximately 3.9 cm in the craniocaudal dimension not significantly changed allowing for differences in measurement technique.There is surrounding low density vasogenic edema. Again seen is intraventricular extension with hemorrhage including the lateral, third, and fourth ventricles. There is stable rightward midline shift measuring approximately 7 mm at the level of the third ventricle and unchanged. There has been slight interval decrease in the right sided ventricular dilatation and stable left temporal horn dilatation. There is unchanged position of right transfrontal ventriculostomy with its tip in the right inferior frontal horn near the foramen of Monro. There is periventricular low density which matches the previous FLAIR abnormality on the recent MRI and is consistent with transependymal edema. There remains diffuse sulcal effacement.
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1.No significant change in large left thalamic hemorrhage with intraventricular extension. Surrounding edema and mass effect including midline shift is not significantly changed. 2.Minimal interval enlargement of ventricular system compared to 1/21/2015 but not significantly changed since 1/19/2015.
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Generate impression based on findings.
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60 year-old male with bilateral knee pain Right knee: Ossified body superior to the patella may reside within the suprapatellar pouch. There is severe medial tibiofemoral and lateral patellofemoral joint space narrowing and tricompartmental osteophytes. Bone infarcts are noted within the distal femur and proximal tibia. Moderate joint effusion.Left knee: There is moderate medial tibiofemoral and lateral patellofemoral joint space narrowing and tricompartmental osteophytes. Bone infarcts are noted within the distal femur and proximal tibia. Probable joint effusion.
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1. Severe osteoarthritis, right greater than left.2. Bilateral joint effusions.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a mildly FLAIR hyperintense lesion in the region of the pineal gland, measuring 15 mm AP by 9 mm CC by 11 mm transverse, which demonstrates only peripheral enhancement which may represent normal pineal tissue with associated central cyst. The remainder of the midline structures and craniocervical junction are within normal limits.CERVICAL SPINE
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1. No MR evidence of demyelinating disease within the brain or cervical spine.2. Incidental probable pineal cyst.3. No significant cervical spondylotic changes.
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Generate impression based on findings.
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Reason: Please evaluate for interval change in dysplastic nodules, presence of HCC/malignancy. History: Hep C Cirrhosis ABDOMEN:LIVER, BILIARY TRACT: Nodular, cirrhotic changes. Increased reticular T2 signal with delayed enhancement, compatible with areas of confluent fibrosis. No ductal dilatation. Cholelithiasis. Mild ascites. Patent hepatic and portal venous system. Again seen are multiple subcentimeter low T2, T1, nonenhancing nodules throughout the liver without restricted diffusion compatible with dysplastic nodules. A stable cluster of 3 is noted in the right hepatic lobe (1101:36, 1501:104). Other T1, bright, nonenhancing nodules without dark, T2, correlating signal likely represent siderotic nodules. Previously seen segment 8 lesion does not appear to demonstrate arterial enhancement, and is grossly stable in size, but is too small to adequately characterize.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small fat-containing ventral hernia.OTHER: No significant abnormality noted.
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1.Cirrhosis with sequela of portal hypertension. Multiple dysplastic and siderotic nodules. No enhancing lesion suspicious for hepatocellular carcinoma.
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Generate impression based on findings.
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Clinical Female 42 years old Reason: 42 year female with incisional hernia; please evaluate for abnormalities History: hernia ABDOMEN: There is situs inversus.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Surgical changes around the gastric cardia and fundus. At least 3 ventral incisional hernias are seen. The one located more cephalad and to the right of midline is broad-based containing colon and is nonobstructive. One located more cephalad and to the left of midline, has a narrow neck measuring 2.4 cm in length (Series IV image 54), and a sac approximately 11 cm (Series IV image 52) containing colon but no small bowel or fluid in the hernia sac.The one located more caudally is a large hernia measuring about 17 cm transverse (Series IV image 84) and the sac neck measures about 5.5-cm (Series IV image 83). It contains multiple loops small bowel and mesentery. There is no fluid in the hernia sac. Bowel loops within the sac are normal to minimally thickened and prominent in caliber. A suture line is seen in one of the bowel loops within the hernia sac see sagittal image 71. Correlate clinically.No evidence of obstruction, intramural air, free air, or free or loculated intraperitoneal fluid.BONES, SOFT TISSUES: Postsurgical changes intra-abdominal. Hernias as described above.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: IUD in place.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes intra-abdominal wall.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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Situs inversus. Ventral hernias as described, the largest located in the midline containing small bowel with very mild wall thickening and prominent caliber. The proximal intraperitoneal bowel is not dilated. There is no fluid in the hernia sacs
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Generate impression based on findings.
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5-year-old male with right distal femur fractureVIEWS: Right knee AP/lateral (two views) 01/22/15 Overlying cast obscures fine bone detail. Again seen is a predominantly transverse fracture through the distal femoral metadiaphysis in near anatomic alignment with surrounding periosteal reaction and callus formation.
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Healing right distal femoral fracture.
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Generate impression based on findings.
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Reason: r/o pneumonia History: hypoxia, congential heartVIEWS: Chest AP/lateral (two views) 01/22/15 Cardiac silhouette is mildly enlarged. No pleural effusion or pneumothorax. Interval improvement of subsegmental atelectasis at the medial bases. Interval removal of epicardial leads. Round right lower lung opacity may represent infection.
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Round right lower lung opacity may represent infection.
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Generate impression based on findings.
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Time average mean velocities: Right middle cerebral artery: 143 cm/sec.Right internal carotid artery: 147 cm/sec.Left middle cerebral artery: 143 cm/sec.Left internal carotid artery: 157 cm/sec.
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Normal time average mean velocities of intracranial blood vessels as described above (<180 cm/sec).
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Generate impression based on findings.
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79-year-old female with non-Hodgkin lymphoma. Reevaluation and compared to previous. CHEST:LUNGS AND PLEURA: Stable subcentimeter right middle lobe pulmonary nodule (series 4, image 48) measuring 0.8 x 0 .4 cm, previously 0.7 x 0.4 cm. No new nodules or evidence of air space disease is seen. No pleural disease.MEDIASTINUM AND HILA: Slightly prominent pretracheal lymph node (series 3, image 31) unchanged in size measuring 1.3 x 1 .1 cm, previously 1.2 x 1.2 cm. No new foci of lymphadenopathy seen. Mild coronary artery calcification again noted.CHEST WALL: No significant abnormality noted. Scattered normal sized bilateral axillary lymph nodes.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted in the liver. Gallstones again seen with moderately distended gallbladder. No a biliary tract abnormality..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Benign cortical cyst seen in right kidney slightly larger than previous but with characteristics of a benign nature. Smaller subcentimeter cortical cysts seen in both kidneys. No significant abnormalities otherwise seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No adenopathy identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No adenopathy seen. Small left common femoral lymph node (series 3 , image 173) referenced previously measures 0.8 x 0.7, previously 1.2 x 1.1 cm. No foci of enlarged lymph nodes seen in the pelvis.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1. No significant adenopathy seen in theabdomen or pelvis with reference lymph node measurements made above to compare with 2009 examination. Stable mildly prominent pretracheal isolated thoracic lymph node unchanged since 2009. 2. Benign subcentimeter right middle lobe nodule unchanged since 2009. 3. Gallstones again seen without other biliary tract complication.
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Generate impression based on findings.
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Chronic post nasal drip and cough. There is minimal scattered ethmoid sinus mucosal thickening. The paranasal sinuses are otherwise clear. The nasal cavity is clear. There is no significant nasal septal deviation. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. There is a nonspecific subcentimeter left cheek skin nodule. There are bilateral lens implants.
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Minimal scattered ethmoid sinus mucosal thickening. The paranasal sinuses are otherwise clear.
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Generate impression based on findings.
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Reason: s/p rectal irrigation, evaluate for stool burden History: constipationVIEW: Abdomen AP (one view) 01/22/15 Gastrostomy tube, cecostomy tube, surgical staples and surgical clips are present. Small to moderate stool burden with amorphous stool within the descending colon. Nonobstructive bowel gas pattern. No pneumoperitoneum, pneumatosis intestinalis, or portal venous gas. Sacrum malformation is again seen.
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Decreased stool burden.
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Generate impression based on findings.
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There is mild nonspecific prominence of the ventricles as well as the subarachnoid space especially along the frontal convexities. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. There is scattered mild mucosal thickening within the paranasal sinuses, as well as near complete opacification the right sphenoid sinus. The visualized portions of mastoids/middle ears are grossly clear. There is significant prominence of soft tissue along the posterior nasopharynx which is nonspecific but likely represents hypertrophied lymphoid tissue within the adenoids in a patient of this age. There is mild right lateral frontal supraorbital soft tissue swelling without fracture.
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No acute intracranial abnormality. Mild right lateral frontal supraorbital soft tissue swelling without fracture.
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Generate impression based on findings.
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Reason: r/o pneumonia History: cough and feverVIEWS: Chest AP/lateral (two views) 01/22/15 Aortic arch, cardiac apex, and stomach are left-sided. Moderate peribronchial cuffing suggestive of reactive airway disease/bronchiolitis pattern. There is mild tenting of the right hemidiaphragm suggestive of eventration.
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Reactive airway disease/bronchiolitis pattern.
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Generate impression based on findings.
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The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is an incidental empty sella.
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No acute intracranial hemorrhage. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended.
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Generate impression based on findings.
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61-year-old female with a history metastatic breast cancer to lungs and retroperitoneal lymph nodes status post chemotherapy with complete imaging response. Currently not on treatment. Please evaluate for recurrent disease. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Scattered small normal subcentimeter lymph nodes seen without evidence for lymphadenopathy.CHEST WALL: Left anterior chest wall Port-A-Cath system the tip of the catheter in the distal superior vena cava. Status post right mastectomy. No axillary adenopathy. Diffuse degenerative changes of the thoracic spine with S-shaped scoliosis.ABDOMEN:LIVER, BILIARY TRACT: Benign cyst unchanged in segment two. No parenchymal liver masses otherwise seen. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Small subcentimeter para-aortic lymph nodes are again seen. These appear similar in size to the 2013 examination. However see pelvis discussion below.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse degenerative changes of the lumbar spine with no focal lesion seen to suggest metastatic disease. Nuclear medicine bone scintigraphy is more sensitive indicator of metastatic skeletal disease.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Slightly enlarged lymph nodes are seen in the left common iliac chain (series 3, image 142 and 150) which appears slightly more prominent than 11/21/13 examination and are in the area where increased metabolic activity had been seen on the 6/24/13 PET examination. Reference lymph node (image 150) measures 1.3 x 1.2 cm which by my measurement on 11/21/2013 examination measured 1.1 x 0.9 cm. similarly, left external iliac lymph nodes are slightly enlarged and enhancing when compared with 11/21/13 examination (see series 3 images 171 through 177). Reference lymph node (image 175) measures 2.2 x 0.9 cm which measured 1.6 x 0.7 cm on 11/21/13. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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Slight increase in size of scattered pelvic lymph nodes. As these changes are small in size, there remain uncertain, howeverenhancement seen in these nodules not appreciated on 11/21/13 examination and is worrisome for recurrence. If further imaging characterization would be helpful, PET/CT would be recommended..
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Generate impression based on findings.
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Female, 79 years old, headache x 3 weeks and HTN, eval for mass, svd. Mild patchy periventricular hypoattenuation is seen, left side more than right, a non specific finding which most commonly reflects age indeterminate small vessel ischemic disease. The cerebral and cerebellar hemispheres and brainstem are otherwise 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 morphology. No pathologic intracranial enhancement is seen. The visualized paranasal sinuses and mastoid air cells are clear. The bones of the calvarium and skull base are intact. A right globe prosthesis is in place. The left vitreous is uniformly hyperattenuating.
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1. Mild age indeterminate small vessel ischemic disease. 2. No evidence of intracranial hemorrhage, mass effect, or other findings which would account for the patient's symptoms.3. Uniformly hyperattenuating left vitreous probably reflects ophthalmologic intervention. Correlation with history of retinal detachment repair is suggested.
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Generate impression based on findings.
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The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is focal abnormal density in the left caudate body with associated mild ex vacuo dilatation of the anterior body of the left lateral ventricle, consistent with a chronic infarct. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. The orbital lenses are surgically absent.CERVICAL SPINE
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1. No acute intracranial hemorrhage. Chronic left caudate infarct. If there remains clinical concern for an acute ischemic event, MRI of the brain is recommended.2. No acute fracture or traumatic subluxation, with minimal grade 1 degenerative retrolisthesis of C4 on C5 and C5 on C6. Moderate scattered spondylotic changes with up to moderate left foraminal narrowing at C4-C5.
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Generate impression based on findings.
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Male 57 years old; Reason: PLease evaluate for liver malignancy or cirrhosis related changes History: 57 yo M with hepatitis C and EtOH history with ultrasound showing liver mass. ABDOMEN:LUNG BASES: Reticular opacities, likely atelectasis or scarring.LIVER, BILIARY TRACT: Vague 1.5-cm hepatic hypodensity seen on portal venous phase (12:43) with punctate arterial enhancement (10:41) and no definite gradual filling in of the lesion on delayed images. Three similar appearing lesions without the focus of arterial enhancement are seen in the dome of the liver (12:28, 12:16) in the right and left hepatic lobes and are incompletely characterized. Cholelithiasis. There are subtle changes of cirrhosis, including widening of the fissures, and mild caudate lobe hypertrophy.SPLEEN: Nonspecific subcentimeter splenic hypodensity. Splenomegaly measuring up to 13.2 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter hypodensities in both kidneys are too small to accurately characterize, but probably cysts.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta and its branches. A few shotty retroperitoneal lymph nodes are not enlarged by size criteria.BOWEL, MESENTERY: Gastroesophageal varices.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
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1.Subtle changes suggestive of hepatic cirrhosis, particularly given findings seen in portal hypertension such as splenomegaly and gastroesophageal varices, further described above.2.Indeterminate hepatic lesions can be further characterized with MRI. Please obtain a hepatobiliary phase.3.Cholelithiasis.
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Generate impression based on findings.
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Initial staging of Ewing sarcoma. Left hip pain.RADIOPHARMACEUTICAL: 7.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 83 mg/dL. Today's CT portion grossly demonstrates left PICC line with tip in the right atrium. Small bilateral pleural effusions are present. A permeative lesion of the left iliac wing with periostitis and significant masslike enlargement of the adjacent musculature is present.Today's PET examination demonstrates a large markedly hypermetabolic mass (SUV max = 14.1) centered at the left iliac wing with significant extension into the anterior and posterior soft tissues, consistent with the patient's diagnosis of Ewing sarcoma.There are innumerable additional abnormal hypermetabolic osseous foci throughout the entire axial and proximal appendicular skeleton (entire red marrow distribution), consistent with widespread additional osseous tumor involvement.The spleen demonstrates abnormal diffusely mildly increased activity above the liver which is suspicious for diffuse splenic involvement with tumor. However, this appearance can also be seen with benign marrow stimulation such as with anemia or with exogenous stimulating agents.No additional suspicious FDG avid lesion is identified.
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1.Large markedly hypermetabolic mass centered at the left iliac wing with significant extension into the soft tissues, compatible with the patient's diagnosis of Ewing sarcoma.2.Innumerable additional hypermetabolic widespread osseous tumor involvement throughout the axillary and proximal appendicular skeleton.3.Diffusely increased splenic activity is suspicious but equivocal for diffuse splenic involvement with tumor.
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Generate impression based on findings.
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Male 51 years old abdominal pain right upper quadrant. LIVER: 15.1 cm length. Normal echotexture. Punctate cyst in the dome of the liver which is also seen on CT. Flow in the portal vein is hepatopedal, peak velocity .2 m/secGALLBLADDER, BILIARY TRACT: Normal gallbladder. No intrahepatic or extra hepatic biliary dilatation. Common bile duct 1 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Morphologically normal 10.4 cm in length.OTHER: Left kidney 10.5 cm in length. Normal echogenicity no hydronephrosis. 0.5 x 0.4 cm cyst.Spleen 8.3 cm in length.No evidence of ascites.
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No findings to explain abdominal pain. Small left renal cyst and punctate hepatic cyst. Otherwise normal.
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Generate impression based on findings.
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68-year-old male with provided history of "enrolled in clinical trial". Further review of medical record reveals history of myelofibrosis. Within the limits of a non-IV contrast enhanced examination is limited due to thyroid solid parenchymal organs and vascular structures, the following observations can be made:CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No changes seen in smile scattered normal size lymph nodes in the mediastinum and hilar regions without lymphadenopathy or other masses. Severe coronary artery calcification again identified. Small amount of pericardial fluid again seen.CHEST WALL: Sclerotic changes seen throughout the system compatible with the diagnosis of myelofibrosis.ABDOMEN:LIVER, BILIARY TRACT: Hepatomegaly again noted. Prior noted right hepatic liver lesion with calcifications has not significantly changed (series 4, image 110) measuring 5.4 x 3 .5 cm, previous a 5.0 x 3.5 cm. Focal fatty infiltration about the left lobe adjacent to falciform ligament unchanged. No other liver parenchymal lesions are seen and no change overall in the liver. Cholelithiasis again noted without complication.SPLEEN: Marked splenomegaly again seen unchanged in size with craniocaudal length of 26 cm. No focal abnormalities are seen, however the lack of IV contrast limits parenchymal evaluation.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Benign liver cyst seen unchanged. No other significant abnormality seen.RETROPERITONEUM, LYMPH NODES: Scattered slightly enlarged retroperitoneal periaortic lymph nodes are again seen with the largest measuring 1.6 x 1.2 cm (series 4, image 130) unchanged since prior exam when this node measured 1.6 x 1.3 cm. No new foci of retroperitoneal adenopathy or other masses are seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Diffuse sclerosis of the skull system again seen compatible with myelofibrosis diagnosis.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Sigmoid colon diverticulosis again seen without complication. No other abnormalities.BONES, SOFT TISSUES: Sclerosis of the skeletal system compatible with known diagnosis of myelofibrosis.OTHER: No significant abnormality noted
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1. Diffuse sclerosis of the skeleton and hepatosplenomegaly, compatible with diagnosis of myelofibrosis and are unchanged. 2. No change in appearance of nonspecific calcified right lobe liver mass. 3. No significant lymphadenopathy with no change in size of slightly prominent retroperitoneal lymph node.
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Generate impression based on findings.
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Restaging lymphoma.RADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 81 mg/dL. Today's CT portion of the neck, abdomen, and pelvis grossly demonstrates small air-fluid levels in both maxillary sinuses consistent with sinusitis. Extensive atherosclerotic including coronary arterial calcifications are noted. Hypodense left renal lesion is likely a cyst.Today's PET examination demonstrates a medium-sized focus of moderately increased activity involving the T11 vertebral body. It is similar in uptake compared with previous (currently SUV max = 5.1), but has increased in size and is very suspicious for progression of osseous tumor activity. The remaining spine demonstrates a somewhat heterogeneous appearance an additional osseous tumor involvement is possible.There are small, subtle but new mild to moderately hypermetabolic nodular foci involving the right iliacus muscle anterior to the iliac wing (SUV max = 2.4), which are suspicious but equivocal for additional tumor progression.Markedly hypermetabolic pulmonary foci most notably in the left mid and upper lung correspond with a ground glass appearance on CT and are considered most likely infectious/inflammatory. These have progressed from the prior PET/CT. No additional suspicious FDG avid lesion is identified elsewhere.
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1.Hypermetabolic T11 lesion has progressed in size from previous, very suspicious for osseous tumor progression. Additional heterogeneous appearance to the spine raises the question of additional osseous tumor progression.2.Subtle new hypermetabolic nodular soft tissue foci involving the right iliacus muscle is suspicious but equivocal for additional tumor progression.3.Hypermetabolic pulmonary ground glass abnormalities most likely represent an infectious/inflammatory etiology.Diagnostic CT of the chest also performed at today's visit will be reported separately.
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Generate impression based on findings.
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6 month history of left throat/neck pain with mild dysphagia; current smoker. There appears to be mildly asymmetric prominence of the left palatine tonsil. There is no evidence of significant cervical lymphadenopathy by size criteria. The salivary glands are unremarkable. There is an elongated pyramidal lobe, which is an anatomic variant of the thyroid gland. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. There is mild opacification of the ethmoid sinuses. The imaged intracranial structures are unremarkable. There is minimal emphysema in the partially-imaged lungs.
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Apparent mildly asymmetric prominence of the left palatine tonsil, which is nonspecific, although neoplasm cannot be entirely excluded and endoscopy may be useful for further evaluation. Otherwise, no evidence of significant cervical lymphadenopathy by size criteria.
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Generate impression based on findings.
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Reason: persistent epistaxis (both anterior and posterior) with epistat (anterior/posterior) balloon in place. Source of bleeding reported from the left posterior nasal cavity. Right common carotid artery: No stenosis at the carotid bifurcation on the basis of NASCET criteria. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. Right external carotid artery: No evidence for arteriovenous fistula, pseudoaneurysm or neovascularity.Left common carotid artery: No evidence for carotid stenosis on the basis of NASCET criteria. Venous and parenchymal phases were within normal limits. No evidence for aneurysm, AVM or AV fistula. Left external carotid artery: No evidence for arteriovenous fistula pseudoaneurysm or neovascularity.Right common iliac artery: No contra-indications to closure device.Embolization:Microcatheter injections of right and left sphenopalatine arteries demonstrate position of the microcatheter and embolization of these territories.Post embolization arteriograms:Right sphenopalatine artery: There is a slow flow in the sphenopalatine artery.Right external carotid artery: Slow flow in the right sphenopalatine artery.Left sphenopalatine artery: There is a slow flow in the sphenopalatine artery.Left external carotid artery: Slow flow in the right sphenopalatine artery.
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1.Successful bilateral sphenopalatine artery embolization for epistaxis.
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Generate impression based on findings.
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Assess fractures Three views of the right foot with weight-bearing reveals fractures of the second third and fourth metatarsals proximally. The fracture lines are indistinct consistent with healing. The bones are in anatomic alignment.
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Healing metatarsal fractures in anatomic alignment
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Generate impression based on findings.
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There is a right parietal approach ventriculostomy catheter, which courses through the right parietal lobe into the trigone of the right lateral ventricle with its tip along the frontal horn of the right lateral ventricle, unchanged in position. There is hypoattenuation within the brain parenchyma adjacent to the ventriculostomy tube compatible with gliosis.The patient is status post suboccipital craniectomy. The ventricles are unchanged in size and configuration. The sulci are prominent, consistent with mild age-related volume loss. There is pronounced cerebellar atrophy particularly of the vermis. There is no midline shift or mass effect. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There are no areas of abnormal attenuation or pathological enhancement. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses are grossly clear. Bilateral temporal bones demonstrate no findings to suggest cholesteatoma. No osseous destruction. There is scattered opacification of the bilateral mastoid air cells.
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1. No findings to suggest residual or recurrent cholesteatoma. 2. Evidence of prior suboccipital craniectomy and pronounced volume loss in the cerebellum. Prior MRI also demonstrates extensive superficial siderosis in the posterior fossa. Presumably these findings are all related to prior posterior fossa hemorrhage.
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Generate impression based on findings.
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There is a complete absence of the corpus callosum with a possible interhemispheric cyst, given possible differential flow related artifact along the expected course of the third ventricle. The basal cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. There is bilateral colpocephaly. It is difficult to determine if there is superimposed hydrocephalus, but mild prominence of bilateral temporal horns suggests a degree of hydrocephalus. There is mild prominence of the subarachnoid space along the bilateral frontal and temporal lobes.There is probable mild hypoplasia/dysplasia of the vermis without clear fastigial point, and severe upward rotation of the vermian tissue. The cerebellar hemispheres are present and symmetric, possibly mildly hypoplastic. There is prominence of the cerebral aqueduct and fourth ventricle, which is contiguous with a retrocerebellar cyst. There is mild associated scalloping of the inner table of the calvarium, and a falx cerebelli is seen.The myelination pattern is grossly appropriate for age. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is fluid in the left mastoid air cells and middle ear.
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1. Complete agenesis of the corpus callosum with questioned interhemispheric cyst, versus flow-related artifact.2. Findings suggestive of Dandy Walker spectrum, such as Dandy Walker variant versus Blake pouch cyst.2. Mild hydrocephalus is suspected.3. Findings compatible with developing benign enlargement of subarachnoid spaces of infancy which should resolve by two years of age. Follow imaging may be obtained as clinically indicated.
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Generate impression based on findings.
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54 year-old female with weight loss, abdominal discomfort and shortness of liver edge. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild hepatomegaly is seen. Benign perfusion defect is seen adjacent to the falciform ligament/round ligament (series 3, image 42) a common variant. No parenchymal mass lesions are seen abdomen the liver. Hepatic vasculature is normal.Gallbladder and biliary tract are normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous changes in the uterus. No other abnormalities.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted
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1. Hepatomegaly without other diagnostic abnormality seen in the liver. 2. Myomatous uterus. 3. No other abnormalities seen.
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Generate impression based on findings.
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Medial ankle pain Three views of the right ankle unremarkable. No fractures.
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Negative right ankle examination
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Generate impression based on findings.
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History of fracture October 2014 Three views of the left wrist reveal diffuse soft tissue swelling. There is a small ossicle dorsal to the carpal bones that most likely represents a triquetral fracture of indeterminate age. Incidental note is made of congenital fusion of the lunate and triquetrum.
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Triquetral fracture of indeterminate age. No previous radiographs in our system
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Generate impression based on findings.
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Pain for months. Evaluate for stress fracture Three views of the left foot reveal questionable widening between the first and second metatarsals suspicious for a Lisfranc subluxation. This widening is best seen on the oblique view This appears somewhat more conspicuous than on the previous exam. No acute fractures are seen. A. MR exam would be helpful if clinically indicated
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Questionable Lisfranc subluxation with widening of the space between the first and second metatarsals.
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Generate impression based on findings.
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The exam is limited by a relatively weak arterial phase contrast bolus.CT HEAD: There is no evidence of intracranial hemorrhage. There is an unchanged small focus of low attenuation within the left putamen that may represent a chronic lacunar infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is thickening and a salt and pepper appearance of the skull, which is likely related to renal osteodystrophy. CTA HEAD: There is diffuse mild to moderate stenosis involving the bilateral distal cervical, petrous, cavernous, and supraclinoid internal carotid arteries. There is no significant stenosis of the anterior, middle, and posterior cerebral arteries. There is an infundibulum or aneurysm that measures up to 2 mm and is directed inferomedially at the origin of the right posterior communicating artery. The intracranial vertebral arteries and basilar artery are patent. CTA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is extensive atherosclerotic calcification throughout much of the cervical arteries. This results in moderate to severe stenosis of the proximal right common carotid artery and severe severe stenosis of the proximal left internal carotid artery. There are postoperative findings in the distal right common carotid artery and the proximal internal carotid artery related to carotid endarterectomy. The origin of the left vertebral artery is not well-defined due to technical limitations, but there appears to be perhaps severe stenosis. There are also scattered foci of calcifications along the remainder of the left vertebral artery with perhaps up to moderate stenosis. The right vertebral appears to be grossly patent. MISCELLANEOUS: There are multiple dental caries and periapical lucencies. There is degenerative spondylosis of the cervical spine, which is most pronounced at C5-C6. There is a right internal jugular venous catheter.
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1. Extensive diabetic vasculopathy of the head and neck vasculature with up to moderate to severe right common carotid artery stenosis, severe proximal left internal carotid artery stenosis, and perhaps severe left vertebral artery stenoses, although the assessment is limited due to technical factors. 2. Postoperative findings related to right carotid bulb region endarterectomy without significant stenosis. 3. An infundibulum or aneurysm measures up to 2 mm at the origin of the right posterior communicating artery. 4. No evidence of acute intracranial hemorrhage. However, CT is insensitive for the detection of non-hemorrhagic acute infarct.5. Dental disease.
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Generate impression based on findings.
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Reason: ET tube placement History: BradycardiaVIEW: Chest AP (one view) 01/22/15 ET tube tip is at the thoracic inlet. NG tube side-port is just below the GE junction with tip below the field of view.Cardiothymic silhouette is top normal. Large lung volumes. Increasing right upper and left lung opacities on background of chronic interstitial changes. No pleural effusion or pneumothorax.
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Increasing right upper and left lung opacities.
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