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Generate impression based on findings. | Clinical question: History of head and neck cancer. Evaluate disease and compare/measurements to prior scan. Signs and symptoms: As above. Enhanced neck CT:There is no detectable intracranial abnormality on this portion visualized images.Bilateral cavernous sinuses and skull base remains unremarkable.Images through the orbits are unremarkable.All paranasal sinuses and bilateral mastoid air cells are well pneumatized.Nasopharynx, nasal passage and bilateral temporalis fossa remains unremarkable.Extensive postoperative changes at the level of the oral cavity and including the floor of the mouth and placement of a flap is again noted without any change.Previously noted soft tissue thickening with a superficially located ulceration at the level of the right mandibular angle is again identified. In the medial aspect of this thickened soft tissue there are multiple surgical clips similar to prior exam. There is no convincing evidence of any interval change in the size of this finding which is suspected of postoperative change. It measures approximately 28 mm in AP axis similar to prior. The transverse axis of finding cannot be measured accurately due to numerous metallic surgical clips however grossly appear similar to prior study. There is suggestion of slightly lower density of the finding particularly along its dorsal aspect, which may indicate reduced enhancement compared to prior exam. Possibility of an overlapping infection cannot be entirely ruled out. The right internal jugular and internal carotid artery abuts the dorsal aspect of this finding.The size of superficial ulceration however, appears slightly smaller.There is no convincing evidence of any associated bony changes of the mandible adjacent to the above findings.There is no detectable lymphadenopathy in the neck by CT size criteria. This is a similar observation is prior study.The visualization of tracheostomy and without interval change since prior exam.Enhanced head CT:Examination demonstrates no detectable abnormal enhancement. The brain parenchyma or leptomeninges to suggest metastatic disease.Unremarkable. Cortical sulci, ventricular system, CSF, cisterns, and gray -- white matter differentiation.Calvarium and skull base remain unremarkable.Images through the orbits are unremarkable.All visualized paranasal sinuses and bilateral mastoid air cells/middle ear cavities are well pneumatized. | 1.Enhanced neck CT demonstrates no convincing evidence of interval change a focus of soft tissue thickening at the level of the right mandibular angle and inseparable from the inferior tip of the superficial lobe of right parotid gland. Superficial ulceration of the lesion appears slightly smaller. The density of the lesion appears lower compared to prior exam, which may suggest less enhancement. No evidence of cervical lymphadenopathy.2.Negative enhanced head CT. |
Generate impression based on findings. | Melanoma with cough and night sweats LUNGS AND PLEURA: Mild dependent atelectasis. No suspicious pulmonary nodules or masses and no specific signs of pneumonia. Subtle peribronchial thickening and ground glass opacity surrounding in the right middle lobe medial segmental airway, visible only on the high resolution series.MEDIASTINUM AND HILA: Small amount of debris in the proximal thoracic esophagus which is mildly patulous.Left chest port tip in the superior cavoatrial junction. Mildly enlarged mediastinal and hilar lymph nodes. Right hilar and subcarinal lymph nodes appear slightly more prominent compared to the previous examination. Main pulmonary artery is slightly enlarged, suggesting pulmonary arterial hypertension.CHEST WALL: Interval removal of right axillary drain with some residual scarring, nonspecific by CT. Right axillary surgical clips. Subcentimeter suppled clavicular lymph nodes, nonspecific in appearance. Left chest port.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant lymphadenopathy. Probable flash filling hemangioma the right hepatic lobe (3/103). | No specific signs of pneumonia. Subcarinal and right hilar lymph nodes are slightly larger than on the previous study. The upper esophagus is slightly patulous and contains debris however there is no conclusive evidence of bronchiolitis or aspiration-related pneumonitis on the at the time of exam. Very subtle bronchial wall thickening and inflammatory change within the medial segment of the right middle lobe is new and may represent an evolving or resolving inflammatory or infectious process. |
Generate impression based on findings. | Reason: Eval for metastatic disease History: 52F hx breast cancer known vertebral bone lesions CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Basilar scarring/atelectasis.MEDIASTINUM AND HILA: Prominent precarinal lymph node measures 9 x 9 mm (series 4, image 32). Heart size is normal. No pericardial effusion.CHEST WALL: Status post right mastectomy. A subpectoral breast implant is present. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Indeterminate left adrenal nodule is unchanged.KIDNEYS, URETERS: Nonspecific hypodense focus in the left midpole likely represents a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Expansile soft tissue mass involving the inferior left L5 vertebral body, intervertebral disk space, and left S1. Status post lumbosacral fusion without evidence of hardware complications.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Expansile soft tissue mass involving L5 and S1 compatible with metastatic disease. |
Generate impression based on findings. | Male, 81 years old, history of prostate cancer with new back and neck pain. Evaluate for progression of disease. An apex-left scoliosis is noted. In addition, there is a grade 1 anterolisthesis of C4 relative to C5 and C5 relative to C6. No discrete bony lesions are seen to suggest metastatic disease.Congenital anomalies of the craniocervical articulation are demonstrated including atlanto-occipital assimilation. The posterior arch of C1 is unfused. The odontoid process is asymmetric, and the left lateral mass of C2 is elevated relative to the right, likely contributing to scoliosis as above.C2-3: Severe right and moderate left facet hypertrophy. Small posterior disk-osteophyte complex. No significant spinal canal narrowing. Moderate right foraminal narrowing. C3-4: Severe right and moderate left facet hypertrophy. Posterior disk-osteophyte complex, asymmetric to the right paracentral region. Mild effacement of the right lateral aspect of the spinal canal. Severe right foraminal narrowing. C4-5: Severe right and mild left facet hypertrophy. Posterior disk-osteophyte complex, slightly asymmetric to the right paracentral/foraminal region. Mild effacement of the right lateral aspect of the spinal canal. Severe right and moderate left foraminal narrowing. C5-6: Severe right and mild left facet hypertrophy. Posterior disk-osteophyte complex asymmetric towards the right paracentral/foraminal region. Moderate effacement of the right lateral aspect of the spinal canal. Severe bilateral foraminal narrowing.C6-7: Mild bilateral facet hypertrophy. Posterior disk-osteophyte complex with perhaps a small superimposed central disk protrusion. No significant generalized canal stenosis. Severe bilateral foraminal narrowing. C7-T1: Mild bilateral facet hypertrophy. Mild posterior disk-osteophyte complex. No significant spinal canal compromise. Severe left and moderate right foraminal narrowing. T-SPINE | 1. No evidence of focally destructive bony lesions to suggest the presence of metastatic disease to the spine.2. Congenital anomalies of the craniocervical junction as above.3. Variable scoliotic curvature throughout the spine.4. Advanced degenerative disk disease with relatively mild scattered areas of canal compromise in the cervical spine, as well as areas of moderate to severe canal compromise in the lumbar spine. |
Generate impression based on findings. | Male; 57 years old. Reason: h/o parotid cancer History: r/o lung mets. LUNGS AND PLEURA: Scattered scarlike opacities are unchanged, but no suspicious pulmonary nodules or masses are seen. No focal air space opacity or pleural effusion.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications are again noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Previously described small accessory splenule is incompletely visualized on the current study. | No evidence of metastatic disease or significant interval change. |
Generate impression based on findings. | Head and neck cancer CHEST:LUNGS AND PLEURA: Mild apical radiation fibrosis. Right middle lobe atelectasis persists despite clearance of the majority of debris seen previously within the airways. Stable left lower lobe intrapulmonary lymph nodes, present since 2011.MEDIASTINUM AND HILA: Tracheostomy tube above the lung carina. The descending portion of the left subclavian artery contains chronic eccentric mural thrombus. Normal heart size. No significant lymphadenopathy. Eccentric mural thrombus in the anterior aspect of the proximal descending thoracic aorta containing calcification. Left PICC terminates in the left brachiocephalic vein near the midline.CHEST WALL: Left PICC. Numerous small right axillary lymph nodes measuring up to 9 mm, previously 7-mm (3/32). In addition a small subpectoral lymph node (3/29) has increased in size. Multilevel endplate degeneration in the lower thoracic spine, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic disease of aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Gastrostomy tube retention device in the stomach.BONES, SOFT TISSUES: Pelvic bones appear slightly osteopenic for age.OTHER: No significant abnormality noted. | No suspicious pulmonary nodules or masses. No mediastinal lymphadenopathy. Upper normal sized right axillary/subpectoral lymph nodes have increased in size slightly, of unclear significance |
Generate impression based on findings. | Hodgkin's lymphoma. Pre transplant evaluation. CHEST:LUNGS AND PLEURA: Right upper lobe nodule all it is smaller and less round. No other focal opacity is identified.MEDIASTINUM AND HILA: Few small superior mediastinal lymph nodes are again noted. No hilar lymphadenopathy is identified. Heart size is normal.CHEST WALL: Left-sided central line has its tip in right atrium.ABDOMEN:LIVER, BILIARY TRACT: Normal enhancement. No biliary ductal dilatation. Gallbladder is incompletely distended.SPLEEN: Normal in size.PANCREAS: Normal in appearance.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric cortical enhancement. No pelvicaliceal dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Semisolid material is seen in the distal esophagus most likely due to GE reflux. Duodenojejunal junction is normally positioned.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No free peritoneal fluid or air is identified.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Incompletely distended and normal in appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No free fluid is identified. | Decrease in size of right upper lobe nodule which is most likely infectious/inflammatory. Unchanged small mediastinal lymph nodes. |
Generate impression based on findings. | Reason: Pt is post-treatment CRT for right BOT CA SCCa History: Pt is post-treatment CRT for right BOT CA SCCa LUNGS AND PLEURA: Interval development of upper lobe patchy groundglass opacities and septal thickening compatible with edema and possibly related to radiation therapy.Diffuse bronchial/bronchiolar wall thickening.Increasing right middle lobe and bilateral basilar atelectasis/consolidation suggestive of aspiration.Small bilateral pleural effusions are new.MEDIASTINUM AND HILA: Tracheostomy tube in place.Increasing adenopathy in the superior mediastinum, paratracheal, and prevascular spaces.Left-sided pacemaker with leads in place. CHEST WALL: Degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Virtually visualized renal hypodensities. G-tube in place. | 1.Diffuse bronchial/bronchiolar wall thickening compatible with aspiration bronchiolitis.2.Increasing right middle lobe and lower lobe atelectasis/consolidation compatible with aspiration.3.New small bilateral pleural effusions.4.Increasing mediastinal lymphadenopathy which may be reactive in origin.5.New diffuse upper lobe groundglass opacities and septal thickening compatible with edema probably secondary to radiation pneumonitis. |
Generate impression based on findings. | Clinical question: Rule out bleed or obstruction in patient with GBM on Avastin. Signs and symptoms: Headache with nausea and emesis Nonenhanced head CT: Unremarkable images through posterior fossa and mid normal size and midline fourth ventricle.Images through the supratentorial space demonstrate no evidence of any acute new findings. Size of the supratentorial ventricular system remains within normal and stable since prior study. Midline is maintained.Vasogenic edema in the left posterior temporal lobe and extending to the left occipital and parietal remain similar to prior exam and a resultant regional effacement of adjacent cortical sulci and subtle mass effect on the trigone of left lateral ventricle.Expected postoperative changes of the left posterior parietal -- occipital craniotomy, similar to prior study. | 1.No evidence of any acute new finding since prior exam.2.Stable normal size of the supratentorial ventricular system and subtle mass effect on left lateral ventricle from patient's known left hemispheric tumor.3.Revisualization of a stable focus of low-attenuation/vasogenic edema and tumor in the left occipital/posterior temporal region and its regional mass-effect. |
Generate impression based on findings. | Right chest pain and lesion site, compared to prior CT scan. History of lung/vertebral lesions and right rib lesion/mass LUNGS AND PLEURA: Nodule is again seen in the left lung base. No consolidation or pleural effusion.MEDIASTINUM AND HILA: The heart is normal in size and there is no pericardial effusion.CHEST WALL: Two expansile, predominantly lytic lesions with sclerotic margins are again seen in the anterolateral aspect of the right sixth rib. Cortical step off of the proximal-most lesion is again seen, likely representing a pathologic fracture.Vertebral body lesions with sclerotic margins are seen along the anterior endplates of T7-T9 and in T12, especially in T9.UPPER ABDOMEN: No significant abnormality noted. | 1. Expansile predominantly lytic lesions in the right sixth rib with pathologic fracture in the more proximal lesion. This may be due to eosinophilic granulomatosis and malignancy is considered less likely.2. Multiple thoracic vertebral body lesions, possibly representing Schmorl's nodes.3. Left lung base nodule is unchanged which may also be related to eosinophilic granulomatosis. |
Generate impression based on findings. | Reason: h/o HNC, baseline scans - pre CRT, compare to outside History: none CHEST:LUNGS AND PLEURA: Mild upper zone emphysema and scarring.Mild groundglass and small nodular opacities in the posterior segment of the right upper lobe, likely secondary to infection and/or aspiration.No suspicious nodules.MEDIASTINUM AND HILA: Slightly inhomogeneous thyroid gland.Moderate thickening of the upper esophagus, unchanged.Mildly enlarged lymph nodes in the AP window area, all less than 10 mm in diameter.Moderate coronary artery calcification.Catheter tip in the SVC.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Some retained dense contrast material is present in the distal small bowel.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Mild right upper lobe opacity compatible with infection or aspiration. No specific evidence of metastases. |
Generate impression based on findings. | 37-year-old male with history of metastatic renal cell carcinoma on gem/cape/bev, image to determine response to therapy. The previously described left level 4 supraclavicular conglomerate nodal mass is again visualized. This demonstrates both cystic and soft tissue components and measures 2.8 x 1.8 cm in maximal axial dimensions. The prior scan had streak artifact related to contrast injection which partially obscured the lesion and the prior measurement also likely incorporated a portion of the adjacent scalene muscle. This mass is slightly smaller than on the prior exam. The previously described node located inferior to this lesion is stable in size measuring 2.5 x 1.6 cm in maximum axial dimensions (previously 2.7 x 1.7 cm in similar dimensions). Multiple smaller level 2 nodes are demonstrated bilaterally, though none are significant by size criteria or changed from previous.There are scattered probable secretions demonstrated within the trachea (axial images 66, 73). There are no suspicious masses. Vascular structures are normal. The thyroid is unremarkable. There are no focal bony lesions demonstrated. | 1.Slight interval decrease in size of the lobulated left level IV conglomerate nodal mass.2.Interval stability of the probable node located inferior to this.3.Future follow-up should utilize a right-sided injection of contrast, to decrease streak adjacent to the referenced pathology. |
Generate impression based on findings. | Clinical question: Hodgkin's lymphoma, on therapy. Signs and symptoms: Baseline pre-transplant to rule-out infection. Maxillofacial CT:Frontal sinuses are well pneumatized and unremarkable.Ethmoid sinuses are well pneumatized and unremarkable.Significantly larger left chamber of the sphenoid sinus is well pneumatized and patent sphenoethmoidal recess. The right chamber of the sphenoid sinus is very small (anatomical variation) measuring approximately 6 times 9-mm in transaxial dimensions and is nearly completely opacified slight mucosal thickening. The right sphenoethmoidal recess remains patent however.Maxillary sinuses are well pneumatized bilaterally and with patent bilateral ostiomeatal units.There is significant nasal septum deviation with rightward deviated septum in contact with the right inferior turbinate.Bilateral mastoid air cells, and middle ear cavities are well pneumatized and unremarkable.Unremarkable images through the orbits. | 1.A very small right chamber of the sphenoid sinus (an anatomical variation) is opacified however, with patent right sphenoethmoidal recess.2.All other paranasal sinuses and including larger left chamber of the sphenoid sinus remains well pneumatized and unremarkable.3.There is rightward nasal septum deviation with mucosal contact with the right inferior turbinate. |
Generate impression based on findings. | Retromolar trigone cancer evaluate for lung metastases LUNGS AND PLEURA: Multiple pulmonary nodules not significantly changed compared to previous. Largest nodule at the right apex measures 5 x 7 mm (4/14), previously 6 x 8mm on 2/2011 and 6 x 8mm on 2/19/13. Centrally, this lesion appears slightly more solid compared to the prior studies though it is not increased in size, possibly due to retraction from scarring. Moderate to severe emphysema. 6-mm ground glass nodular density in the right lower lobe was not present previously and should be followed to resolution. No pleural fluid.MEDIASTINUM AND HILA: A 6mm low left paratracheal lymph node (3/37) is slightly larger compared to prior studies (2-3 mm) and should be followed on the patient's subsequent exam for growth. Coronary artery calcifications. A mildly enlarged left lower paraesophageal lymph node is unchanged (3/62).CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. New lymph node in the gastrohepatic ligament measures 8mm in short axis (3/102). | 1. Enlarging subcentimeter lymph nodes adjacent to the esophagus could be reactive if the patient has a recent history of esophagitis. CT is insensitive for the detection of esophageal pathology. Consider correlation with endoscopy if clinically warranted. Distribution is somewhat atypical for occult nodal metastases from head and neck cancer, but this may be considered if the patient has lymphadenopathy in the neck.2. A single groundglass nodule the right lower lobe could be postinflammatory and may be followed for resolution at the time of the patient's next scheduled the exam. If it not resolve with time of subsequent study, yearly follow up for a total of 3 years would be recommended.3. No pulmonary nodules suspicious for metastases. |
Generate impression based on findings. | Reason: h/o HNC, s/p induction, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules.No suspicious pulmonary nodules or masses.Mild bronchial/bronchiolar wall thickening and subtle groundglass opacities suggestive of aspiration/bronchiolitis.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities most likely representing cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mild bronchial/bronchiolar wall thickening in scattered groundglass opacities suggestive of aspiration/bronchiolitis.2.No evidence of metastatic disease. |
Generate impression based on findings. | Clinical question: History of head and neck cancer. Status post chemo/radiation. Evaluate for response. Signs and symptoms: None. Enhanced CT of soft tissues of neck:Limited view of intracranial space is unremarkable.Unremarkable bilateral cavernous sinuses and skull base.Unremarkable images through the nasopharynx and nasal passage.Unremarkable bilateral temporalis fossa.Examination redemonstrates extensive postoperative changes of a right neck dissection which includes removal of right submandibular gland. Bilateral internal jugulars, common carotid, and internal carotid arteries are visualized and unremarkable.There is no convincing evidence of residual and/or recurrence of tumor or any cervical adenopathy by CT size criteria.Unremarkable thyroid lobes. No detectable osseous or cartilaginous erosive/sclerotic changes. Examination demonstrates similar to prior exam. Fairly extensive degenerative changes of cervical spine with large hypertrophic spurs in particular at C5 -- C6. There are multi-level neural foraminal compromise and suspected spinal stenosis. | Stable post operative/therapy changes of neck and without convincing evidence of residual tumor or lymphadenopathy by CT size criteria. |
Generate impression based on findings. | Male, 66 years old, history of retromolar trigone cancer status post surgery and RT. Evaluate for recurrence. Extensive postoperative change is demonstrated including asymmetric volume loss of the left aspect of the tongue and tongue base as well as resection and flap reconstruction of the left soft palate and oropharynx. The previously seen retromolar trigone/palato-pharyngeal tumor has been resected. A portion of the alveolar ridge of the left mandible has also been removed. Within this altered background, no definite soft tissue mass or suspicious enhancement is seen.Evidence of a left neck dissection is seen. The fascial planes through the left neck are effaced. No pathologic adenopathy is detected by size criteria.The parotid glands are unremarkable. The submandibular glands are both small but free of focal lesions. The thyroid is also unremarkable. The cervical vessels remain patent. Emphysema is evident in the visualized lungs. No concerning bony lesions are seen. | Extensive postsurgical and posttreatment change in the left neck. No evidence of residual or recurrent primary tumor. No pathologic adenopathy. |
Generate impression based on findings. | Female 22 years old; Reason: 22 year old with GSW paraplegia now with likely urosepsis, eval for renal stone and signs of pyelonephritis History: abd pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Moderate perinephric inflammation. Mild collecting system prominence. Status post removal of the stent. The right kidney is hypodense and is mildly edematous. The inflammation extends into the retroperitoneum. No nephrolithiasis. No fluid collections.Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. Inflammation from the right kidney kidney extends adjacent to the right colon. The appendix is gas containing and is normal in caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No distal ureteral bladder calculi. Bladder is decompressed by a Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Minimal right collecting system dilatation following stent removal.2.Right renal inflammation extends to the retroperitoneum. The findings are suggestive of pyelonephritis without definite abscess. |
Generate impression based on findings. | Reason: h/o HNC, CRT, compare to previous, measurements pls History: none LUNGS AND PLEURA: Interval improvement in the nodular opacities in the right middle lobe.Bronchial wall thickening and bronchiectasis similar in appearance to the prior exam.Scattered areas of scarring/discoid atelectasis redemonstrated.No new suspicious pulmonary nodules or masses.No pleural effusion.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Severe coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine and stable anterior wedging of several midthoracic vertebrae..UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable exophytic left renal cysts. | Interval improvement in the nodular opacities presumably secondary to aspiration. No evidence of metastatic disease. |
Generate impression based on findings. | Female 71 years old Reason: eval pulm process such as copd, pls use hi res History: rh failure The sensitivity of this exam is limited by patient motion.LUNGS AND PLEURA: Numerous cystic appearing lesions are seen throughout the pulmonary parenchyma, predominantly in the right perihilar region, which appear to communicate with bronchi, but are difficult to characterize due to patient motion. The etiology is unclear but may represent emphysema. There is mild bibasilar atelectasis.There is evidence of mild bilateral pleural thickening/effusions.MEDIASTINUM AND HILA: There is cardiomegaly with prominence of the right atrium and ventricle. The pulmonary artery is dilated.There is moderate calcification of the walls of the coronary arteries and aortic arch. A central venous catheter is in place with the tip in the cavoatrial junction. The esophagus appears patulous. Numerous calcified granulomas are seen in the right hilum.There is a lucency in the anterior/superior mediastinum, which may represent a small amount of mediastinal air, but may also be artifactual due to patient motion.CHEST WALL: There is prominent body wall edema. Mild multilevel degenerative changes seen in the thoracic and cervical spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. A single hypodense foci is seen in hepatic segment II, which too small to characterize. There is diffuse haziness of the mesentery. | 1.Dilated right atrium and ventricle with associated cardiomegaly and anasarca, which may represent right heart failure.2.Cystic lesions seen in the pulmonary parenchyma, likely representing emphysematous changes.3.No specific evidence of pulmonary edema or infection.4.Lucency in the anterior/superior mediastinum, which may represent pneumomediastinum or be artifactual related to patient motion. Correlate clinically. |
Generate impression based on findings. | Male, 58 years old, history of esophageal cancer, baseline scan pre-CRT. Soft tissue thickening along the tracheoesophageal groove within the upper thorax is demonstrated compatible with the stated history of esophageal cancer. For reference, this tissue measures 2.3 x 1.5 cm (image 82 series 4). This seems to have increased from the prior examination where the same region measured 1.9 x 1.0 cm, though this difference could in some degree of present differences in luminal distention. The area of soft tissue referenced on the prior examination along the left paraesophageal space is not as clearly depicted on the present examination which may reflect differences in technique or tumor regression. A right paraesophageal lymph node is redemonstrated measuring 8 mm short axis (image 84 series 4), previously 6 mm. An additional previously referenced right paraesophageal node more superiorly is not clearly depicted on the present study and may have become incorporated within the tracheoesophageal groove mass. A left submental lymph node is seen measuring 1.1 by 0.7 cm (image 53 series 4), previously 1.2 x 0.9 cm.Otherwise, the aerodigestive mucosal tract is unremarkable. The salivary glands and the thyroid are free of focal lesions. The cervical vessels remain patent. Mild emphysema in the lung apices. No concerning bony lesions are seen. | Redemonstration of soft tissue thickening involving the upper thoracic esophagus compatible with the patient's history. This seems to have progressed mildly along the right tracheoesophageal groove. However, the previously referenced left paraesophageal soft tissue thickening is not as well demonstrated on the current study which may reflect tumor regression.Small paraesophageal lymph nodes are stable to at most mildly enlarged. A submental reference node is smaller. |
Generate impression based on findings. | 83 M w/ possible IPF on CXR, nodules, r/o malignancy. LUNGS AND PLEURA: Subpleural reticular interstitial opacities and honeycombing predominantly at the lung bases. Bilateral subpleural calcifications are also basilar predominant and may represent asbestos exposure. Associated traction bronchiectasis and architectural distortion are also noted. These findings are again demonstrated on the prone views and are compatible with a UIP pattern, which may be idiopathic or secondary to specific etiologies such as mixed connective tissue disease or asbestos exposure. No significant air trapping is seen on expiration views. There are no centrilobular nodules or ground glass opacities. No focal air space opacity or pleural effusion is present. No suspicious pulmonary nodules or masses. Scattered calcified granulomata.Scattered areas of mosaic attenuation are likely secondary to diminished pulmonary vascularity. MEDIASTINUM AND HILA: Mildly enlarged right paratracheal and right hilar lymph nodes are likely reactive in etiology. Calcified hilar and mediastinal nodes are indicative of prior granulomatous disease. Mild cardiomegaly. Dense aortic and coronary arterial calcifications.CHEST WALL: Degenerative disease affects the visualized spine and glenohumeral joints.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered hepatic and splenic granulomata, otherwise no significant abnormality noted. | 1.Pulmonary findings are compatible with a UIP pattern as described above. This may be idiopathic or secondary to specific etiologies such as mixed connective tissue disease or asbestos exposure. 2.No suspicious pulmonary nodules/masses, ground glass opacities, or significant air trapping. |
Generate impression based on findings. | 56-year-old female, with peripheral T-cell lymphoma -- status post auto stem cell transplant. CHEST:LUNGS AND PLEURA: Postop changes are again seen in the right lung with the prior noted spiculated lesion in the right middle lobe decreasing in size and appearance now appearing mostly as groundglass density (series 6, image 50) measuring 0.8 x 0.7, previously 1.2 x 0.8 cm. A second. Reference lesion more cephalad (series 6, image 46) has also decreased in density and size and now measures 0.8 x 0.7, previously 0.9 x 0.8. No new nodules, infiltrates or masses are seen. No pleural abnormalities are seen.MEDIASTINUM AND HILA: Scattered small subcentimeter mediastinal lymph nodes are unchanged and no new or enlarged lymph nodes are seen.CHEST WALL: Right chest wall infusion port again seen with tip of catheter in the distal superior vena cava. No axillary adenopathy seen. No bony or other chest wall abnormalities seen.ABDOMEN:LIVER, BILIARY TRACT: No parenchymal liver lesions seen. Gallbladder wall thickening seen on prior examination as is often. The gallbladder now appears normal. No biliary tract abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small benign cysts are again seen bilaterally. No other abnormality seen.RETROPERITONEUM, LYMPH NODES: No lymph node enlargement seen. No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Stable postoperative appearance in the chest with resolving nonspecific two focal right middle lobe lesions being followed. 2. No evidence of lymphadenopathy in the chest, abdomen or pelvis. 3. Resolution of prior abnormal gallbladder wall thickening with a normal appearing gallbladder. Now. |
Generate impression based on findings. | Reason: eval for acute intrabd process History: pain and redness near j-tube entry site ABDOMEN:LUNG BASES: Postoperative changes of gastric pull up are noted with portion of a stent. Patchy consolidation of the right lower lobe parenchyma surrounding gastric pull up. LIVER, BILIARY TRACT: Hypodense lesions in the liver are again seen with the addition of new hypodense lesions, largest in the left hepatic lobe measuring 3.4 x 2.3 cm. Previously referenced segment two lesion measuring 3.0 x 2.8 cm is not as well demarcated and measures 2.8 x 2.6 cm. There are venous collaterals around the pancreatic head due to SMV thrombosis.SPLEEN: Splenic vein drains via collaterals.PANCREAS: Pancreas appears atrophic.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion in the upper pole of the left kidney, likely a renal cyst, stable compared to prior exam.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and the iliac arteries bilaterally. IVC filter.BOWEL, MESENTERY: J-tube terminates at the lumen of the bowel. There are no fluid collections around the J-tube. No bowel obstruction is evident.BONES, SOFT TISSUES: Moderate degenerative joint disease of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter within the bladder.LYMPH NODES: Few scattered inguinal lymph nodes bilaterally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.J-tube with tip in the lumen of the bowel. No surrounding fluid collections or abscesses.2.Interval increase in size of hepatic lesions with new hepatic lesions. |
Generate impression based on findings. | Reason: pseudocyst? History: h/o pancreatitis, etoh, now with hyperbili and aki ABDOMEN:LUNG BASES: Basilar scarring/atelectasis. Hiatal hernia.LIVER, BILIARY TRACT: Mildly lobular contour of the liver. Hepatic steatosis. No intra-or extra hepatic ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No CT evidence of pancreatitis, peripancreatic fluid collection, or pancreatic mass.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroid.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of biliary dilatation or pancreatitis.Fatty liver. Follow up is suggested |
Generate impression based on findings. | Female 59 years old; Reason: Eval for hematoma, pt with abd pain, AKI, abd hematoma. Eval for renal compression as well History: abd pain, PH pt on remodulin, now with AKI ABDOMEN:LUNGS BASES: Reticular nodular changes in the lung bases. Heart size is enlarged.LIVER, BILIARY TRACT: Liver has a nodular contour and is hyperdense. Several well marginated hypoattenuating lesions may represent cysts. No evident ductal dilatation. Gallbladder contains probable calculi.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hyperdense left upper pole subcentimeter renal lesion too small to characterize on noncontrast CT. No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Large left rectus hematoma. Hematoma measures 15 x 11 cm (image 76/series 3) previously, 13 x 11 cm.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: There is a nearly empty.LYMPH NODES: Small bilateral inguinal nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left rectus hematoma. Body wall skin thickening.OTHER: No ascites or intra-abdominal hematoma. | 1.Near stable size measurement of the left rectus muscle hematoma. |
Generate impression based on findings. | Prostate carcinoma CHEST:LUNGS AND PLEURA: Stable micronodulesMEDIASTINUM AND HILA: CardiomegalyCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Stable prominent adrenal glandsKIDNEYS, URETERS: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Stable reference portacaval lymph node best seen on image 101 series 3 measuring 2.3 x 1.6 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable mildly enlarged bilateral external iliac lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination |
Generate impression based on findings. | 37-year-old male with metastatic renal cell carcinoma, right supraclavicular lymph node. Evaluate for progression of disease on therapy. CHEST:LUNGS AND PLEURA: Micronodules seen some with high density indicative of prior granulomatous disease, which are unchanged. There is a new nodular ground glass density focus in the right lower lobe (series 5, image 65) measuring 5 mm, which is nonspecific in its appearance and could be inflammatory but should be followed on subsequent examinations. No other abnormalities are seen. No pleural abnormalities are noted.MEDIASTINUM AND HILA: Stable left supraclavicular adenopathy (series 3, image 4) measuring 2.6 x 2 .3 cm, previously 2.7 x 2 .4-cm. smaller right hilar lymph nodes are again seen with the. Reference lymph node (series 3, image 58), decreased in size and now measure 1.4 x 1.0 cm compared with 1.8 x 1.2 cm previously. No new foci of enlarged lymph nodes are identified.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left nephrectomy without evidence of tumor recurrence in the surgical bed. Right kidney shows no diagnostic abnormalities.RETROPERITONEUM, LYMPH NODES: Aortic caval lymph node mass has decreased in size (series 3, image 119) and now measures 2.8 x 1.5 cm compare with previous 4.3 x 2.8 cm.. No new lymphadenopathy is seen.BOWEL, MESENTERY: Due to limited intra-abdominal fat, the prior noted left omental conglomerate mass postero-laterally is difficult to separate from adjacent spleen and colon. Best measurement estimate (series 3, image 112) is 3.2 x 2 .2 cm, unchanged from prior measurement 3.2 x 2.1 cm. BONES, SOFT TISSUES: No change in the L1 and L2 vertebral body lytic lesions with peripheral sclerosis. No new lesions are identified.OTHER: No significant abnormality noteddPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noteddBLADDER: No significant abnormality noteddLYMPH NODES: No significant abnormality noteddBOWEL, MESENTERY: No significant abnormality noteddBONES, SOFT TISSUES: No significant abnormality noteddOTHER: No significant abnormality notedd | 1. Stable pulmonary, parenchymal micronodules most likely from prior granulomatous disease. 2. New nonspecific 5-mm groundglass density in right lower lobe, which may be inflammatory, but merits follow up on further examinations to exclude metastasis. 3. Stable supraclavicular, mediastinal and hilar lymph nodes. 4. Decreased size of aortocaval lymph node mass. 5. Stable appearance to lytic lesions in L1 and L2 vertebral bodies. 6. No change in appearance to the omental and peritoneal disease. |
Generate impression based on findings. | Metastatic uterine carcinoma CHEST:LUNGS AND PLEURA: Stable right upper lobe spiculated nodule best seen on image 27 of series 5 measuring 1.1 x 1.3 cm. Relatively stable right lower lobe referenced nodule best seen on image 58 of series 5 measuring 0.6 cm in diameter.No significant change in extensive left lung pleural and parenchymal abnormalities suggestive for lymphangitic spread of tumor. Emphysema again noted.MEDIASTINUM AND HILA: Stable enlarged and heterogeneous thyroid. Stable mediastinal lymph nodes. Reference right hilar lymph node best seen on image 39 of series 3 is unchanged measuring 1.5 x 1.2 cm.CHEST WALL: Extensive sclerotic bony metastatic lesions unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in extensive sclerotic bony metastatic lesionsOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absentBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination |
Generate impression based on findings. | Reason: eval acute intraabd process, ?appy History: 3 weeks RLQ abd pain, low grade fever, hx fibroids ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality noted,PANCREAS: No significant abnormality noted,ADRENAL GLANDS: Fat density left adrenal nodule, unchanged.KIDNEYS, URETERS: No significant abnormality noted,RETROPERITONEUM, LYMPH NODES: Left gonadal vein coil. Duplicated IVC. Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No evidence of appendicitis or bowel obstruction. No free intraperitoneal air, pneumatosis, or free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Progressive calcification of multiple uterine fibroids. Overall size of leiomyomatous uterus has decreased measuring 14.8 x 14.5 cm (series 4, image 100), previously 19.2 x 17.2 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of appendicitis.2.Interval decrease in size of leiomyomatous uterus. 3.Cholelithiasis without CT evidence of cholecystitis. |
Generate impression based on findings. | Metastatic melanoma CHEST:LUNGS AND PLEURA: Scattered micronodulesMEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without acute inflammation. No hepatic lesion. Hepatic vessels patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple right renal low attenuation foci; favor cysts.RETROPERITONEUM, LYMPH NODES: Mildly enlarged retroperitoneal lymph nodes. A representative right common iliac lymph node best seen on image 129 of series 8 measures 1.5 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Fat-containing umbilical herniaOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Fibroid uterus; 6.5 x 8.4 cm cystic lesion within the pelvis best seen on image 159 of series 8; favor left adnexal cyst with possible associated hydrosalpinx.BLADDER: No significant abnormality noted.LYMPH NODES: Mildly enlarged external iliac lymph nodes. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Mildly enlarged retroperitoneal and pelvic lymph nodes; nonspecific finding.Large pelvic cystic mass; favor left adnexal cyst with possible associated left hydrosalpinx. Fibroid uterus. |
Generate impression based on findings. | 71-year-old male with persistent leaking of urine from prior SPT tract (inferior to Indiana pouch.). Prior cystectomy. 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: Punctate calculus. Again seen in the upper pole of left kidney. Nonobstructing calyceal location. Small amount of residual contrast is seen in the renal pelvis, presumably from CT examination from 9/23/13. Air is again noted in the left urinary collecting system.Contrast material in the right renal calyceal and pelvis system and ureter are seen from reflux from the contrast administered into the Indiana pouch. This obscures the ability to visualize the prior noted calyceal calculi seen on prior examination. No evidence of extravasation of contrast is seen through the renal pelvis or ureter to the pouch. No perinephric fluid collections are seen and no renal masses are noted although lack of IV contrast limits evaluation. Benign cortical cysts are again seen in the right kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes are again seen. The Indiana pouch is noted in the right. Abdomen/pelvis, unchanged in appearance. It is well opacified from the contrast administered through the catheter through the ostomy. No evidence of extravasated contrast is seen out from the urinary neobladder to suggest leak. Specifically, the percutaneous track from the prior SPT catheter in the right lower abdomen/pelvis is well seen and no evidence of any extravasated contrast is seen in this location.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prior cystoprostatectomy without abnormality otherwise seen.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 | 1. No evidence of extravasation of contrast administered into Indiana pouch. No source for leak identified. |
Generate impression based on findings. | Neutropenia with history of appendicitis with cough CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Central line has been removed. Nonocclusive thrombus within the right brachiocephalic vein is noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No 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 significant abnormality noted.BOWEL, MESENTERY: No significant change in peri -appendiceal acute inflammatory soft tissue stranding and regional adenopathy. No abscessBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | CVP line has been removed. A small nonocclusive thrombus within the right brachiocephalic vein is present. No acute lung process.No significant change in periappendiceal acute inflammatory soft tissue stranding and regional adenopathy. No abscess. |
Generate impression based on findings. | Female 53 years old; Reason: patient with history of bladder cancer, s/p 4 cycles of chemotherapy. please assess for disease progression History: bladder cancer CHEST:LUNGS AND PLEURA: No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion no mediastinal lymphadenopathy.Thyroid isthmus nodule, unchanged by CT.CHEST WALL: Right chest wall port terminates at the cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenic hypodensities, nonspecific and unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Asymmetric moderate right hydronephrosis due to narrowing of the right distal ureter at its anastomosis (177/series 4) differential considerations include focal lesion or stenosis.The left kidney enhances homogeneously. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: The retroperitoneal lymph nodes have decreased in size. Reference left periaortic node measures 0.9 x 0.7 cm (image 109/series 4) previously, 1.8 x 1.2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: HysterectomyBLADDER: CystectomyLYMPH NODES: Pelvic nodal disease has decreased in size. A the reference left pelvic lymph node is difficult to measure and measures approximately 0.9 x 0.8 cm (image 165/series 4) previously, 2.6 x 2.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Significant decrease in the size of the retroperitoneal lymph adenopathy with target lesions measuring less than 1 cm.2.Persistent moderate right hydronephrosis due to obstruction at the level of the distal ureter which may be due to focal mass or stenosis |
Generate impression based on findings. | 62 year-old female with metastatic melanoma, known palpable disease and leg. A marker was placed along the anterolateral aspect of the knee at the level of the tibial plateau. Deep to this marker is a nodular mass of soft tissue density measuring approximately 3 x 1 cm in transverse dimension and 2 cm in craniocaudal dimension. Poorly defined soft tissue density within the subcutaneous fat anteromedial to the mass is noted and probably simply represents edema along the patellar tendon. Inferior and posterior to the mass is a second mass arising from the skin lateral to the proximal tibial epiphysis, measuring just approximately 13 x 5 mm in transverse dimension and approximately 1 cm in craniocaudal dimension. There is reticulation of the adjacent subcutaneous fat. I see no additional masses within the lower leg or foot. Moderate to severe osteoarthritis affects the knee and there is a small knee joint effusion with extension posteromedially into a tiny Baker's cyst. Osteoarthritic changes also affect the foot and ankle.Several additional nodular masses are seen within the subcutaneous fat of the anteromedial thigh. Two such masses are situated approximately 10 cm above the knee joint line, the more anterior of the two measuring approximately 14 x 9 mm in transverse dimension by 17 mm in cranial caudal dimension, and the more posterior of the two measuring approximately 16 by 10 mm in transverse dimension and 25 mm in craniocaudal dimension. Approximately 4 cm more superiorly is an additional nodular mass in the anteromedial subcutaneous fat measuring approximately 14 x 14 mm in transverse dimension by 23 mm in craniocaudal dimension. Approximately 5 to 6 cm more superiorly is yet another subcutaneous mass with a low-density center suggesting necrosis measuring approximately 16 x 12 mm in transverse dimension by approximately 20 mm in craniocaudal dimension. Mild reticulation of subcutaneous fat is noted adjacent to these various masses. There is an elongated left inguinal lymph node measuring approximately just over 3.5 cm in length but less than 1 cm in width, which is nonspecific and does not necessarily contain tumor. I see no deep masses nor do I see any lytic lesions within the bones. Moderate osteoarthritis affects the left hip. Please refer to the dictated report for the CT scan of the abdomen and pelvis for description of pelvic visceral findings. | Findings compatible with metastatic melanoma as described above. |
Generate impression based on findings. | Male 65 years old; Reason: Recurrent pancreas cancer please assess and provide index lesion measurements for RECIST History: As above CHEST:LUNGS AND PLEURA: No dominant lung lesion. The pleural spaces are clear. Left lower lobe pulmonary nodule (image 59/ ser 5) and right lower lobe granuloma unchanged. Right subcentimeter pulmonary nodule (image 67 series 5) not definitely previously present.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Vertebral body height loss at the T7/T8 vertebral bodies as well as the disk space, sequelae of prior diskitis/osteomyelitis.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver contour is smooth. Multiple bilobar hepatic metastatic lesions.Reference right hepatic lobe lesion measures 4.5 x 3.7 cm (image 75/series 3) previously, 3.9 x 3.8 cm.Reference left hepatic location measures 1.9 x 1.3 cm (image 72/series 3) previously, 1.9 x 1.7 cm.SPLEEN: Unchanged splenic vein occlusion with multiple collaterals.PANCREAS: Hypodense pancreatic body lesion and measures 1.2 x 1.2 cm (image 95/series 3) previously, 1.5 x 1.1 cm.There is retropancreatic soft tissue that extends into the region of the SMAADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive portacaval lymphadenopathy. Reference portacaval lymph node measures 1.9 x 1.1 cm (image 88/series 3) previously, 1.1 x 0.9 cm.Calcific arteriosclerotic disease of the aorta.Small retroperitoneal lymph nodes are have progressed.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Increase in the size of the liver lesions.2.Increase in the size of the portacaval lymphadenopathy. |
Generate impression based on findings. | 50 year-old male with generalized abdominal pain and signs of small bowel obstruction -- rule-out small bowel, malignancy or stricture. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No intrinsic abnormality is seen in the stomach. Since prior CT examination, there has been resolution of the prior noted disproportional dilatation of small bowel loops and clearing of the prior noted pseudo-feces sign in the distal small bowel which previously had an appearance of a small bowel obstruction. Today's examination shows no evidence of obstruction with normal caliber small bowel, extending through to the colon. No residual desiccated material is seen in the distal small bowel. There is some submucosal fat deposition in the distal terminal ileum and cecum, which indicates some inactive and prior history of inflammation, but no current evidence of abnormal thick wall or stricture.Colon shows predominantly fluid contents with scattered diverticular changes throughout, without evidence of diverticulitis. No evidence of any colon obstruction is seen with fluid extending to the rectumBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Since prior CT examination, there has been resolution of the prior noted disproportional dilatation of small bowel loops and clearing of the prior noted pseudo-feces sign in the distal small bowel which previously had an appearance of a small bowel obstruction. Today's examination shows no evidence of obstruction with normal caliber small bowel, extending through to the colon. No residual desiccated material is seen in the distal small bowel. There is some submucosal fat deposition in the distal terminal ileum, which indicates some inactive and prior history of inflammation, but no current evidence of abnormal thick wall or stricture.Colon shows predominantly fluid contents with scattered diverticular changes throughout, without evidence of diverticulitis. No evidence of any colon obstruction is seen with fluid extending to the rectum.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Resolution of the findings seen on 9/22/13 without signs today of small bowel obstruction. Terminal ilial and right colon submucosal fat deposition indicates prior history of inflammatory bowel disease, but without active inflammation at current time. |
Generate impression based on findings. | 66 year-old woman with cirrhosis and splenic artery aneurysm. Need for follow-up for evaluation. ABDOMEN:LUNG BASES: Unchanged atelectasis in the right lower lobe. LIVER, BILIARY TRACT: Postsurgical changes secondary to prior liver transplant.SPLEEN: The splenic aneurysm currently measures 3.4 x 2.0 cm, stable to slightly enlarged compared to the prior examination. However, on the 4/7/2011 examination, it measured 1.5 x 2.1 cm. It has clearly enlarged since that time and embolization in Interventional Radiology is indicated based on growth, size criteria (>2cm), and the fact that the patient is a liver transplant recipient (which places her at higher risk for rupture).Also noted are subcentimeter intrasplenic aneurysms.PANCREAS: Multiple small, cystic pancreatic lesions are again noted as described previously.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Rusher retained gastrojejunostomy tube noted with tip in the small bowel.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Slow-growing splenic artery aneurysm which meets numerous criteria as noted above for a prophylactic embolization. Consultation with Interventional Radiology is advised as clinical indicated.These findings were discussed with the clinical service (pager 6111) at the time of dictation. |
Generate impression based on findings. | Reason: lymph or venous impingement/obstruction causing bilateral LE edema. Has history of penile cancer, thought to be cured. History: bilateral LE edema, history of penile cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple scattered calcifications throughout the liver consistent with granulomata.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal mass, likely a myelolipoma, is unchanged in size, measuring 1.7 x 1.6 cm.KIDNEYS, URETERS: Hypodense renal cyst in the upper pole of the left kidney, unchanged and exam.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of aorta and bilateral iliac arteries. Mildly ectatic aorta remains unchanged. No lymphadenopathy or mass effect on the IVC.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Few benign appearing inguinal lymph nodes bilaterally.BOWEL, MESENTERY: Right inguinal hernia containing only mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No abnormalities to account for patient's symptomatology.2.Redemonstration of left adrenal myelolipoma, unchanged compared prior exam. |
Generate impression based on findings. | Clinical question: Evaluate for acute process. Signs and symptoms: altered mental status. Nonenhanced head CT:There is no evidence of an acute intracranial process. CT however, is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF, cisterns, and gray -- white matter differentiation. Midline is maintained.Unremarkable. Calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Evaluate fluid collection. Signs and symptoms: Fever, headache, history of Chiari decompression. Nonenhanced head CT:Examination demonstrates extensive postoperative changes of suboccipital craniectomy and removal of posterior arch of C1 for Chiari decompression.There is a large epidural fluid collection posterior to the thecal sac at the level of craniectomy measuring approximately 22 mm in AP axis and 63-mm in visualized portion of the fluid collection in craniocephalad axis. The inferior extent of the collection is beyond the field of this study. It measures approximately 52 mm in transverse axis.This collection demonstrates mass effect with complete effacement of subarachnoid space anteriorly and mild forward displacement of the cerebellum. This is a new finding since prior brain MRI from 7 -- 23 -- 13.The fourth ventricle remains a small home are unchanged since prior MRI exam.Unremarkable images through the supratentorial space and with normal size of ventricular system as most maintained midline. | 1.Large pseudomeningocele at the level suboccipital craniectomy with resultant mass-effect and slight forward displacement of cerebellum and effacement of subarachnoid space at the level of foramen magnum.2.Normal size of ventricular system and maintained midline.3.Unremarkable intracranial contents otherwise. |
Generate impression based on findings. | Reason: stone History: severe sudden left abd pain with radiation to left leg ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted. Surgical clips noted in the gallbladder fossa, status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Calcified stones within the left lower pole. The left kidney is enlarged compared to the right, and slightly larger than on prior exam with associated perinephric fat stranding. No identified calcifications within the ureters. No hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Umbilical hernia containing only fat.PELVIS:UTERUS, ADNEXA: Prominent uterus with intrauterine fluid is again visualized. Lack of change over several years comparing to prior exams favors benign etiology but cervical stenosis cannot be ruled out.BLADDER: Foley catheter within a collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Renal calculi within the lower pole of the left kidney are again visualized. No obstructing stones or hydroureter is noted.2.Slightly enlarged left kidney with perinephric stranding. In the absence of IV contrast, these findings may represent pyelonephritis or sequelae after passing of an obstructed renal calculus. |
Generate impression based on findings. | Clinical question: Rule-out intracranial hemorrhage, versus lesion. Signs and symptoms: HIV, CD4 160. Nonenhanced head CT:There is no detectable acute intracranial process. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF, cisterns, and gray -- white matter differentiation. In comparison with prior MRI from March of 2013 is no appreciable interval change.Calvarium is intact.Images through the orbits are unremarkable.All paranasal sinuses, bilateral mastoid air cells, and middle ear cavities are well pneumatized and unremarkable. | Negative nonenhanced head CT. |
Generate impression based on findings. | Reason: Rule out pancreatitis History: epigastric pain, n/v ABDOMEN:LUNG BASES: Basilar atelectasis. No pleural effusions.LIVER, BILIARY TRACT: Hypoattenuating focus on the major interlobar fissure consistent with a focal perfusion defect. Status post cholecystectomy. Common bile duct is dilated, increased from prior exam. New mild intrahepatic biliary ductal dilatation.SPLEEN: The spleen is surgically absent.PANCREAS: The distal body and tail are surgically absent. There is evidence of prior cyst-gastrostomy. There is slight enlargement of the pancreatic head measuring 4.1 cm, previously measuring 3.1 cm (series 3, image 51). Mild peripancreatic soft tissue density compatible with postsurgical scarring. No evidence of fluid collections. The splenic vein is absent. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. No pneumatosis, intraperitoneal free air, or free fluid in the pelvis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status post distal pancreatectomy/splenectomy without CT evidence of pancreatitis -- the pancreas commonly appears normal in mild pancreatitis. 2.Slight enlargement of the pancreatic head and increased biliary ductal dilatation compared to the prior exam without acute findings, likely reflect events that occurred between the prior CT examination and the current examination. |
Generate impression based on findings. | Acute mental status change. Rule out intracranial hemorrhage. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.Orbits, paranasal air sinuses and mastoid air cells are unremarkable. There is a degree of calvarial hyperostosis with multiple punched-out lucent lesions demonstrated (for example series 5 image 16), several of which were not demonstrated on the exam one year prior. | No intracranial animality demonstrated. Hyperostosis and multiple lucent lesions of the calvarium were not demonstrated one year prior which most like they represent sequelae of myeloma. |
Generate impression based on findings. | Male, 53 years old, history cancer, status post CRT. Surgical change consistent with supraglottic laryngectomy is redemonstrated. Asymmetric soft tissue thickening along the region of the left aryepiglottic fold including the lateral and posterior aspects of the supraglottic mucosa remains unchanged, likely related to surgery.Erosive change involving the right aspect of the hyoid bone is also stable. The thyroid cartilage continues to appear heterogeneous, unchanged.Within this surgically altered background, no new soft tissue mass or suspicious enhancement is seen. No pathologic adenopathy is identified by size criteria.The salivary glands and thyroid are within normal limits. The cervical vessels remain patent. Lung apices show no significant abnormality. No concerning bony lesions are detected. | Stable post surgical and treatment related change in the neck. No evidence of recurrent primary tumor or pathologic adenopathy. |
Generate impression based on findings. | 5-year-old female. Hematuria. Status post fall. Evaluate for renal hematoma/laceration. ABDOMEN:LUNG BASES: Lung bases are clear.LIVER, BILIARY TRACT: Normal appearance of the liver.SPLEEN: Normal appearance of the spleen.PANCREAS: Normal appearance of the pancreas.ADRENAL GLANDS: Normal appearance of the adrenal glands. KIDNEYS, URETERS: Symmetric enhancement of both kidneys with no evidence of laceration or hematoma. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber of the bowel. The duodenojejunal junction is normally positioned.BONES, SOFT TISSUES: Normal appearance of the bones. OTHER: No free fluid.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Normal appearance of the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber of the bowel.BONES, SOFT TISSUES: Normal appearance of the bones.OTHER: No free fluid. | No evidence of solid organ injury. Normal appearance of both kidneys. |
Generate impression based on findings. | 82-year-old female with e. coli bacteremia --? Source of infection. ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits evaluation of solid parenchymal organs and vascular structures, the following observations can be made:LUNG BASES: Atelectasis at both lung bases no abnormality seen in the left base -- there may be a small pleural effusion on the right.LIVER, BILIARY TRACT: No parenchymal liver abnormalities seen within limits of non-IV contrast enhanced examination. Gallbladder and biliary tract show no abnormalities.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic left kidney compared with larger right kidney. Neither kidney shows a large mass lesions. The lack of IV contrast limits ability to evaluate. Mild fullness to the right renal pelvis is seen without significantly dilated ureters seen - without IV contrast. Complete evaluation. This potential for proximal ureteral obstruction cannot be undertaken. No perinephric fluid collections are seen.. No evidence of any stone disease is seen.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of abnormality in the stomach, small bowel, with rapid transmission of orally administered contrast. Colon is filled with feces throughout -- there is extensive diverticular changes in the descending colon and sigmoid colon, but without complication to suggest diverticulitis. No free peritoneal fluid is seen. No loculated fluid collections noted.BONES, SOFT TISSUES: Diffuse subcutaneous edema.OTHER: Focal aneurysmal dilatation of the right common iliac artery is seen to maximum diameter of 2.8 cm (series 3, image 84). No other abnormalities are seen in the aorta or iliac arteries, however, lack of IV contrast limits ability to evaluate this.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of abnormality in the small bowel, with rapid transmission of orally administered contrast. Colon is filled with feces throughout -- there is extensive diverticular changes in the descending colon and sigmoid colon, but without complication to suggest diverticulitis. No free peritoneal fluid is seen. No loculated fluid collections noted.BONES, SOFT TISSUES: Diffuse degenerative changes in the bony skeleton without focal abnormality seen.OTHER: Focal aneurysm of the right common iliac artery to maximum diameter of 2.8 cm. | 1. No definite source of infection seen in the abdomen or pelvis. 2. Moderate fullness to the right renal collecting system without dilated ureter -- this may represent a long-standing U-P disproportion and not be of consequence -- clinical correlation and comparison with any prior available imaging studies could be helpful. This may merely represent increased volume to right kidney with the atrophic left kidney. 3. Right common iliac artery aneurysm diameter of 2.8 cm. |
Generate impression based on findings. | Pneumonia scan CXR please eval. Chronic airway obstruction. LUNGS AND PLEURA: Severe emphysema with interval development of dependent fluid and wall thickening within pre-existing cystic air spaces, septal thickening and ground glass opacity throughout the right lung but predominantly within the right lower lobe. Interval enlargement of the a subpleural lymph node on the right (647). In addition, there are several solid nodules within the left lung which are unchanged. New area of subsegmental atelectasis in the left upper lobe. In the periphery of the lungs bilaterally, subpleural ossification and traction bronchiectasis is noted consistent with fibrosis. MEDIASTINUM AND HILA: Interval development of mild bilateral mediastinal and right hilar lymphadenopathy since the previous examination. For reference a right hilar lymph node measures 12 mm in short axis (4/51). Calcified right hilar lymph nodes may be the result of healed granulomatous infection, pre-present previously. Moderate coronary artery calcifications. Normal heart size. No pericardial fluid.CHEST WALL: Mild degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating hepatic lesions is incompletely assessed basilar paste technique at most likely reflect cysts. Subcentimeter lesions are too small to accurately characterize. Cholelithiasis. | Diffuse and groundglass opacity associated with interstitial thickening and fluid within pre-existing bullae in the right lung most compatible with pneumonia. Six-week follow-up plain films recommended to assess for resolution. Pulmonary nodules in the left lung are unchanged and likely post infectious/post inflammatory. Interval development of lymphadenopathy, most likely reactive. |
Generate impression based on findings. | Clinical question: Evaluate for stenosis/narrowing. Signs and symptoms: Upper extremity weakness. CT of cervical spine:The alignment. The vertebral column is anatomical.There is mild degenerative disk disease present.There is no evidence of fracture.There is no convincing evidence of central spinal stenosis. However, CT is insensitive for evaluation of spinal stenosis.Minimal left neural foraminal compromise at C3 -- C4 and C4 -- C5 is noted and unremarkable. At the other levels.No detectable paraspinal soft tissue abnormalities. | With the exception of minimal degenerative changes nonenhanced CT of cervical spine remains within normal limits. |
Generate impression based on findings. | Acute mental status change. The current ossification of vertebral and cavernous carotid arteries bilaterally. The study focus of hypoattenuation posterior aspect the right cerebellar hemisphere representing sequelae of a chronic right pica stroke (axial se 4 im 6) No intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.Orbits, paranasal sinuses and mastoid air cells are unremarkable. | Unchanged examination. No acute intracranial pathology demonstrated. |
Generate impression based on findings. | Reason: eval adrenal mass, liver masses, diagnosed with primary adrenal mass with likely liver mets at osh History: abd pain, htn, hypercortisolism ABDOMEN:LUNG BASES: Small right pleural effusion with overlying compressive atelectasis. No suspicious pulmonary nodules or masses.LIVER, BILIARY TRACT: Multiple bilobar heterogeneously enhancing masses in the liver measuring up to 11.9 x 11.2 cm in the right hepatic lobe (series 9, image 23). The intrahepatic IVC and right hepatic vein are compressed and deviated. Enlarged periportal lymph node measures 1.8 x 1.6 cm (series 9, image 45). The gallbladder is contracted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Large heterogeneously enhancing right adrenal mass measures 6.4 x 2.2 cm (series 9, image 42). The mass abuts the IVC posteriorly without definite evidence of direct invasion.KIDNEYS, URETERS: Nonspecific left upper pole hypodense focus. Nonobstructive calculus in the left lower pole. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Couple small retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the abdomen and pelvis. No loculated fluid collections.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Probable primary adrenal malignancy with hepatic metastases, although large masses such as this can be difficult to differentiate liver primary tumor invading adrenal gland. 2.Enlarged periportal lymph node.3.Small amount of free fluid in the pelvis is nonspecific. |
Generate impression based on findings. | Male, 79 years old, paralysis agitans, status post placement of deep brain stimulator. Early postoperative change is demonstrated including right scalp swelling and subcutaneous air and creation of a right coronal burr hole through which traverses a stimulator lead. This lead courses inferiorly and posteriorly through the frontal lobe to terminate within the right thalamus. Pneumocephalus along the frontal lobes is an expected postoperative finding.No large extra-axial fluid collections, parenchymal hemorrhage, edema or mass effect is detected. The ventricular system is patent and within normal limits for size. A band of lipomatous tissue is redemonstrated coursing along the body and splenium of the corpus callosum. | Expected postsurgical findings following placement of a right-sided deep brain stimulator lead. |
Generate impression based on findings. | Reason: eval for sbo History: abd pain. no flatus or bm. hx of sbo ABDOMEN:LUNG BASES: Minimal bibasilar atelectasis.LIVER, BILIARY TRACT: Calcified gallstone within the gallbladder neck. Few scattered calcifications in the right lobe of the liver, segment 5.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific soft tissue density mass in the left adrenal gland measuring 2.1 x 1.5 cm. Normal right adrenal gland.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted. A few scattered subcentimeter lymph nodes.BOWEL, MESENTERY: Dilated loops of proximal and mid small bowel with air-fluid levels measuring up to 5.5 cm in diameter. There is evidence of desiccated material near the transition point to collapsed distal small bowel that simulates feces. These findings are consistent with small obstruction. The transition point is noted in the low midabdomen upper pelvis with distal collapsed loops of small bowel and colon.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: Dilated loops of proximal and mid small bowel with air-fluid levels measuring up to 5.5 cm in diameter. There is evidence of desiccated material near the transition point to collapsed distal small bowel that simulates feces. These findings are consistent with small obstruction. The transition point is noted in the low midabdomen upper pelvis with distal collapsed loops of small bowel and colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Findings most consistent with small bowel obstruction with distal collapsed bowel.2.Left adrenal mass with soft tissue density is nonspecific. |
Generate impression based on findings. | Lethargy. Rule out intracranial hemorrhage or traumatic injury. No intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is appropriate for the patient's age and the midline is intact. The orbits, sinuses and mastoid air cells are unremarkable. There are no displaced fractures demonstrated. | No abnormality demonstrated. |
Generate impression based on findings. | Reason: 55 male with AML, neutropenia, r/o pulmonary infiltrate. Recent probable fungal pneumonia found on CT History: recent fungal pneumonia seen on CT last week LUNGS AND PLEURA: Increasing groundglass opacities in the right lower Landman with accompanying bronchial wall thickening and mild bronchiectasis represent recurrent infection/aspiration.Areas of scarring/discoid atelectasis are also noted in both lower lobes.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal.Small pericardial effusion increased since the prior exam.CHEST WALL: Left PICC line with its tip in left subclavian vein.Sclerotic foci in the right seventh rib compatible with a bone island.Gynecomastia.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Increasing groundglass opacities in the right lower lobe with bronchial/bronchiolar wall thickening and bronchiectasis compatible with recurrent infection/aspiration.2.New small pericardial effusion . |
Generate impression based on findings. | Male, 79 years old, history of oral cavity cancer, recurrent. Extensive chronic postsurgical change is redemonstrated. This includes partial right hemimandibulectomy, right hemiglossectomy, and resection of the right submandibular gland. Interval new surgical change is also demonstrated including revision of the myocutaneous flap bridging the extensive surgical defects noted above. This flap now completely covers the mandibular osteotomy which was previously exposed to air. A small amount of additional mandibular bone has probably also been taken.A band of low density soft tissue thickening is seen along the buccal surface of one of the patient's pre-existing flaps. It is uncertain if this reflects the site of cancer recurrence. This region measures 2.3 x 1.0 cm on the present study (image 34 series 5), and previously measured 2.6 x 1.6 cm. No such finding was present on a more remote examination dated 04/22/13.Within this extremely altered background, and accounting for streak artifact which obscures some parts of the oral cavity, no definite new soft tissue mass or pathologic enhancement is seen. No pathologic adenopathy is detected in the neck by size criteria.The cervical vascular structures remain patent, though there is extensive atherosclerotic calcification at the level of the carotid bifurcations. The residual salivary glands and thyroid are within normal limits. A tracheostomy tube is in stable position. Small subcutaneous nodule adjacent to the manubrium is stable at 9 x 7 mm.Dedicated chest CT will be reported separately.Extensive degenerative changes are demonstrated in the cervical spine. No concerning bony lesions are detected.Limited intracranial views are unchanged. This includes mucosal thickening affecting the right greater than left maxillary sinuses. | Interval surgical change consisting of revision of the right neck myocutaneous flap which now completely covers the mandibular osteotomy bed.A band of low density soft tissue thickening is seen along the right buccal space which is smaller than on the prior preoperative study. It is not clear if this represents the site of tumor recurrence. No definite new masses or pathologic adenopathy are seen on the present examination.Extensive chronic surgical and treatment related change is redemonstrated in the right neck as above. |
Generate impression based on findings. | Vertigo following a fall. Rule out mass/bleed. A there is a degree of sulcal and ventricular prominence most like representing age related change. There is patchy ill-defined periventricular/subcortical white matter hypoattenuation which most often represent sequelae of chronic small vessel ischemic disease. There is calcification of the cavernous carotids and vertebral arteries bilaterally with a focus of encephalomalacia at the right posterior temporal lobe representing sequela of an old MCA stroke. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white differentiation is maintained bilaterally and the midline is intact. The orbits are unremarkable. There is opacification of a few scattered mastoid air cells bilaterally and left maxillary sinus a nonaggressive appearing bony lesions. | Atherosclerotic disease with an old right MCA stroke without evidence of acute ischemia or acute intracranial pathology. |
Generate impression based on findings. | Loss of consciousness, potentially seizure. Assess for intracranial pathology. Ventricles and sulci are slightly prominent, though have not significantly increased since prior exams. There is no acute intracranial pathology including mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. There is a chronic lower fracture of the left medial orbital wall with a small focus of fat herniating into one of the lateral right sided ethmoid air cells (series 3 image 10). There is soft tissue density implying bilateral maxillary sinus disease and scattered opacification of mastoid air cells bilaterally. | No acute intracranial pathology. Incidental note of maxillary sinus disease and a chronic left orbital blowout fracture of the medial wall. |
Generate impression based on findings. | Reason: t ALL with relapse in CSF/ baseline evaluation prior to PSCT History: none LUNGS AND PLEURA: No is a subcentimeter nodule is identified throughout the lungs are a bronchovascular distribution.Patchy ground glass opacities identified in the upper lung zones.There is elevation of the right hemidiaphragm with basilar atelectasis..No pleural effusions. MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size normal evidence of pericardial effusion.CHEST WALL: No axillary lymphadenopathy.Left PICC line with its tip in the SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis without evidence of cholecystitis. Splenomegaly. | Numerous subcentimeter pulmonary nodules in a bronchovascular distribution suggesting this may be secondary to this patient's lymphoproliferative disorder. Atypical infection cannot be excluded. |
Generate impression based on findings. | CVA. There is sulcal and ventricular prominence which is prominent for the patient's age, though which has been stable in configuration since an examination in 2011. There is no acute intracranial pathology including mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. Imaged portions of the orbits and paranasal sinuses are unremarkable. There are no aggressive appearing bone lesions or fractures. | Stable prominence of sulci and ventricles relative to patient age. No acute intracranial pathology. |
Generate impression based on findings. | Signs of myasthenia gravis evaluate for thymoma. Generalized weakness. LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No masses or nodules in the thymic bed.CHEST WALL: Nonspecific subcentimeter hypoattenuating lesion in the left thyroid lobe which may contain a small calcification (3/1), nonspecific and incompletely evaluated by CT.15 x 12 mm lytic lesion in the T3 vertebral body posteriorly ( sagittal series, image 48, 5/19 on the axial images). This lesion has an irregular sclerotic margin anteriorly with loss of the posterior vertebral body cortex which would be atypical for hemangioma (5/19). However, the posterior contour of the lesion is convex which would be atypical for malignancy. Punctate focal sclerosis in the T1 vertebral body is too small to accurately characterize.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Subcentimeter hypoattenuating lesion in the right hepatic lobe (3/87) is too small to characterize, nonspecific. | 1. Indeterminate lytic-appearing lesion in the T3 vertebral body of unclear etiology. Recommend thoracic spine MRI for further characterization. Differential considerations include metastasis or possibly atypical hemangioma. Infection may be considered in the appropriate clinical context as a diagnosis of exclusion.2. No signs of thymoma or other acute abnormality.3. Punctate nonspecific lesion in the left thyroid gland too small to characterize by CT. |
Generate impression based on findings. | Male; 68 years old. Reason: mesothelioma, s/p pleurectomy decortication 1 month ago. please evaluate for residual disease and provide target lesions if any are available. CHEST:LUNGS AND PLEURA: Postsurgical changes compatible with interval pleurectomy, decortication, and removal of right pleural tumor. There is resultant right lung volume loss and mild compensatory expansion of the left lung. Diaphragmatic mesh is located along and replaces the right pericardium. The left lung is otherwise unremarkable. Mild right basilar atelectasis and residual pleural gas are noted. The parenchymal surface of this gas collection appears thickened and minimally nodular which is nonspecific, but this finding is most compatible with scarring and/or adjacent atelectasis considering that the pleural border is smooth.MEDIASTINUM AND HILA: Extension of tumor into the mediastinum is no longer noted. No significant hilar or mediastinal adenopathy is appreciated. Heart size is normal. There is no pericardial effusion.CHEST WALL: Mild degenerative changes in the visualized spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small accessory splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: See above.OTHER: No significant abnormality noted. | 1.Postsurgical changes compatible with pleurectomy, decortication, and removal of right pleural tumor.2.No definite evidence of residual or metastatic disease. 3.Residual right pleural gas with minimally thickened and nodular border, most compatible with adjacent scarring/atelectasis as detailed above. |
Generate impression based on findings. | Male; 66 years old. Reason: Please eval for brain mets History: AMS, h/o cancer Mild global parenchymal volume loss with ex vacuo dilatation of the ventricular and sulcal CSF spaces, commensurate for the patient's age. The ventricles are symmetric in configuration. No abnormal mass lesions or abnormal intracranial enhancement. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Redemonstration of extensive deep white matter and periventricular hypoattenuation, most likely due to age-indeterminate small vessel ischemic change.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The calvarium is intact. | 1. No abnormal mass lesions or abnormal intracranial enhancement.2. Extensive white matter hypoattenuation is similar to prior exam and most likely due to age-indeterminate small vessel ischemic change. |
Generate impression based on findings. | 55 year old male, Reason: with hyperaldosteronism, evaluate for adenoma vs hyperplasia History: as above ABDOMEN:LUNG BASES: 4 mm subpleural nodule in the right middle lobe (series 7, image 1). Basilar atelectasis. Cardiac enlargement.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Nonspecific peripheral splenic hypodensity. Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: The adrenal contours are smooth and normal. No adrenal enlargement or mass.KIDNEYS, URETERS: Nonspecific right mid pole hypodense focus likely represents a simple cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis. Mildly prominent mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Normal adrenal contours without enlargement or mass. |
Generate impression based on findings. | Reason: 73 year old female with low-grade B cell NHL of the small bowel. Compare to prior scan. History: None Lack of intravenous contrast was evaluation of lymph nodes, mediastinum, and solid organ pathology.CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No significant lymphadenopathy. Moderate triple vessel coronary calcification. Heart size is normal. No pericardial effusion. Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal adenoma.KIDNEYS, URETERS: Atrophic kidneys.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Short segment circumferential wall thickening of a left lower quadrant small bowel loop with mild aneurysmal dilation of the lumen (coronal image 98, axial image 144) is new since recent prior examinations, but in a distribution is similar to that seen on the 2008 CT examination when original small bowel involvement identified.. Enlarged regional mesenteric lymph nodes measuring up to 3.1 x 1.8 cm (series 3, 150) are now seen in this region, slightly larger than on prior examinations.BONES, SOFT TISSUES: Anterior abdominal wall mesh.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Surgically absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | New short segment circumferential wall thickening of a left lower quadrant small bowel loop with enlarged regional mesenteric lymph nodes. Findings are consistent with recurrent lymphoma of the small bowel. |
Generate impression based on findings. | Tonsil cancer . Baseline exam. CHEST:LUNGS AND PLEURA: A solitary large benign appearing calcific density with associated deformity suggesting scarring is observed in the right upper lobe peripherally. Old prior granulomatous disease exposure. Other than scattered mild central lobular emphysema, greater in both apices, no superimposed additional pulmonary abnormalities. Specifically no findings to suggest metastatic disease or effusions.MEDIASTINUM AND HILA: Small scattered cysts throughout the thyroid, partially visualized. Please correlate with pending neck CT study.No lymphadenopathyThe cardiac and pericardium are within normal limits.Questionable small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No acute abnormalities identified within this limited view of the upper abdomen. A large irregular benign appearing calcification is observed in the spleen, likely old granulomatous disease exposure and/or prior trauma. | Old granulomatous disease exposure observed in the right upper lobe and spleen. No superimposed acute abnormality or findings to suggest metastatic disease |
Generate impression based on findings. | Reason: pt with recurrent cancer of HNC please reeval History: as above CHEST:LUNGS AND PLEURA: Upper lobe predominant centrilobular emphysema.New small focal subpleural area of groundglass opacity in the right upper lobe most likely related to aspiration.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Left chest port with catheter tip in the SVC.Tracheostomy in place.New tissue density along the right lateral wall of trachea may represent adherent mucous.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Severe coronary artery and aortic calcification.CHEST WALL: Extensive degenerative changes with mild dextroscoliosis throughout the thoracic spine. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable intrahepatic and extrahepatic biliary dilatation. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic changes of aorta its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.NG tube in place.BONES, SOFT TISSUES: Severe degenerative changes and changes of degenerative disk disease.OTHER: No significant abnormality noted. | No interval change without evidence of metastatic disease. |
Generate impression based on findings. | Non-small cell lung cancer, follow-up CHEST:LUNGS AND PLEURA: Grossly similar right middle lobe mass with large central areas of decreased attenuation suggesting necrosis. When measured in similar fashion, and oblique measurement remains 6.2 cm (image 48 series 3). Increased peripheral right particular and traction bronchiectasis again suggest radiation fibrosis and associated consolidation and obstructive changes. Again no effusion yet stable appearing pleural thickening both laterally and posteriorly. No new superimposed suspicious pulmonary findings, specifically no nodules or masses. Left lung remains clear.MEDIASTINUM AND HILA: Borderline mediastinal lymph nodes remain unchanged, multiple visualized solitary nodes are stable.Severe coronary calcifications without additional coronary or pericardial abnormality. Specifically the pericardial effusion has resolved. Heavy descending aortic calcificationsCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. Extensive aortic and branch atherosclerotic diseaseBOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable right middle lobe mass with peripheral changes suggesting associated adjacent radiation fibrotic change |
Generate impression based on findings. | Lung cancer, status post 10 cycles of chemotherapy. Please compare CHEST:LUNGS AND PLEURA: Unchanged left lower lobe nodule adjacent to the descending thoracic aorta remains 1.2 x 1.7 cm (image 55 series 5). Immediately adjacent mild minimal subsegmental atelectasis within the superior segment left lower lobe is also stable and may represent an element of post radiation change and/or scarring. No new screw post surrounding abnormality or other findings in either lung to suggest nodules or masses. Only minimal basilar atelectasis observed. No effusions.MEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are within normal limitsCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable and unchanged left lower lobe nodule without new superimposed changes or abnormalities. Reference measurements provided |
Generate impression based on findings. | Reason: severe asthma History: SOB, Wheezing, cough, excessive mucous production LUNGS AND PLEURA: Severe motion limits sensitivity.There does appear to be bronchial wall thickening diffusely.No air space opacities are suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Mild coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Motion severely limits the exam. There is mild bronchial wall thickening which may be related to reactive airway disease. No significant pulmonary abnormalities noted. |
Generate impression based on findings. | Clinical question: Follow-up on hemorrhage. Signs and symptoms: Altered, loss of consciousness. Nonenhanced head CT:There is no evidence of new hemorrhage since prior exam.Large acute hematoma in the left thalamus is again identified. It measures approximately 40 times 20 mm in size compared to prior measurement of 26 x 42. The edge of the hematoma is poorly defined, likely representing breakdown of hematoma. Surrounding vasogenic edema demonstrates no significant change in overall mass effect and midline shift to the right remains fairly similar to prior exam and measures at approximately 8-mm.There is interval decreased blood in the lateral ventricles, and very minimal residual blood is however, still present.Mildly dilated right lateral ventricle and smaller left lateral ventricle appears similar in size to prior study.Fairly extensive periventricular and subcortical low attenuation white matter remain similar to prior study and representing extensive age indeterminate small vessel ischemic stroke.Revisualization of severe dolichectatic basilar artery. | 1.No evidence of new hemorrhage since prior exam. CT however, is insensitive for detection of acute ischemic strokes.2.Slightly smaller left thalamic acute hemorrhage, as detailed above.3.Stable overall, mass effect by hematoma since prior exam, with approximately 8mm midline shift.4.Stable size of ventricular system and the decreased intraventricular hemorrhage since prior study..5.Extensive, age indeterminate, small muscle ischemic strokes, as detailed. |
Generate impression based on findings. | Reason: Evaluate for evidence of diverticulitis. History: Left lower quadrant pain greater than right lower quadrant pain for 3 weeks. ABDOMEN:LUNG BASES: Sternotomy wires. No significant abnormality noted.LIVER, BILIARY TRACT: Linear hyperdensity along the dependent portion of the gallbladder is most likely layering of gravel stones although focal calcification of the gallbladder wall cannot be ruled out. No evidence of gallbladder wall thickening or ductal dilatation. Small area of focal portal venous flow sparing around the fissure of the ligamentum teres.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Minimal atherosclerotic calcifications of the aorta and bilateral iliac arteries.BOWEL, MESENTERY: Stomach and small bowel appear normal. Colon is feces filled, with extensive diverticular changes seen in descending and sigmoid colon, without signs to suggest diverticulitis or showing any adjacent inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Extensive diverticular changes of the sigmoid colon and distal descending colon without evidence to suggest diverticulitis --- no focal wall thickening or adjacent fluid or mesenteric inflammatory changes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Extensive confluent diverticular changes without any evidence of complication to suggest diverticulitis. |
Generate impression based on findings. | Lung cancer and status post chemotherapy and radiation treatment. CHEST:LUNGS AND PLEURA: Interval resolution of the previously described minimal effusion. Associated mild questionable enlargement of the posterior right upper lobe nodule (image 36 series 5) currently measuring 8 x 7 mm prior measurement of 3 x 4 mm. When compared to prior studies, the interval change may be less pronounced given differences in volume averaging, however distinct enlargement and associated fullness is currently observed. Small associated satellite nodules are seen superiorly with minimal spiculation.Diffuse marked to severe centrilobular emphysemaMEDIASTINUM AND HILA: No lymphadenopathyThe cardiac and pericardium are within limits. Minimal aortic arch atherosclerotic disease.Stable appearing ill-defined mild soft tissue density the intermedius time suggesting residual thymus.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable minimal cholelithiasis. Liver otherwise unremarkableSPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst, unchanged. Right kidney unremarkablePANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Concern for increased size of the right upper lobe posterior nodule with reference measurements provided. Although possibly artifact, appearance is suggestive of recurrence or possibly a new lung primary. Consider close follow-up even PET imaging |
Generate impression based on findings. | 41-year-old female with sarcoidosis and large B-cell non-Hodgkin lymphoma in remission after chemotherapy. Compare to prior scans. CHEST:LUNGS AND PLEURA: No nodules, masses or infiltrates. No pleural abnormalities are identified.MEDIASTINUM AND HILA: No significant lymph node enlargement is seen in the mediastinum. The prior referenced right hilar post vena cava lymph node (series 3, image 35) measures 0.7 x 0 .5 cm, previously 0.8 x 0.9 cm. No new areas of lymph node enlargement are seenCHEST WALL: Left chest wall port has been removed. No abnormalities are seen in the axilla or chest wall.ABDOMEN:LIVER, BILIARY TRACT: No significant lesion is seen in the liver parenchyma -- the prior noted. Subcentimeter nonspecific hypodensity in segment 7 is unchanged. No new or suspicious liver lesions are seen. Hepatic venous, and portal venous structures all appear normal.Gallbladder and biliary tract appear normal.SPLEEN: Slightly prominent spleen size again seen, unchanged without focal lesion.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No enlarged lymph nodes seen. No retroperitoneal abnormalities noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: IUD unchanged with expected position and appearance. No other abnormalities in the uterus. Physiologic appearing cystic changes are noted in the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged lymph nodes seen..BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Continued decrease in size of mediastinal/hilar lymph nodes with now only normal-sized small lymph nodes seen as measured above. 2. No abdominal/pelvic lymphadenopathy or other significant abnormality seen. |
Generate impression based on findings. | Reason: eval for interstitial lung disease; rheumatoid arthritis with chronic methotrexate use History: new crackles on exam and new cough LUNGS AND PLEURA: There is a nodule (image 17 series 4) now measures 4 mm x 4 mm previously measuring 5 mm.No predominant centrilobular emphysema.Several micronodules along the fissures are unchanged and most likely represent intrapulmonary lymph nodes.Mild basilar pleural thickening similar in appearance to prior exam.No new suspicious pulmonary nodules or masses.No evidence of interstitial lung disease.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Mild cardiac enlargement without evidence of a pericardial effusion.Mild coronary artery calcification.CHEST WALL: Stable minimally prominent axillary and internal mammary lymph nodes.Degenerative changes in the thoracic spineUPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No interval change. No new suspicious pulmonary nodules or masses. No evidence of interstitial lung disease. |
Generate impression based on findings. | Reason: possible pseudocyst History: same Lack of intravenous contrast limits evaluation of lymph nodes, mediastinum, and solid organ pathology.ABDOMEN:LUNG BASES: Moderate pericardial effusion. Basilar consolidation/scarring. Right base granuloma. No pleural effusions.LIVER, BILIARY TRACT: Mild intra-and extrahepatic biliary ductal dilatation, unchanged. Left hepatic lobe granuloma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive right upper pole stone. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta without aneurysmal dilatation. Mildly prominent periaortic lymph nodes.BOWEL, MESENTERY: VP shunt catheter terminates in the right hemi-abdomen. There is an increasing simple fluid collection loculated around the coiled catheter tip measuring 3.5 x 3.4 x 6.6 cm (axial image 62, coronal image 61). Large duodenal diverticulum.BONES, SOFT TISSUES: Degenerative changes at L4/5.OTHER: Percutaneous gastrostomy tube is in place.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increasing loculated simple fluid collection around VP shunt catheter tip compatible with a CSF pseudocyst. 2.Mild intra-and extrahepatic biliary ductal dilatation, unchanged. 3.Moderate pericardial effusion. |
Generate impression based on findings. | Reason: evaluate for uteteral stone History: severe right flank pain ABDOMEN: Within the limitations of a non-IV contrast enhanced examination which limits evaluation of solid organ parenchyma and vascular structures, the following observations can be made:LUNG BASES: Mild bibasilar atelectasis.LIVER, BILIARY TRACT: Small subcentimeter hypodense liver cyst in the right lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is perinephric fat stranding with mild fullness to the right renal collecting system and mild right hydroureter. There is a punctate calculus at the right ureterovesical junction or within the bladder.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Punctate calculus either at the right ureterovesical junction or already passed and within the bladder. |
Generate impression based on findings. | Metastatic lung cancer status post 6 cycles of chemotherapy. CHEST:LUNGS AND PLEURA: Continued volume loss in the right lung with progression of radiation fibrosis and architectural distortion. Cavitary mass in the right upper lobe difficult to reproducibly measure in the AP dimension due to now adjacent post therapeutic consolidation and atelectasis , approximately 5.3 x 2.8 cm (3/26), previously 4.5 x 2.7 cm. Although the long axis of the lesion in measures larger, this could be the result of architectural distortion.Contralateral metastases with reference left upper lobe nodule measuring 8 x 8 mm, previously 8 x 7 mm (4/21). Left apical nodule measures 4 mm, previously 3-mm (4/15). Right upper lobe nodular lesion in the lung periphery measures 5 mm, previously 4-mm (4/18).MEDIASTINUM AND HILA: Right supraclavicular lymph node 11 mm, previously 10-mm (3/7). Necrotic high right paratracheal lymphadenopathy (3/11) has not significantly changed. Diffuse soft tissue opacity surrounding the trachea and approximately 3/4th the circumference of the SVC (3/28), grossly unchanged. The right upper lobe pulmonary artery is encased for a short distance. Non-index enhancing subcarinal lymph node is smaller (3/39). Adjacent soft tissue inseparable from the esophagus unchanged. Small bilateral enhancing inferior pulmonary ligament and paraesophageal lymph nodes unchanged. Soft tissue surrounding the bronchus intermedius, proximal right lower and middle lobe bronchi and medial wall of the left main bronchus unchanged. Moderate circumferential pericardial fluid collection, slightly increased in size.Filling defect posterior lateral to the distal aspect of the left chest port tubing in the superior vena cava compatible with chronic adherent thrombus but unchanged.CHEST WALL: Left chest port. Right breast and axillary surgical clips.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoattenuating lesion at the apex of the left kidney unchanged in size..PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Right upper lobe cavitary mass and pulmonary metastases with reference measurements as above. Please note that the mass is difficult to measure in the AP dimension (long axis) due to evolving adjacent radiation fibrosis. Otherwise measurements are not significantly changed.2. Chronic filling defect in the SVC adjacent to the distal port catheter compatible with chronic thrombus.3. No new lesions. |
Generate impression based on findings. | 62 year old female status post saphenous loop to AT w/ scapular based flap. Evaluate for bony fixation. The patient has undergone surgery since the prior study with what appears to be debridement and resection of the medial cortex and much of the medullary cavity of the distal tibial metadiaphysis. A 6 x 4 x 1 cm fragment of bone, presumably representing the scapular component of the surgical flap, is affixed to the remaining native tibia via two plate and screw devices. Vascularized soft tissue density superficial to the scapular flap presumably represents the muscular component of the flap which extends directly to the anteromedial skin surface. Soft tissue density replaces the medullary canal of the distal metadiaphysis extending proximally into the distal diaphysis over a total craniocaudal distance of approximately 14 cm. This extensive marrow replacement was not evident on the prior study and while it may somehow be related to the interval surgery, we cannot exclude the possibility of osteomyelitis. Supporting the possibility of osteomyelitis is what appears to be endosteal erosion along the lateral aspect of the distal tibia that was not clearly evident on the prior study. The remainder of the tibia and the other bones are demineralized with relatively normal appearing fatty marrow. There is reticulation of the subcutaneous fat of the leg compatible with edema which becomes confluent in multiple locations but no discrete rim enhancing fluid collection is seen to confirm abscess. There is diffuse fatty atrophy of the musculature of the leg with extensive atherosclerotic calcifications. Note is made of multiple skin staples. | 1.Postoperative changes of scapular based flap along the distal tibia as described above.2.The medullary cavity of the distal tibia is replaced with soft tissue density that is new compared with the prior study and appears to be associated with endosteal erosion. Therefore, we cannot exclude the possibility of osteomyelitis. However correlation with extent of surgical debridement is recommended. |
Generate impression based on findings. | Reason: 50 y/o female with h/o DLBCL s/p chemo. Compare to prior scan. History: none CHEST:LUNGS AND PLEURA: Pulmonary micronodules. No pleural effusions.MEDIASTINUM AND HILA: No lymphadenopathy. Heart size is normal. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Scattered hypodense foci too small to further characterize, but most consistent with benign cysts. Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive left mid pole calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable L3 superior end plate deformity.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable exam without recurrent lymphadenopathy in the chest, abdomen, or pelvis. |
Generate impression based on findings. | Male 67 years old Reason: 67 yo male with hx of carcinoid tumor that extends to pancreas; please do pancreatic protocol cT scan and evaluate for abnormalities History: abdominal pain ABDOMEN:LUNG BASES: There is a nonspecific focus of ground glass opacity along the posterior medial right lower lobe.LIVER, BILIARY TRACT: There is no evidence of intra-or extra hepatic biliary ductal dilatation and the hepatic vasculature appears patent. There are several hypodense foci within the hepatic parenchyma, which are consistent with simple cysts.SPLEEN: No significant abnormality notedPANCREAS: There is no evidence of focal mass lesion within the pancreatic parenchyma to suggest carcinoid involvement.ADRENAL GLANDS: There is a small right-sided adrenal nodule which is consistent with a benign adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There is no evidence of retroperitoneal lymphadenopathyBOWEL, MESENTERY: There is a 2.1 x 2.5 cm (image 82, series 10) arterial enhancing mass within the mesentery, which contains a surgical clip suggesting previous biopsy. This mass is consistent with possible mesenteric metastasis of the patient's reported carcinoid tumor. There are numerous small mesenteric lymph nodes surrounding this mass. There is evidence of a prior small bowel resection and primary anastomosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There is no evidence of pathologic lymphadenopathy.BOWEL, MESENTERY: There is a 2.1 x 2.5 cm (image 82, series 10) arterial enhancing mass within the mesentery, which contains a surgical clip suggesting previous biopsy. This mass is consistent with possible mesenteric metastasis of the patient's reported carcinoid tumor. There are numerous small mesenteric lymph nodes surrounding this mass. There is evidence of a prior small bowel resection and primary anastomosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of pancreatic involvement from the patient's reported carcinoid tumor.2.Arterial enhancing mesenteric based mass containing biopsy clips concerning for mesenteric metastasis of the patient's reported carcinoid tumor.3.Benign adrenal adenoma. |
Generate impression based on findings. | Reason: Lung cancer - please re-eval. Thansk. History: Lung cancer CHEST:LUNGS AND PLEURA: Interval decrease in the spiculated right upper lobe nodule with new (image 42 series 6) now measuring 12 mm x 9 mm previously measuring 13 mm x 13 mm.Left apical scar like opacity and right lower lobe subpleural scarring/atelectasis unchanged.No new suspicious pulmonary nodules or masses.Moderate upper lobe predominant centrilobular emphysema.MEDIASTINUM AND HILA: Interval decrease in precarinal lymphadenopathy (image 40 series 4) now measuring 8 mm in its short axis previously measuring 14 mm..Cardiac size is normal without evidence of a pericardial effusion.Stent within the circumflex artery and marked coronary artery and aortic calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Incompletely evaluate exophytic mass extending from the right kidney unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable 0.9-cm on the carina abdominal aortic aneurysm.IVC filter unchanged.Extensive atherosclerotic changes of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes in the spine.OTHER: No significant abnormality noted. | 1.Interval decrease in size of the right upper lobe spiculated mass and mediastinal lymphadenopathy.2.No new sites of disease.3.Stable infrarenal abdominal aortic aneurysm. |
Generate impression based on findings. | Clinical question: 41 year-old female with sarcoidosis and large B-cell non-Hodgkin's lymphoma in remission after chemotherapy. Compared with prior exam. Signs and symptoms: None. Enhanced neck CT:Limited view of intracranial space is unremarkable.Cavernous sinuses and the skull base remains unremarkable.Images through the nasopharynx and nasal passage are unremarkable with the exception of significant leftward nasal septum deviation and a bony septal spur.Unremarkable images through the oropharynx, and oral cavity.There is a right sided jugulodigastric node (axial image 6 image 8 and coronal reformatted series 8030 Image 54) measuring 11 x 13 x 14-mm which is new since prior exam. There is no evidence of any additional lymphadenopathy by CT size criteria.Unremarkable salivary glands.Unremarkable larynx, thyroid, and the vasculature of the neck.No detectable supraclavicular or axillary lymph nodes.Limited images through mediastinum and upper lung fields are unremarkable. Previously noted right paratracheal node is only partially visualized and appears smaller than prior study. Please review dedicated report CT chest performed. | 1.There is a new right jugulodigastric node measuring at 11 x 13 x 14-mm in size as detailed above. No evidence of any additional cervical lymph nodes by CT size criteria and unremarkable neck exam otherwise.2.Previously known right paratracheal node is only partially visualized on this study and appears a smaller. Please see report of CT of chest performed the state. |
Generate impression based on findings. | Lung cancer, please follow-up CHEST:LUNGS AND PLEURA: Interval reversal and increased size of the paramediastinal left upper lobe mass (image 32 series 5). Currently measuring 5.8 x 4.8 cm (image 37 series 3), previously 5.0 x 4.8 cm when measured at similar fashion. The mass appears fuller with more convex margins. Central hypodensity again suggest central necrosis. More concerning is now new bilateral nodular metastatic foci are observed involving both the right upper and lower lungs. The 1 cm nodule in the right upper lobe currently measures 5.9 x 5.5 cm (image 45 series 5) with a lobular appearance and displacement and questionable involvement of associated pulmonary artery. For reference the right lower lobe demonstrates a smaller entirely new lesion measuring 1.7 x 1.7 cm (image 59 series 5).MEDIASTINUM AND HILA: No distinct new lymphadenopathy although the left paramediastinal mass extends into the prevascular mediastinal space. Multiple necrotic right hilar lymph nodes, however the reference subcarinal lymph node currently measures 1.5 cm in short axis from a prior measurement of 1.2 cm (image 54 series 3).Small hiatal hernia. The cardiac and pericardium are otherwise significant for mild coronary calcificationsCHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: A new suspicious left lobe hypodensity measuring 2.8 x 2.8 cm (image 120 series 3) suspicious for metastatic disease. The remainder of the liver is unremarkable. The gallbladder is normal.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: A small nodularities observed in the left adrenal measuring under 1 cm. Prior imaging demonstrate a mild nodular appearance and definite changes difficult to discern. Right adrenal is unremarkableKIDNEYS, URETERS: A new cortical hypodensity is observed in the right inferior kidney measuring 2.2 x 1.8 cm (image 144 series 3) again concerning for metastatic disease. Scattered bilateral renal cysts otherwise unremarkable and unchangedPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild scattered lumbar degenerative changes with vacuum phenomena. No suspicious lytic or blastic lesions are identifiedOTHER: No significant abnormality noted. | Marked interval progression and advancement of metastatic foci now involving the opposite contralateral lung as well as the liver and suspected right kidney. Reference measurements provided |
Generate impression based on findings. | Male, 46 years old, history of tonsil cancer. Treatment related change is demonstrated in the right neck including thickening of the platysma and infiltration of the fascial planes. These findings are not substantially changed.No pathologic adenopathy is detected by size criteria. A reference calcifying right level 2 lymph node measures 6 x 5 mm (image 42 series 3), previously 7 x 6 mm. A more anteriorly positioned level 2 node measures 7 x 4 mm (image 42 series 3), previously 7 x 5 mm.The aerodigestive mucosa is within normal limits. Salivary glands and thyroid are free of focal lesions. The right internal jugular vein fails to opacify, a stable finding. Vasculature is otherwise unremarkable. Lung apices show no specific abnormality. No concerning bony lesions are seen. | Stable treatment related change in the right neck. No evidence of recurrent primary tumor or pathologic adenopathy. |
Generate impression based on findings. | Mesothelioma on observation. CHEST:LUNGS AND PLEURA: Right hemithorax volume loss and postsurgical changes consistent with history of mesothelioma and pleurectomy. Small amount of anteriorly loculated pleural fluid has decreased in volume compared to the prior examination pleural thickening at the right lung base posteriorly with adjacent small paraspinal lymph nodes not appreciably changed. Index level measurement at the level of the intraventricular septum at the 3 o'clock position is 8 mm, previously 6-mm (3/70). No contralateral pleural lesions.MEDIASTINUM AND HILA: Mildly enlarged high right paratracheal lymph node 9 mm, previously 10-mm. Other mediastinal lymph nodes are similar to previous. Index right hilar lymph node stable at 9-mm. Right chest port tip in the right atrium.CHEST WALL: Several mildly enlarged right internal mammary chain lymph nodes (3/33, 3/50, 3/63) have slightly increased in size and number compared to the prior examination.Right intercostal lymphadenopathy (3/67, 71) has increased compared to the previous study.Right chest port. Right rib fractures with osseous nonunion. Adjacent to these fractures there is a small amount of fluid with associated indeterminate hyperattenuating soft tissue in the right lateral chest wall, unchanged. ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Pleural nodularity adjacent to the liver unchanged (3/6)SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Small perinephric soft tissue nodule (3/99) slightly larger given the benefit of retrospect.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Numerous small retroperitoneal lymph nodes, abnormal in multiplicity. Some in have increased in size over the last two studies.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Suture line along the proximal right colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Although there is no significant change in index level measurement, several small lymph nodes in the chest wall (right internal mammary and right intercostal) and abdomen have enlarged in the interim. |
Generate impression based on findings. | 74-year-old male with lung cancer. Status post resection and colon cancer -- follow up examination. CHEST:LUNGS AND PLEURA: Status post left pneumonectomy with expected finding stable in appearance. A prior described micronodule along the major fissure laterally is again seen, associated with some benign-appearing pleural thickening and is unchanged. No no nodules or masses or infiltrates seen in right lung. No pleural abnormality seen.MEDIASTINUM AND HILA: Thyroid nodules. Again seen in the left lobe of thyroid. Coronary artery calcification again seen.There is a new small lymph nodes seen in the anterior/superior mediastinum (series 3, image 28) which measures 1.0 x 1.1 cm.. No definite lymph node was seen on the prior examination in this area. While this lymph node is small, the fact that it is new merits follow-up evaluation to exclude metastatic disease. No other enlarged lymph nodes are identified in the mediastinum.A new enlarged right cardiophrenic angle lymph node is seen (series 3, image 73) measuring 1.7 x 1.6 cm, previously 0.7 cm. These two enlarging lymph nodes are worrisome for metastatic disease.. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: A new subcentimeter ill-defined hypodensity is seen in the posterior right lobe segment 7 superiorly (series 3, image 87). No abnormality was seen in this region on prior examination and while this is nonspecific, early focus of liver metastasis cannot be excluded in this merits close follow-up evaluation. No other lesions are seen in the liver. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No lymphadenopathy seen, and no other masses. Infrarenal inferior vena cava filter is seen, unchanged in appearance.BOWEL, MESENTERY: Anterior midline ventral hernia again seen without complication involving small and large bowel. Bowel, otherwise is intrinsically normal in appearance. No mesenteric fluid identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post left pneumonectomy without evidence of definite tumor recurrence in the right lung. 2. Small, but new lymph nodes seen in the anterior/superior mediastinum in the right cardiophrenic angle space worrisome for possible metastases. 3. Nonspecific subcentimeter hypodensity new in the superior right lobe of the liver -- this cannot definitely be called a metastasis at this time, but certainly merits close evaluation at follow-up.Summary: Several subtle abnormality seen that may be post inflammatory, but merit close follow up to exclude metastatic disease. |
Generate impression based on findings. | Clinical question: stroke. Signs and symptoms: Comatose. Unenhanced head CT:Large focus of edema, consistent with ischemic stroke involving the left superior aspect of cerebellar is again identified and interval increase in its extent and associated mass effect, evident by flattening and mild deviation of the forefoot across the midline. Noted is some hemorrhagic conversion.Very significant edema of the left hemisphere, consistent with a subacute ischemic change demonstrate very significant interval increase in its mass effect, which results in complete effacement of all the left hemispheric cortical sulci, complete effacement of left lateral ventricle, complete effacement of basal cisterns, midline shift to the right of approximate the 28 millimeter and transtentorial downward herniation. There is no evidence of hemorrhagic changes.The right lateral ventricle demonstrate interval increased size/ hydrocephalus.Revisualization of high density left MCA. | 1.Interval significant increased mass-effect and increased extent of left hemispheric nonhemorrhagic subacute ischemic stroke with resultant 28-mm midline shift to the right, transtentorial downward herniation and right-sided hydrocephalus. No hemorrhagic conversion.2.Interval increased mass-effect and to a lesser degree extent of left cerebellar subacute ischemic stroke with evidence of new mass effect on the fourth ventricle. |
Generate impression based on findings. | Non-small cell lung cancer, compare to prior. CHEST:LUNGS AND PLEURA: Stable pulmonary appearance with the small to moderate right pleural effusion and underlying focal consolidation posteriorly. The more nodular reference right lower lobe metastatic site continues to measure 1.7 x 1.4 cm (image 66 series 4). No new suspicious focal lesions.Again observed is a small stable centimeter ground glass focus observed in the posterior left lung (image 53 series 4). Scattered micronodules are also all unchanged bilaterallyMEDIASTINUM AND HILA: Continued decreasing reference subcarinal lymph node, currently measuring 9 mm from a prior measurement of 1.1 mm (image 55 series 3). No new suspicious lymph nodesThe cardiac and pericardium remains significant for atherosclerotic disease without additional new abnormality.Small hiatal herniaCHEST WALL: Stable scattered degenerative changes without additional superimposed lytic or blastic lesions.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Granulomatous changes are unchangedADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable appearing right renal cystPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable degenerative changesOTHER: No significant abnormality noted. | Stable right lower lobe pulmonary appearance again most suggestive of post radiation scarring with persistently decreasing lymphadenopathy |
Generate impression based on findings. | 79-year-old male with history of metastatic prostate cancer CHEST:LUNGS AND PLEURA: 5-mm nodule in the left upper lobe on image number 35, series number 5, unchanged. Other micronodules are also unchanged.MEDIASTINUM AND HILA: Indexed posterior mediastinal lymph node measures two by 1.8-cm image number 50, series number 3, increased in size compared to previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Unchanged hepatic cysts. Cholelithiasis without CT evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense lesions and hyperdense right renal lesion are unchanged compared to previous study.RETROPERITONEUM, LYMPH NODES: Left para-aortic lymph node measures 2.2 x 2.2 cm image number 113, series number 3. The lymph node adjacent to the aortic bifurcation measures 1.7 by 1.2-cm image number 134, series number 3, not significantly changed. Other aortic lymph nodes are also grossly stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Indexed external iliac lymph node measures 1.6 by 1 cm image number 167, series number 3, not significantly changed from previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in the size of the posterior mediastinal and some of the retroperitoneal likely metastatic lymph nodes. Some of the retroperitoneal lymph nodes and pelvic indexed lymph node are stable. left upper lobe pulmonary nodule is unchanged. |
Generate impression based on findings. | 45-year-old male with history of metastatic urothelial cancer CHEST:LUNGS AND PLEURA: right upper lobe pulmonary nodule is unchanged measuring 3 mm on image number 23, series number 5. No newnodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal adenopathy. Index left aortic lymph node measures 1.9 x 1.6 cm image number 131, series number 4 smaller compared to previous study. Other retroperitoneal lymph nodes are also smaller compared to previous study.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: Index left common iliac artery measures 1.1 by 1.2-cm image number 151, series number two, smaller compared to previous study.Index left inguinal lymph node measures 2.5 x 2.1 cm image number 204, series number 4, not significantly changed compared to previous study.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: A left-sided lymphocele measures 8 .7 x 5.2 cm, slightly increased in size compared to previous study. | Interval decrease in the size of the index retroperitoneal and pelvic adenopathy and pelvic lymphocele. Inguinal adenopathy, stable in size. |
Generate impression based on findings. | 81-year-old female with history of urothelial cancer 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: Bilateral renal cysts are unchanged including the minimally complex cyst on the right side. Bilateral mild dilatation of the collecting system and ureters are also unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy is unchanged. Herniation of the nonobstructed colon segments into the ostomy site is noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Status post cystectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on findings. | Male, 71 years old, history of follicular non-Hodgkin's lymphoma, on observation. Lymphadenopathy involving levels 1 through 5 and the bilateral axillae is redemonstrated, not significantly changed from the prior examination. For reference, a right level 2 lymph node measures 1.6 x 1.6 cm (image 60 series 4), previously 1.7 x 1.6 cm. A right supraclavicular node measures 1.3 x 1.0 cm (image 70 series 4), previously 1.2 x 1.0 cm. A left level 2 node measures 1.0 x 0.8 cm (image 57 series 4), previously 0.9 x 0.7 cm.The aerodigestive mucosa is within normal limits. The salivary glands and thyroid are free of focal lesions. Cervical vessels remain patent. Lung apices are clear. No concerning bony lesions are seen. | Stable lymphadenopathy. |
Generate impression based on findings. | Mesothelioma, follow-up. CHEST:LUNGS AND PLEURA: Moderate interval progression of the diffuse nodular pleural thickening and known mesothelioma involving the left hemithorax. Particular attention is placed on nodular thickening throughout the left major fissure and the left upper lobe stable nodule (image 36 series 5). The small nodule adjacent to the left major fissure in the left lower lobe is also unchanged (image 48 series 5).Moderate central lobular emphysema and mild basilar changes suggesting atelectasis and or questionable aspiration Reference measurements are as follows:1. At the level of the clavicular heads (image 22 series 3), the 11 o'clock lesion measures 3.4 cm from a prior measurement of 1.9 cm2. At the level of the aortic arch (image 35 series 3) the 10 o'clock lesion is unchanged measuring 1.2 cm3. At the level of the main pulmonary artery (image 50 series 3) the 4 o'clock lesion has increased currently measuring 1.8 cm from a prior measurement of 1.3 cm.4. At the level of the GE junction (image 89 series 3) the 4 o'clock lesion measures 1.4 cm from a prior measurement of 1.2 cmMEDIASTINUM AND HILA: No discrete isolated lymphadenopathy, however the pleural disease is adjacent to and indistinguishable from the aortic arch and descending aorta at the level of the pulmonary arteryThe cardiac and pericardium are otherwise within limits, other than coronary calcifications and atherosclerotic diseaseCHEST WALL: Degenerative changes scattered throughout the thoracic spine without interval change. No new lytic or blastic lesionsABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small suspected renal cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Stable atherosclerotic and degenerative changes of lumbar spineOTHER: No significant abnormality noted. | Interval progression of known left sided mesothelioma with reference measurements provided. Intrapulmonary nodules are otherwise unchanged it remains suspicious for metastatic disease |
Generate impression based on findings. | Female, 58 years old, eye pain. Concern for sinus disease. The frontal sinuses and frontoethmoidal recesses are clear. There is a small nonobstructive osteoma at the level of the left frontoethmoidal recess.One of the posterior right ethmoid air cells is opacified, similar to prior. The remaining ethmoid air cells are clear. The sphenoid sinuses and sphenoethmoidal recesses are clear.Mucosal thickening is evident along the floors of the bilateral maxillary sinuses. This is grossly stable on the right and mildly progressed on the left. The maxillary outflow pathways are narrow bilaterally which is unchanged and likely congenital. No obvious obstructive processes are seen.The bilateral middle nasal turbinates are pneumatized. The nasal cavity is unremarkable. The nasal septum is intact and deviates mildly towards the right on both axial and coronal images.The mastoid air cells and middle ear cavities are clear.Images through the orbits show no specific abnormality. | Mild sinus mucosal thickening as above. No evidence of active sinusitis. |
Generate impression based on findings. | History of hypoxemia and suspected pulmonary embolus. Check for pneumonia PULMONARY ARTERIES: Pulmonary arterial system is well visualized and unremarkable. Specifically no findings to suggest pulmonary embolusLUNGS AND PLEURA: Persistent moderate right pleural effusion with underlying compression atelectasis and partial consolidation of the right lower lobes. No discrete focal lesions or distinct areas to suggest an underlying lesion, however suspected atelectasis may be associated with partial consolidation and infection. Serial imaging to ensure clearance is needed.The left lung demonstrates improved overall aeration and a small pleural effusion consistent with the recent thoracentesis. No associated postprocedural complications.ETT has been removed.MEDIASTINUM AND HILA: The cardiac and pericardium are unremarkable, specifically no evidence of heart strain.No lymphadenopathy. Specifically however the enlarged previously described retroperitoneal lymph nodes are not identified given that imaging does not extend very far into the abdomen.ET tube has been removedCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Specifically no significant ascites or abdominal fluid is observed in this limited evaluation. Using fatty liver is also suggested although the appearance is accentuated due to the bolus timing and specified specific PE protocol. | No findings to suggest pulmonary embolus with interval essentially stable appearing right lower lobe findings. Interval resolution and or drainage of the left pleural effusion. |
Generate impression based on findings. | Male, 7 months old, status post head injury with clear rhinorrhea, epistaxis, crying more. Evaluate for intracranial bleed versus fracture. Scalp soft tissues are unremarkable. The bones of the calvarium and skull base are intact. The mastoid air cells and middle ear cavities are well pneumatized. The paranasal sinuses are only partially developed. There is minimal opacification in the right ethmoid air cells. No intracranial hemorrhage or abnormal extra-axial fluid collection is detected. No parenchymal edema or mass effect is seen. The ventricular system is patent and normal in size. Overall brain morphology is normal. | No acute intracranial abnormalities. |
Generate impression based on findings. | 71-year-old male with follicular lymphoma on observation. Currently. Also has lingular mass -- compare to prior scans. CHEST:LUNGS AND PLEURA: Minimal change change in the two nodular masses seen in the lung parenchyma. Largest of these is in the lingula and measures 2.5 x 1.8-cm (series 4, image 82) previously 2.7 x 1.7 cm. The groundglass right upper lobe nodule (series 4, image 49) measures 0.7 x 0.6 cm, unchanged. No new nodules, masses or infiltrates are seen. No pleural abnormalities or effusions are seen.MEDIASTINUM AND HILA: Prior noted mildly enlarged mediastinal and left internal mammary lymph nodes are seen, unchanged in their size and distribution. No new foci of lymph node enlargement are seen.CHEST WALL: Bilateral axillary prominent lymph nodes are seen right greater than left in a pattern unchanged in distribution. The referenced right axillary lymph node (series 3, image 18) measures 1.9 x 2.5 cm, previously 2.8 x 2.2 centimeters. Remaining lymph nodes appear subjectively, not significantly changed.ABDOMEN:LIVER, BILIARY TRACT: No change in the benign hypodense small liver lesions dating back to October/2012, and, presumably representing cysts. No new lesions are seen. Portal venous, and hepatic venous structures appear normal. Gallstones again seen in the gallbladder without complication and no other abnormalities in the, biliary tract.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Hepatoduodenal ligament and retroperitoneal, periaortic, lymph nodes are essentially unchanged in their distribution and size. The prior referenced left periaortic lymph node (series 3, image 133) measures 2.0 x 1.2 cm compared with 1.9 x 1.2 cm previously. The numerous other clusters of small and slightly enlarged lymph nodes throughout. This region appear similarly unchanged. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Diffuse pelvic lymphadenopathy is again seen with slight improvement in measurements in most regions as reflected in the. Reference measurements below:Right common iliac lymph node (series 3, image 161) measures 1.9 x 1 .3 cm, previously 2.0 x 1.9 cm).Left external iliac lymph node (series 3, image 187) measures 4.6 x 2 .3 cm, previously 4.8 x 2.6 cm.Right external iliac lymph node ((series 3, image 25) measures 3.6 x 2.0, previously 4.6 x 2.5Bilateral inguinal lymph nodes show similar mild decreases in size, with the referenced right inguinal lymph node (series 3, image 195) measuring 1.4 x 1 .2 cm, previously 1.6 x 1.4 cm.No new lymphadenopathy or other masses are seen.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No change in appearance to the left chest. Lingular subpleural nodule, where the small right upper lobe ground glass nodule. No new thoracic lesions are identified. 2. Slight decrease in size of the diffuse retroperitoneal and pelvic adenopathy as measured above. |
Generate impression based on findings. | Metastatic lung CA on Tarceva therapy over one month CHEST:LUNGS AND PLEURA: Dominant mass in the right lower lobe measures 4.8 x 3.1 cm (4/76), previously 3.9 x 2.7 cm, larger.Multiple pulmonary nodules have increased in size in the interim. New beaded and serpiginous opacities in the lingula (4/61), suspicious for endovascular spread of tumor.Pleural enhancement near the costophrenic angles likely reflects tumor.MEDIASTINUM AND HILA: Heterogeneous nodule in the right thyroid lobe, nonspecific by CT. Coronary artery calcifications. No pericardial fluid. Normal heart size. Numerous metastases as follows:Subcentimeter left low cervical lymph nodes larger and more numerous (3/1, 3,14). Mild stenosis of the proximal left subclavian artery. New and enlarging soft tissue density nodules near the right hilum consistent with segmental level nodal metastases (3/43-41). New moderate left interlobar lymphadenopathy (3/56) and right lower interlobar level lymphadenopathy (3/62).Small but densely enhancing right cardiophrenic lymph node (3/75).CHEST WALL: Complex pathologic fracture of the left medial clavicle with permeative underlying metastases and periosteal reaction.Adjacent soft tissue mass has become necrotic, and extending between the clavicular heads and effacing the anterior margin of the left thyroid gland.Interval progression in size and number of left axillary and sub-pectoral necrotic lymph nodes. A small but abnormally enhancing lymph node is seen near the axilla on the right.Soft tissue metastasis left posterior chest wall near the diaphragm (3/93) is larger. Soft tissue deposit left lateral chest wall (3/105) is larger. There a few additional subcentimeter chest wall nodules which are new.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: New hepatic metastases (3/87, 3/105).SPLEEN: Splenic lesion is much larger, now consistent with a metastasis (3/89).ADRENAL GLANDS: Bilateral adrenal gland metastases are larger. Left adrenal gland lesion measures 4.6 x 3.8 cm, previously 2.5 x 2.9 cm (3/9).KIDNEYS, URETERS: Right postero-superior perinephric soft tissue deposit increased in size. Index lesion inferior to the left kidney increased in size, 4.3 x 5 cm (3/129), previously 3.6 x 3.7 cm.PANCREAS: Increase in peripancreatic lymphadenopathy (3/119).RETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic disease. Periaortic soft tissue thickening at the level of the celiac axis appears worse. The numerous left retroperitoneal metastases. Left iliac lymphadenopathy is worse.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Abnormal wall thickening and attenuation in several sites of both large and small bowel consistent with metastatic disease but incompletely assessed due to lack of oral contrast.BONES, SOFT TISSUES: Large mass in the right paraspinal soft tissues invades the spinal canal at L1 causing effacement of the thecal sac. There is also a pathologic fracture of the L1 vertebral body, right pedicle and destruction of the transverse process. Retropulsion of the vertebral body fracture fragment into the spinal canal also causes mass effect on the thecal sac. There and adjacent soft tissue deposit in the spinal canal is noted which may be via direct extension or intraspinal spread of tumor (3/107).Large metastasis in the left iliac wing with chronic pathologic fracture is incompletely included within this scanning range but appears similar. There is an adjacent fluid collection along the medial border of the pelvis which may reflect a chronic extraperitoneal hematoma.Numerous new or larger subcutaneous and intramuscular soft tissue deposits.OTHER: No significant abnormality noted. | Interval progression of metastatic disease with numerous enlarging or new lesions in the chest and abdomen. L1 metastasis extends into the spinal canal and causes effacement of the thecal sac, this may be further assessed with MRI if clinically warranted.. |
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