instruction stringclasses 1
value | input stringlengths 6 8.98k | output stringlengths 5 3.11k |
|---|---|---|
Generate impression based on findings. | Reason: eval for sinusitis History: frequent sinusitis txed without resolution The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated.The frontal sinuses demonstrate some mucosal thickening in the left frontal sinus. This has regressed since the prior exam. ... | 1.Status post paranasal sinus surgery with interval regression of paranasal sinus opacification2.left sided staphyloma |
Generate impression based on findings. | Reason: h/o lymphoma s/p chemo restage History: h/o neck mass CHEST:LUNGS AND PLEURA: Nonspecific pulmonary micronodules are unchanged from the prior study. Lingular bulla is again noted.No consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy is seen. The heart is normal in si... | No lymphadenopathy or interval change from the prior study. |
Generate impression based on findings. | Pancreatic carcinoma: restage the disease CHEST:LUNGS AND PLEURA: Faint right middle lobe opacity, unchanged. No new nodules or masses. No pleural effusions. Central airways are patent. MEDIASTINUM AND HILA: Right chest port tip in the distal SVC.Calcified mediastinal and hilar lymph nodes, unchanged. No new enlarged l... | Interval decrease in size of reference measurements as discussed above. No new findings. |
Generate impression based on findings. | Reason: Pt is an 80 y/o male with urothelial cancer, evaluate for recurrence History: bladder cancer CHEST:LUNGS AND PLEURA: Left apical pulmonary nodule now measures 1.3 x 1.1 cm (image 16, series 10348). Subtle calcifications are seen within this nodule.Multiple additional nonspecific pulmonary micronodules have not ... | Status post cystectomy without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | 79-year-old female with stage IV metastatic melanoma -- reevaluate disease status following additional systemic therapy. CHEST:LUNGS AND PLEURA: Right apical referenced nodule (series 5 comment 27) is not changed in size and measures 0.9 x 0.9 cm.MEDIASTINUM AND HILA: Right paratracheal lymph node (series 4, image 35) ... | 1. Stable appearance to the reference right upper lobe lung mass. 2. Stable appearance to left retroperitoneal periaortic reference lymph node another smaller lymph nodes. |
Generate impression based on findings. | 76-year-old male with history of urothelial cancer status post neoadjuvant chemo and surgery, evaluate progression CHEST:LUNGS AND PLEURA: Bilateral lower lobe irregular opacities are likely infectious/inflammatory.Scattered micronodules are unchanged. Resolution of small bilateral pleural effusions.MEDIASTINUM AND HIL... | 1.No definite evidence of recurrent or metastatic disease.2.Mild left-sided hydronephrosis.3.Small amount of pelvic ascites.4.Fluid collection in the left pelvis likely represents a lymphocele or postoperative seroma.5.Irregular bibasilar opacities are likely infectious/inflammatory. |
Generate impression based on findings. | Reason: History metastatic renal cancer, assess for progression History: None CHEST:LUNGS AND PLEURA: Previously noted spiculated left upper lobe nodule has decreased in density and size and is likely postinfectious/postinflammatory. No suspicious pulmonary nodule or mass. No consolidation or pleural effusion.MEDIASTIN... | Increase in mediastinal lymphadenopathy. |
Generate impression based on findings. | Reason: liver tumor History: liver tumor post intraoperative rfa LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusionsMEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No significant abnormality noted.A... | 1. Ablated right hepatic lobe mass suboptimally evaluated due to inherent hyperattenuation of the treated lesion.2. Non visualization of the previously noted hepatomas with low attenuation in the liver suggesting post rfa response.3. Interval thrombosis of the portal vein. |
Generate impression based on findings. | Male 29 years old; Reason: 29 yr old male with h/o lymphoma, s/p MUD SCT, day 100 evaluation CHEST:LUNGS AND PLEURA: New air space nodules adjacent to right heart order was likely representing infectious or inflammatory changes. No suspicious pulmonary lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart s... | 1.Decrease in size of the reference mediastinal and hilar nodes. |
Generate impression based on findings. | 43-year-old female with metastatic colorectal cancer restaging after chemotherapy. CHEST:LUNGS AND PLEURA: No new infiltrates, nodules or effusions seen. prior noted linear opacities most likely representing scarring unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall infusion ... | 1. Right hepatic lesions have decreased in size since examination of 6/13. 2. Laparoscopic gastric banding with abnormal phi angle suggesting slippage. 3. No other evidence of recurrence or residual tumor seen. |
Generate impression based on findings. | Reason: Evaluate subcarinal lymphadenopathy History: Seen on CXR LUNGS AND PLEURA: Interval right lung wedge resections.Tree in bud opacities and faint central lobular nodules are similar in appearance to the prior exam.Mild dependent atelectasis.Calcified right lower lobe granuloma.No suspicious pulmonary nodules or m... | Minimal tree in bud opacity and centrilobular nodules without significant interval change. No suspicious pulmonary nodules. No evidence of hilar or mediastinal lymphadenopathy. Prominent calcified right hilar lymph node most like represents what was noted on recent lateral chest x-ray. |
Generate impression based on findings. | 64 year old female with chronic cough, question of chronic aspiration/mild bronchiectasis. LUNGS AND PLEURA: A 9-mm nodule is noted in the left lung base which measures 9 mm (series 5, image 72), previously measuring 6 mm.Mild left lower lobe atelectasis is noted adjacent to the large hiatal hernia.Mild bronchiectasis ... | 1.9-mm pleural-based nodule in the left lung base is increased in size from 6 mm in 2011. Continued follow up is recommended to exclude malignancy.2.Mild right lower lobe bronchiectasis without findings to suggest aspiration.3.Large hiatal hernia appearing similar to the prior study. |
Generate impression based on findings. | 58-year-old male with history of incidental lung nodule. LUNGS AND PLEURA: Scattered micronodules are present, some of which are calcified, measuring less than 4 mm and not significantly changed since the prior study from 2011. No new or suspicious pulmonary nodules identified.No pleural effusions.MEDIASTINUM AND HILA:... | No new or suspicious micronodules identified. No significant interval change since the prior study from 2011. |
Generate impression based on findings. | 72-year-old female with history of abdominal pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant a... | Hepatic flexure and proximal transverse colon could not be optimally evaluated since its decompressed. The rest of the bowel segments are unremarkable. |
Generate impression based on findings. | History of melanoma CHEST:LUNGS AND PLEURA: Index mass in the right lower lobe now measures 2.8 by 2.5 cm on image number 43, series number 5, slightly enlarged compared to previous study.MEDIASTINUM AND HILA: Index subcarinal node measures 3.1 x 2 .5 cm, increased in size compared to previous study.CHEST WALL: Index l... | Interval progression of disease with interval increase in the size of lung metastases and mediastinal adenopathy and development of subcutaneous nodules and mesenteric adenopathy.Cholelithiasis, unchanged. |
Generate impression based on findings. | Reason: 74 year old female with history diffuse intermittent abdominal pain, please evaluate for etiology of abdominal pain History: abdominal pain ABDOMEN:LUNG BASES: A 5-mm nodule in the right middle lobe, unchanged since previous exam. There is bibasilar atelectasis. There is dilation of the main pulmonary artery su... | 1. No significant interval change in right renal angiomyolipomas. 2. status post cholecystectomy3. 5-mm nodule right middle lobe nodule unchanged. |
Generate impression based on findings. | 53-year-old female with a right locally advanced breast cancer CHEST:LUNGS AND PLEURA: Emphysema.MEDIASTINUM AND HILA: Right thyroid nodules. Pulmonary arteries enlarged.CHEST WALL: Postsurgical changes in the right breast with residual soft tissue density and air likely representing postsurgical changes. Right axillar... | Postsurgical changes with residual soft tissue in the right breast and right axilla. Recurrent tumor cannot be excluded with this CT. Follow-up imaging is recommended for further evaluation.Left adrenal mass which is suspicious for metastatic disease. Further evaluation with MRI is recommendedEmphysema. |
Generate impression based on findings. | Reason: Stage IV pancreas cancer please provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: Bibasilar bronchiectasis in right middle lobe bronchiectasis/fibrosis is present. Scattered nonspecific pulmonary micronodules are noted.No suspicious pulmonary nodule or mass. No consolidation... | 1. Pancreatic head mass with biliary duct dilation and dilation of the pancreatic duct with atrophy of the distal pancreas consistent with given history of pancreas cancer. Mass itself cannot be measured as distinct from normal adjacent enhancing parenchyma. See above discussion. 2. Peripancreatic soft tissue extension... |
Generate impression based on findings. | 93 year-old female with chest pain, rule out aortic dissection. CHEST:LUNGS AND PLEURA: Mild centrilobular emphysema. No focal consolidation or pleural effusions. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild atherosclerotic calcifications of the thoracic aorta. No ... | 1.Focal infrarenal abdominal aortic dissection.2.Thrombosis of the right common and external iliac arteries.3.Mild to moderate right sided hydroureteronephrosis of unknown etiology. Follow up is suggested. |
Generate impression based on findings. | 54-year-old female with pancreatic cancer with bone metastases on chemotherapy. Evaluate for interval change of disease. CHEST:LUNGS AND PLEURA: Atelectasis noted in the lingular region. Scarring seen in the left apical paravertebral location and in the right paratracheal location.. No new infiltrates, nodules, or mass... | 1. Diffuse bony metastasis where most of the lesions appear unchanged but there are scattered new lesions and some lesions with slight increased extension of sclerosis. Nuclear medicine or MRI would be more accurate ways to evaluate extent and activity of disease. 2. There is a presumed scarring seen in the chest witho... |
Generate impression based on findings. | 78-year-old male with history of urothelial cancer, on surveillance. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusions.No suspicious nodules or masses.MEDIASTINUM AND HILA: Moderate coronary artery calcifications. Heart size is normal without pericardial effusion. Calcified mediastinal lymph nodes are... | Stable examination without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Female 77 years old; Reason: 77 year old with locally advanced gastric adenocarcinoma History: asymptomatic CHEST:LUNGS AND PLEURA: No dominant pulmonary lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.CHEST WALL: No significant ab... | 1.Large gastric mass with extension across the gastrohepatic ligament to the liver. Nodules extending from the stomach into the omentum and peritoneum compatible with peritoneal disease.2.Cholelithiasis.3.1.1-cm splenic artery pseudoaneurysm |
Generate impression based on findings. | Male 37 years old; Reason: Chronic pancreatitis, abdominal pain with new onset bacteremia; evaluate for intra-abdominal abscess or source History: Chronic pancreatitis, abdominal pain with new onset bacteremia; evaluate for intra-abdominal abscess or source ABDOMEN:LUNGS BASES: No pleural effusions at the lung bases.LI... | 1.No definite source for the patient's infection.2.Occlusion of the iliac vessels.3.Poor evaluation of the pelvic veins. If DVT is a clinical concern, extremity sonography is recommended.4.Gastric distention indicates gastric outlet or duodenal obstruction.5.Dilated common bile duct with pneumobilia.6.Distended urinary... |
Generate impression based on findings. | Male 32 years old; Reason: Baseline exam prior to new systemic therapy; provide bi-dimensional measurement; compare to outside image History: Stage IV ocular melanoma CHEST:LUNGS AND PLEURA: No dominant pulmonary lesions. The pleural spaces are clear. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No... | 1.Extensive hepatic, peritoneal, mesenteric and possible small bowel involvement of tumor. |
Generate impression based on findings. | Clinical question : Evaluate. Signs and symptoms: Possible TIA, weakness. Nonenhanced head CT: A small chronic left pica territory ischemic stroke is noted. Unremarkable images through posterior fossa otherwise.Extensive periventricular low-attenuation a white matter with resultant ex vacuo I. location dilatation of th... | No acute intracranial process. Please see above comments. |
Generate impression based on findings. | Clinical question: Rule out bleed. Signs and symptoms: Headache status post MVA. Unenhanced head CT:No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unre... | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Rule out mass lesion or obvious infarct. Signs and symptoms: CD4 less than 20, altered mental status. Nonenhanced head CT:There is no detectable acute intracranial process or a mass as is clinically questioned.Slight prominence of cortical sulci and supratentorial ventricular system for patient's sta... | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Rule-out stroke. Signs and symptoms: Change in handwriting with new atrial fibrillation. Nonenhanced head CT:Examination demonstrates a focus of low attenuation involving the cortex and subcortical white matter of left frontal high convexity. There is suspected subtle associated mass effect with this... | 1.Low-attenuation in high convexity left frontal lobe with subtle associated mass effect is concerning for late acute/early subacute nonhemorrhagic ischemic stroke. Recommend follow-up with an MRI exam to exclude other less likely possibilities and including a mass.2.Small focus of low attenuation in the right occipita... |
Generate impression based on findings. | Clinical question: Evaluate for stroke. Signs and symptoms: Reported CVA at outside hospital., possible septic emboli. Unenhanced head CT:Examination demonstrates small focus of low attenuation in the left occipital and far posterior left temporal lobe with subtle associated mass effect. Finding is highly concerning fo... | 1.Late acute to early subacute left occipital and posterior temporal ischemic stroke.2.Chronic high convexity right frontal ischemic stroke.3.Extensive bilateral cavernous carotid and intracranial vertebral artery calcification.4.Unremarkable exam otherwise. |
Generate impression based on findings. | Clinical question: Evaluate. Signs and symptoms: Altered mental status. Nonenhanced head CT:No definitive evidence of any acute intracranial process. CT however is insensitive for detection of early nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -... | 1.No convincing evidence of any acute intracranial process.2.Complete opacification of left mastoid air cells and left middle ear cavity consistent with otitis. |
Generate impression based on findings. | 71 year old female with diffuse pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. Common bile duct is dilated to 8 mm, unchanged.SPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating lesion in the head of the pancreas measures 5.3 x 3.6 cm (4/41), pr... | 1.Possible bowel wall thickening of the cecum and ascending colon with minimal pericolonic fat stranding may suggest colitis, however this is equivocal.2.Stable pancreatic head mass.3.Bilateral unilocular adnexal cysts are incompletely characterized. Recommend pelvic ultrasound for further evaluation.4.Stable right adr... |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage. Signs and symptoms: Fall, hematoma to back of the scalp. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial or calvarial findings.Left occipital soft tissue thickening with minimal increased density is suspicious for small posttraumatic hemor... | 1.No acute posttraumatic intracranial or calvarial findings.2.Small left occipital/suboccipital scalp hemorrhage/edema.3.Mild to moderate age indeterminate small muscle ischemic strokes and mild ex vacuo dilatation of lateral ventricles. |
Generate impression based on findings. | 18 year-old female with rising white blood cell count status post liver transplant, evaluate for fluid collection. ABDOMEN:LUNG BASES: Moderate right pleural effusion with associated atelectasis and consolidation.LIVER, BILIARY TRACT: Right upper quadrant and midline drains are present. Postoperative changes of liver t... | 1. Nonspecific low attenuation collection adjacent posteriorly to the transplant liver which is poorly evaluated on this noncontrast study. This could represent a hepatic contusion or fluid collection adjacent to the liver and ultrasound or contrast enhanced study could be considered for further evaluation if clinicall... |
Generate impression based on findings. | 19 year-old female with chest pain. Motion artifact limits evaluation of fine detail.PULMONARY ARTERIES: Technically adequate study. No pulmonary embolus.LUNGS AND PLEURA: Bibasilar atelectasis. No focal air space opacities. No pleural effusions.MEDIASTINUM AND HILA: Heart size is within normal limits. No pericardial e... | 1.No pulmonary embolus.2.Bibasilar atelectasis. |
Generate impression based on findings. | History of shortness of breath. PULMONARY ARTERIES: Study limited due to motion. Questionable filling defect in the left truncus basalis which may represent pulmonary embolus or may be motion artifact. LUNGS AND PLEURA: Mild centrilobular emphysema. Small right pleural effusion with adjacent atelectasis of the right lo... | 1.Questionable filling defect in the left truncus basalis which may represent pulmonary embolus or may be motion artifact. Discussed with Dr Roggin at the time of dictation. Repeat examination may be obtained if clinically warranted.2.Increased mediastinal lymphadenopathy.3.Expected postoperative fluid collection in th... |
Generate impression based on findings. | 43 year old male with recurrent C. diff colitis, now with abdominal pain, vomiting, diarrhea ABDOMEN:LUNG BASES: Increased bibasilar atelectasis with consolidation.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions evident.SPLEEN: Unchanged nonspecific splenic hypodensity.ADRENAL GLANDS: No sig... | Postsurgical changes without evidence of complication. No acute CT findings to account for the patient's symptoms |
Generate impression based on findings. | 69-year-old female status post cholecystectomy and hysterectomy. Presents with abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilatation or focal hepatic lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abno... | Stable examination since 9/10/2012.No specific acute findings to account for the patient's reported symptoms. |
Generate impression based on findings. | Clinical question: Rule out intracranial hemorrhage versus stroke. Signs and symptoms: As above. Nonenhanced head CT:There is no evidence of acute intracranial process.CT however is insensitive for detection of acute nonhemorrhagic strokes.There is prominence of the cerebellar and vermian folia the patient's stated age... | 1.No acute intracranial process.2.Prominence of cerebellar and vermian folia as detailed an unremarkable nonenhanced head CT otherwise. |
Generate impression based on findings. | Female; 52 years old. Reason: Re-evaluate disease status following recent initiation of systemic therapy; compare to previous scan and provide bi-dimensional measurements History: Stage IV metastatic melanoma There are no previous CT scans of the upper extremity which limits our interpretation of this patient's disease... | Multiple metastatic lesions as described above. |
Generate impression based on findings. | Severe abdominal pain, weight loss and concern for pancreatitis. Focus on pancreas. Severe abdominal pain restricting p.o. intake. On Imuran. Left sided colonic wall thickening. ABDOMEN:LUNG BASES: Mild bibasilar bronchiectasis and scarring. Pectus deformity.LIVER, BILIARY TRACT: Subcentimeter segment 4 hypodense nodul... | No definite findings to explain the patient's significant weight loss although prominence of the distal esophagus is noted and should be correlated with patient's prior surgical history and/or upper endoscopy. |
Generate impression based on findings. | 64 year old female with right flank pain ABDOMEN:LUNG BASES: Right basilar linear atelectasis.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 3.7 x 3... | 1.Right perinephric and periureteral fat stranding without nephroureterolithiasis likely represents a recently passed stone.2.Cholelithiasis without evidence of cholecystitis. |
Generate impression based on findings. | History of head and neck cancer, follow-up. LUNGS AND PLEURA: Right apical scarring, unchanged. Scattered micronodules consistent with prior granulomatous disease some of which are calcified, unchanged. No new suspicious pulmonary nodules.MEDIASTINUM AND HILA: Heart and pericardium are normal. Mild coronary artery calc... | No evidence of metastatic disease. |
Generate impression based on findings. | 48-year-old female with fevers and history of miliary TB and HIV Please note that an unenhanced CT is not sensitive for the detection of solid organ lesions. With this limitation, the following observations are made.CHEST:LUNGS AND PLEURA: Bibasilar atelectasis. Right apical irregular opacity measuring 1.2 x 0.6 cm (4/... | 1.Ill-defined pulmonary opacities are likely infectious/inflammatory. Atypical infections such as viral, fungal and mycobacterial etiologies be be considered in the setting of an immunocompromise patient.2.Extensive mediastinal and retroperitoneal lymphadenopathy.3.Splenic hypodensities are nonspecific.4.Moderate peric... |
Generate impression based on findings. | 92 year-old female with altered mental status post fall. There is age-appropriate cerebral atrophy. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brai... | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | 72 year old female with headache for evaluation of postoperative hemorrhage. Within the pituitary gland, there is an ill-defined focus of hyperdensity consistent with blood products, new compared to prior exam. Anterior wall of the sella is absent. Degree of residual mass is difficult to assess given postsurgical chang... | Multiple postsurgical changes and some blood products in the sellar operative bed consistent with transphenoidal hypophysectomy. |
Generate impression based on findings. | 23-year-old male with abdominal pain and vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant a... | No CT findings to explain patient's symptoms. |
Generate impression based on findings. | 72-year-old male with pancreatic cancer undergoing chemotherapy Please note that this examination is limited in sensitivity for solid organ pathology due to lack of IV contrast.CHEST:LUNGS AND PLEURA: The previously seen left apical nodules have progressed to a scar-like cavitation, measuring 3.3 x 2.3 cm (4/30). Perip... | 1. Apparent decrease in size of the pancreatic head mass2. Progression of the left upper lobe nodules to a cavitary lesion with mucus impaction and ground glass opacities. In this short interval, this favors an infectious etiology. |
Generate impression based on findings. | Reason: melanoma History: none CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules are unchanged from the prior study. No suspicious pulmonary nodule or mass is seen 3 no consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal lymphadenopathy is seen. The previously referenced paratrache... | New soft tissue nodule posterior to the left gluteal muscles suspicious for malignancy. |
Generate impression based on findings. | Clinical question: Rule out hemorrhage. Signs and symptoms: Recent fall with loss of consciousness, dysarthria and headache Nonenhanced head CT:No evidence of acute intracranial findings. CT however is insensitive for detection of acute nonhemorrhagic strokes.Mild age indeterminate small vessel ischemic strokes and the... | 1.No acute intracranial process.2.Mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Reason: kidney donor History: kidney donor ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The right kidney measur... | Single bilateral renal arteries and renal veins. Single collecting system bilaterally with no masses or filling defects noted bilaterally. |
Generate impression based on findings. | 33-year-old female with VRE bacteremia and possible liver abscess seen on ultrasound. History of polycystic kidney disease and Cushing's disease. Please note that non-enhanced CT is not sensitive for the detection of solid organ lesions. With this limitation, the following observations are made.ABDOMEN:LUNG BASES: Diff... | 1.Hepatic hypodensities seen on prior ultrasound are not evident on this nonenhanced CT.2.Unchanged subcutaneous emphysema, pneumothorax and pneumomediastinum.3.Left lower lobe nodule is unchanged.4.Diffuse groundglass opacity is not significantly changed and compatible with edema/ARDS or hemorrhage. 5.Pneumoperitoneum... |
Generate impression based on findings. | 67 year old female with history of AML with headache/dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions ... | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | 45-year-old female with metastatic breast cancer with brain metastasis now with weakness. There is an area of hypoattenuation in the right cerebellar lobe correlating with previously known site of brain metastases as visualized on MRI. This area has decreased in size compared to previous CT study. There is evidence of ... | 1. Aside from redemonstration of right cerebellar brain metastasis, previously documented brain metastases on MRI not well visualized on current study. No new enhancing lesions or focal areas of edema.2. Periventricular white matter disease representing either treatment-related changes versus age indeterminant, ischemi... |
Generate impression based on findings. | Clinical question: Evaluate for ischemia, hemorrhage, mass. Signs and symptoms: Disequilibrium and refractory hypertension. Nonenhanced head CT:There is no evidence of acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.The small focus of cortical encephalomalaci... | 1.No acute intracranial process.2.Small vessel ischemic strokes of indeterminate age is a new finding since the prior exam from 2003.3.Focus of low-attenuation in right posterior frontal cortex consistent with small chronic cortical stroke which is also new since prior exam from 2003.4.Unremarkable study otherwise. |
Generate impression based on findings. | Male 62 years old; Reason: eval intra-abdominal hematoma History: lower back pain, leukocytosis, concerning abd XR ABDOMEN:LUNGS BASES: No enhancing mass identified. Liver morphology is normal. The gallbladder is not visualized. The CBD measures 10.2 mm. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No... | 1. Status post cystoprostatectomy with markedly distended neo bladder causing mass effect on the peritoneal structures with focus of high attenuation and gas. |
Generate impression based on findings. | Clinical impression: Assess for intracranial hemorrhage, mass, midline shift. Signs and symptoms: Fall x 2 in 24 hours, it head times. Nonenhanced head CT: There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes. Very minimal periventricular an... | No acute intracranial process. Please see above comments. |
Generate impression based on findings. | 65 year old female. Reason: L flank pain for 3 months now very severe History: pain ABDOMEN:LUNG BASES: Calcified granulomas are seen in the lung bases.LIVER, BILIARY TRACT: Hypodense segment 4 liver lesion likely represents a simple cyst and is unchanged from the prior study.SPLEEN: No significant abnormality notedPAN... | No evidence of hydronephrosis. No renal, ureteral, or bladder stone. |
Generate impression based on findings. | Reason: Super D protocol for broncoscopy guidance History: hemoptysis LUNGS AND PLEURA: Multiple areas of bronchial mucous plugging are present resulting in nodular and tubular opacities. One of the largest such opacities in the left lower lobe has decreased significantly since the previous scan and surrounding groundg... | Diffuse bronchial thickening and bronchiectasis with multiple areas of bronchial mucous plugging and bronchocele formation. These findings raise the question of ABPA (allergic bronchopulmonary aspergillosis) or MAI. Ground glass opacity in the left lower lobe consistent with hemorrhage or aspirated blood has resolved. |
Generate impression based on findings. | 28-year-old male with right-sided tenderness to palpation, nausea, diarrhea ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality n... | Small bowel obstruction with transition point at a right inguinal hernia. Small amount of free fluid in the pelvis. |
Generate impression based on findings. | Reason: New suspected ALL History: suspected ALL LUNGS AND PLEURA: Diffuse bronchial thickening suggestive of bronchitis or asthma.Focal scar like opacities at the lung bases but no sign of pneumonia.MEDIASTINUM AND HILA: No significant lymphadenopathy.Coronary calcification and stents in place.CHEST WALL: Degenerative... | Diffuse bronchial thickening suggestive of bronchitis or asthma.No acute abnormalities. |
Generate impression based on findings. | Clinical question: Chronic sinusitis, radiation therapy to brain on left side in the past. Signs and symptoms: Chronic sinusitis Medtronic fusion sinus CT:The frontal sinuses are not developed which is a congenital anatomic variation.Ethmoid sinuses are well pneumatized and without evidence of disease.Sphenoid sinus is... | No detectable acute or chronic sinusitis. Please see above comments. |
Generate impression based on findings. | History of mesothelioma 15 months post pleurectomy and decortication, follow-up. CHEST:LUNGS AND PLEURA: Postsurgical changes of the right lung base with diaphragmatic graft.Innumerable bilateral pleural and intrafissural soft tissue nodules increased in size compared to prior study including new nodules. Reference mea... | Interval increase in pleural disease, mediastinal and abdominal lymph nodes. Chest wall tumor not significantly changed. Pericardial tumor now extends through the epicardial fat. Possible esophageal invasion at the level of the aortic arch. |
Generate impression based on findings. | 63-year-old male with subdural hematoma status post evacuation. Soft tissue swelling and subcutaneous air over the burr hole site in left frontal bone, decreased from prior exam. There is redemonstration of a left subdural hematoma with associated uncal herniation, subfalcine herniation, and shift of the third ventricl... | Redemonstration of large extra-axial hematoma associated with midline shift, uncal and subfalcine herniation, grossly unchanged from prior exam. |
Generate impression based on findings. | Reason: 73 yod female s/p recent induction chemo for AML; had CT scan 2 weeks ago with lung nodular chnages suspicious for fungal pneumonia, and lvier cyst History: follow-up CT scan, and elevation of LFTs CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules, consistent with fungal infection, have markedly decr... | Marked decrease in the majority of pulmonary nodules, consistent with resolving fungal infection. |
Generate impression based on findings. | 79-year-old male with history of mesothelioma. Follow-up examination. CHEST:LUNGS AND PLEURA: A new left upper lobe parenchymal nodule is noted (series 6, image 35). Small intraparenchymal nodule in the left lower lobe remains stable. Circumferential left pleural thickening is again noted compatible with mesothelioma w... | 1. Mesothelioma with overall stable nodular left pleural thickening and reference measurements provided. No specific signs of upper abdominal spread.2. New left upper lobe nodule is presumably metastatic.3. Interval decrease in left basilar consolidation. Mild right basilar opacities suggestive of atelectasis and/or as... |
Generate impression based on findings. | Reason: 61 y/o with hx adenoid cystic cancer compare t o last CT \T\ measure 1) intraparotid node, 2) LUL nodule, 3) right lobe liver lesion History: post 3 cycles of therapy CHEST:LUNGS AND PLEURA: Multiple bilateral metastases, unchanged from previous.Left upper lobe reference nodule (series 5 image 41) 14 x 13 mm, n... | 1. Stable pulmonary metastases.2. Slightly increased size of hepatic metastases. |
Generate impression based on findings. | History of metastatic breast cancer need baseline scan with measurements if applicable prior to starting therapy. CHEST:LUNGS AND PLEURA: Subpleural reticulation in the anterior right lung with mild bronchiectasis/bronchiolectasis consistent with radiation fibrosis. Heavily calcified nodule left lower lobe most consist... | 1. Skin thickening, subcutaneous fat stranding and small fluid collections in the right chest wall are presumably post-therapeutic, nonspecific without the benefit of comparison to prior studies.2. Indeterminate right adrenal gland nodule; recommend dedicated adrenal gland imaging to exclude a metastasis as it does not... |
Generate impression based on findings. | 72-year-old male with history of bacteremia and groundglass opacities seen on recent CT. Evaluate for interval change/improvement. The patient also has a history of AML on treatment. LUNGS AND PLEURA: Bilateral upper and lower lobe groundglass opacities, subsolid nodules and areas of patchy consolidation are again note... | 1.Interval decrease in bilateral groundglass and patchy airspace opacities since 7/11/13 may reflect a resolving infection, most likely viral pneumonia. Increase in size of a right upper lobe nodule is not specific but raises the possibility of mixed infection such as superimposed fungal pneumonia if the patient is neu... |
Generate impression based on findings. | Reason: h/o unknown primary head and neck cancer History: r/o chest mets LUNGS AND PLEURA: Since the previous scan there has been resolution of patchy groundglass opacity in the left upper lobe but development of new ground glass opacity in the left lower lobe, consistent with aspiration.Multiple nonspecific micronodul... | Evidence of mild recurrent aspiration. No sign of metastatic disease. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.No suspicious nodules.MEDIASTINUM AND HILA: No significant lymphadenopathy.No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contr... | No significant abnormalities and specifically no sign of metastatic disease. |
Generate impression based on findings. | 60 year-old female with serous peritoneal carcinoma status post 6 cycles of chemotherapy CHEST:LUNGS AND PLEURA: Unchanged moderate sized right pleural effusion with associated atelectasis and consolidation. No suspicious nodules or masses.MEDIASTINUM AND HILA: The reference right prevascular lymph node measures 0.8 x ... | 1. Stable lymph nodes and peritoneal thickening.2. Decreased ascites. |
Generate impression based on findings. | Reason: 31 yo M with CF p/w fever, new LLL cavitary lesion on xray, needing CT for further evaluation History: cough, fever LUNGS AND PLEURA: Large area of left lower lobe subpleural consolidation with large areas of internal cavitation, consistent with necrotizing infection, new since the previous scan.New small left ... | Left lower lobe necrotizing pneumonia. |
Generate impression based on findings. | 77-year-old female with MALT lymphoma of the orbit, evaluate for systemic lymphoma CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusions. Scattered calcified and noncalcified micronodules are nonspecific.MEDIASTINUM AND HILA: For neck findings, please see dedicated CT neck performed on the same day. No me... | 1.No lymphadenopathy in the chest, abdomen or pelvis.2.Small fat containing lesion protruding into the bladder lumen may represent a lipoma. |
Generate impression based on findings. | 50 year-old female with gross hematuria and history of kidney stones. History of sarcoidosis ABDOMEN:LUNG BASES: Reticulonodular interstitial opacities with a discrete left lower lobe nodule appears similar to the prior exam and is compatible with history of sarcoidosis.LIVER, BILIARY TRACT: Scattered subcentimeter hep... | 1.Increased areas of infarct involving the right kidney with new multi-focal infarcts of the left kidney. 2.No nephroureterolithiasis or hydronephrosis. |
Generate impression based on findings. | Recurrent neuroblastoma. Assess for therapy response. CHEST:LUNGS AND PLEURA: Stable micronodules off the major fissure of the right lung (image 49, series 80294). No effusions or pneumothorax.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT:... | No evidence of recurrence of disease. |
Generate impression based on findings. | 57-year-old female with HCV cirrhosis ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Unchanged appearance of the right hepatic dome and segment 4 hemangiomas seen on prior MR. Subcentimeter hypoattenuating focus in the lateral left lobe seen only on delayed images... | 1. Cirrhosis without lesions suspicious for HCC. No ascites2. Stable appearance of two hepatic hemangiomas |
Generate impression based on findings. | Female 50 years old; Reason: r/o metastatic disease History: right breast mass, left hip pain CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right breast mass is seen, incompletely characterized and visualized on this examination measuring app... | 1.Right breast mass with no evidence of metastatic disease detected. |
Generate impression based on findings. | Male, 50 years old, with hoarseness and voice changes. The aryepiglottic folds, supraglottic and glottic mucosa are diffusely and bilaterally thickened. This tissue is minimally enhancing if at all. Questionable involvement of the overlying strap muscles of the neck is also noted. The thyroid cartilage through this reg... | Diffuse soft tissue thickening of the supraglottic and glottic components of the larynx with questionable involvement of the overlying thyroid cartilage and strap muscles. The differential diagnosis is broad and would include malignancy, a benign infiltrative process such as sarcoid or Wegener's, and potentially a lary... |
Generate impression based on findings. | Male 72 years old; Reason: Hx of pleural mesothelioma s/p pleurectomy and decortication and chemo. Pls assess for any residual disease. History: None CHEST:LUNGS AND PLEURA: Post-surgical changes are present in the left hemithorax with volume loss and leftward mediastinal shift. Small left pleural effusion with basilar... | 1.No significant residual disease or recurrence detected in the chest, abdomen, or pelvis. |
Generate impression based on findings. | Tonsil CA status post CRT one year ago CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Punctate calcified apical micronodule consistent with a granuloma (5/56). Tiny peri-bronchovascular opacity also in the right apex (5/57) new from previous but too small to accurately characterize. This could refle... | No evidence of metastatic disease. |
Generate impression based on findings. | Assess for interval change in right-sided pleural effusion and pneumonia. CHEST:LUNGS AND PLEURA: Small left pleural fluid collection is stable. Right pleural fluid collection decreased in size, now small. A right-sided pigtail catheter is present in the costophrenic angle and appears to be in communication with the fl... | 1. Improving parenchymal lung abnormality with decrease in size of right pleural fluid collection, now small.2. Presumed postsurgical changes of a recent liver transplant. Small sub-diaphragmatic fluid collection in the may reflect a postoperative hematoma. Please note that vascular patency cannot be assessed by unenha... |
Generate impression based on findings. | Female 52 years old; Reason: Crohn's disease s/p Ex lap and lysis of adhesions for SBO. Now with abdominal pain and high NGT output. Pls eval for SBO History: pain ABDOMEN: Please note that this examination is limited in sensitivity for solid organpathology due to lack of IV contrast.LUNG BASES: Minimal subsegmental at... | 1. Status post near complete resolution of the previously noted small bowel obstruction without evidence of complication. Suggestion of focal ileus in the left lower quadrant.2. Possible small gastric or splenic artery aneurysm. This is not well evaluated on non-contrast CT. CTA may be performed for further evaluation.... |
Generate impression based on findings. | History lung cancer status post lobectomy also history of breast cancer in 1994. Doing well now needs disease evaluation. CHEST:LUNGS AND PLEURA: Postsurgical changes of left lower lobectomy. Suture line suggesting wedge resection in the left upper lobe.Adjacent right upper lobe nodules increased in size. The more medi... | 1. Increase in size and density of right upper lobe nodules, highly suspicious for neoplasm such as minimally invasive adenocarcinoma.2. Stable scarlike groundglass nodule in the left upper lobe and smaller non-index groundglass nodules. 12-month follow-up recommended. 3. Increase in left hilar lymphadenopathy compared... |
Generate impression based on findings. | Poorly differentiated squamous cell carcinoma. Chemo radiation treatment CHEST:LUNGS AND PLEURA: Questionable mild increase in size of the right apical soft tissue nodule sheath into the midline extending into the anterior mediastinum. Current axial measurements are 1.8 x 1.3 cm (image 15 series 3) from a prior measure... | Continued slow growth of the right apical nodular density abutting the pleura and extending into the mediastinum. Central necrosis again observed. Concern for progression of a recurrent neoplasm |
Generate impression based on findings. | Male 64 years old; Reason: mesothelioma, s/p 10 cycles of chemo. please evaluate for disease and compare with previous scans using the same target lesions. History: mesothelioma ABDOMEN:LUNGS BASES: Please refer to the separately reported chest CT for further details.LIVER, BILIARY TRACT: Scalloping of the liver contou... | 1. Stable appearance of the extensive peritoneal nodularity with abdominal and pelvic lymphadenopathy.2. Please refer to the separately reported CT chest for further details. |
Generate impression based on findings. | Mesothelioma, follow-up LUNGS AND PLEURA: Extensive right hemithorax fine loss and pleural thickening again consistent with known mesothelioma. Interval regression, reference measurements provided1. At the level a great vessels (image 18 series 80241), the 4 and 8 o'clock measurements are 2.5 and 4.4 cm, previously 1.9... | Interval progression of known mesothelioma, with reference measurements provided. |
Generate impression based on findings. | Lung cancer status post chemo/RT CHEST:LUNGS AND PLEURA: Emphysema. Calcified nodule right upper lobe most likely a granuloma. Left upper lobe architectural distortion, perihilar bronchiectasis and surrounding soft tissue are grossly unchanged compared to the most recent previous study. Allowing for progressive archite... | Stable examination without signs of recurrent or metastatic disease. |
Generate impression based on findings. | 56 year old male with prostate cancer, evaluate for metastases ABDOMEN:LUNG BASES: Lobular nodule along the left major fissure may represent an intrapulmonary lymph node.LIVER, BILIARY TRACT: Left hepatic lobe hypodensity likely represents a cyst. Hypodensity in the right hepatic lobe is incompletely characterized but ... | No definitive evidence of metastatic disease. Hepatic hypodensities are incompletely characterized but stable in size. |
Generate impression based on findings. | SLE, lupus nephritis complains of tablespoons size hemoptysis each morning. LUNGS AND PLEURA: No pleural fluid. No suspicious pulmonary nodules or masses. As in the posterior lung fields bilaterally, there is a very fine pattern of peripheral pleural and subpleural calcification with small spicules extending into the l... | 1. Extremely subtle, small area of ground glass opacity in the anterior aspect of the right upper lobe. Differential diagnosis includes focal fibrosis versus early or resolving alveolitis.2. Progression of cardiomegaly since 2007.3. Pleural/subpleural dendriform ossification, of unclear clinical significance in the abs... |
Generate impression based on findings. | 73 year old female with history of lobectomy. Follow-up examination. Per the medical record, the patient has a history left upper lobectomy and mediastinal lymph node dissection for management of a T2aN0M0 stage IB adenocarcinoma. LUNGS AND PLEURA: Surgical material is noted in the superior left lung compatible with hi... | 1.Postoperative changes of left upper lobectomy as described above. No specific evidence of recurrent or metastatic disease.2.Branching tubular left lower lobe opacities are suggestive of mucous plugging and infection, possibly post-obstructive given the presence of proximal bronchial narrowing. 3.Small pericardial eff... |
Generate impression based on findings. | Reason: please compare to previous CT scan with RLL and LLL nodules, SUPER D PROTOCOL History: copd, lung nodules LUNGS AND PLEURA: Interval clearing of dense left lower lobe consolidation compatible with pneumonia or infarct. A small focal scar or atelectasis is present in this area.Small poorly defined nodules in the... | 1.Almost complete resolution of left lower lobe consolidation compatible with infarct or infection, and resolution of small right lower lobe nodules. 2.Very small new right upper lobe nodule, likely infectious. |
Generate impression based on findings. | Metastatic lung cancer (unspecified) with brain metastatic disease. CHEST:LUNGS AND PLEURA: Stable left lower lobe cystic lesion in the super segment with vessels than wall thickening and surrounding groundglass opacities. No distinct interval change when compared to 3/29/13. No new suspicious intrapulmonary additional... | Stable left lower lobe cavitary lesion and underlying osseous changes. Reference measurements and descriptions are provided |
Generate impression based on findings. | Metastatic thyroid cancer with brain nodules. CHEST:LUNGS AND PLEURA: No gross significant change in the left hilar mass engulfing multiple central pulmonary vessels which are curly difficult to distinguish without contrast enhancement. Overall axial measurement remains 2.9 x 2.4 cm (image 42 series 5). Also scattered ... | 1. Interval left bronchial stenting with decreased surrounding soft tissues are present a possible interval treatment. The reference left hilar mass measuring however is unchanged. 2. A pancreatic head mass on best appreciated on the coronal image with interval enlargement compared to multiple serial prior exams. |
Generate impression based on findings. | 73-year-old male with peritoneal mesothelioma status post 6 cycles of chemotherapy, compare to prior scan CHEST:LUNGS AND PLEURA: Moderate right-sided pleural effusion with associated compressive atelectasis is best acutely changed in size. Small left-sided pleural effusion is slightly decreased in size.Reference nodul... | 1.Improved peritoneal and mesenteric nodularity.2.Decreased pleural based lesions. 3.Moderate right-sided pleural effusion is unchanged. Small left pleural effusion is slightly decreased. |
Generate impression based on findings. | History of lung adenocarcinoma with brain metastases status post chemoradiation, follow-up. CHEST:LUNGS AND PLEURA: Postsurgical changes consistent with left pneumonectomy. Few scattered micronodules in the right lung, unchanged. No new suspicious nodules or opacities. Mild upper-lobe predominant centrilobular emphysem... | No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Reason: pt with advanced lung ca s/p 2 cycles of newer agents History: now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Complete opacification of the left hemithorax by a large pleural effusion with underlying compressive atelectasis of the left lung and a moderate component of... | 1.Interval progression of pulmonary metastases 2. Multiple new large hepatic metastases. |
Generate impression based on findings. | ALL, pre-stem cell transplant evaluation LUNGS AND PLEURA: Mild centrilobular emphysema. Scattered micronodules, however no distinct focal solitary intrapulmonary lesion. No effusionsMEDIASTINUM AND HILA: Multinodular mild goiterThe cardiac and pericardium are within limits, however the enlarged pulmonary artery raises... | Multiple changes consistent with patient's known ALL, baseline measurements provided |
Generate impression based on findings. | 69-year-old male with history of mesothelioma status post 4 cycles of chemotherapy. Follow up examination. CHEST:LUNGS AND PLEURA: Postoperative changes of left pleurectomy with left-sided volume loss and left diaphragmatic mesh placement are again noted. There is increased pleural fluid anteriorly along the left upper... | Postoperative changes of left pleurectomy and diaphragmatic mesh placement as described above without specific evidence of recurrent disease. |
Generate impression based on findings. | 19 year-old male with Crohn's disease, pain. ABDOMEN:LUNG BASES: No focal pulmonary opacities or pleural effusions.LIVER, BILIARY TRACT: Normal hepatic enhancement without focal lesion. No intra or extrahepatic biliary ductal dilatation.SPLEEN: The spleen enhances normally.PANCREAS: Normal pancreatic enhancement.ADRENA... | Marked inflammation of the cecum, ascending colon and hepatic flexure, compatible with active Crohn's disease. Disease involvement of the terminal ileum is also noted |
Generate impression based on findings. | Pleural mesothelioma status post PD and 4 cycles of chemotherapy. History of parietal pleurectomy. CHEST:LUNGS AND PLEURA: Visceral pleural thickening and volume loss left hemithorax consistent with provided clinical history of mesothelioma. Overall there is an increase in size and number of left sided pleural lesions.... | 1. Continued improvement in size of of left lower lobe nodule.2. Increased in size and number of the left hemithorax pleural lesions, some of which now extend through the chest wall.3. Interval development of extensive soft tissue stranding and nodularity within the mesentery/upper abdominal facets as well as intra-abd... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.