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Generate impression based on findings. | Lymphoma. History of SVC clot. Lovenox administration. Check progression. LUNGS AND PLEURA: No opacity is identified. No pleural effusion is seen.MEDIASTINUM AND HILA: No lymphadenopathy is present. The heart size is normal. Pericardial effusion is not seen.CHEST WALL: Left-sided central line tip is in superior vena cava. Due to the phase of contrast enhancement is much more difficult to evaluate the blood clot. Clot is again identified in the superior vena cava and it is not larger than on the prior exam.UPPER ABDOMEN: No abnormality is identified. | Unchanged blood clot in superior vena cava. |
Generate impression based on findings. | Clinical question: Carotid involvement of cancer. Signs and symptoms: Head and neck pain. Neck CTA:The aortic arch, as well as the origins of the major vessels remain within normal limits.Brachiocephalic and bilateral subclavian arteries are unremarkable.There are normal appearing bilateral vertebral arteries throughout the neck and including their origins. No evidence of vascular compromise/encasement is present.Right common carotid artery and its origin, are unremarkable.Right internal carotid artery and including its origin is within normal limits.Right external carotid artery and its branches are also unremarkable.Left common carotid artery at its origin, are unremarkable.Left internal carotid artery demonstrate normal morphology and caliber throughout its course and without any convincing evidence of encasement.There is no detectable abnormality of the main trunk or the branches of the left external carotid artery .There is revisualization of previously noted on prior CT of soft tissues of neck, extensive contact of patient's left-sided neck mass with the vasculature of the neck on the left at the level of distal common carotid, carotid bifurcation, and proximal internal and external carotid arteries. | 1.Unremarkable CTA of the neck and without convincing evidence of vascular encasement/lumen compromise.2.Very close proximity of patient's large left neck tumor with left carotid system is again identified on the source images. |
Generate impression based on findings. | Female; 43 years old. Reason: h/o palate cancer; eval for mets. LUNGS AND PLEURA: Mild bibasilar scarring/atelectasis, without focal air space opacity or pleural effusion. No suspicious pulmonary nodules or masses to indicate metastatic disease. Very mild apical ground glass opacity and associated mild bronchial wall thickening are suggestive of respiratory bronchiolitis if the patient has a cigarette smoking history. Mild centrilobular emphysema is also noted in the lung apices. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Small accessory splenule. | No evidence of metastatic disease. |
Generate impression based on findings. | Altered mental status, subarachnoid hemorrhage. Evaluate for progression. There is considerable motion artifact on this portable exam which significantly limits sensitivity. Within these limitations, the previously described foci of subarachnoid hemorrhage is demonstrated within a sulcus overlying the left parietal lobe. Other previously described areas of hemorrhage are not clearly demonstrated, though this is likely on the basis of motion. No obvious intraventricular hemorrhage demonstrated. No visualized intracranial mass or obvious hydrocephalus. The midline is intact.There are no depressed fractures of the skull. | Considerably limited examination demonstrating previously described focus of subarachnoid hemorrhage without significant extension. No obvious hydrocephalus or gross mass effect. |
Generate impression based on findings. | Reason: hx of histoplasmosis with recurrent dry, cough, assess for mediastinal LAD History: dry cough LUNGS AND PLEURA: Irregularly marginated right lower lobe nodule measuring 10 mm in maximum diameter, slightly decreased in size and opacity compared to the previous scan.Foci of attenuation of the lung bases suggestive of air trapping, with bronchial thickening compatible with small airways disease.MEDIASTINUM AND HILA: Marked interval decrease in mediastinal and hilar lymphadenopathy.A lower right paratracheal node has decreased from 17 mm to 10 mm in short axis diameter. Other nodes have similarly decreased.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small splenic hypodensities, unchanged or decreased. | Marked decrease in mediastinal and hilar lymphadenopathy and slight decrease in right lower lobe pulmonary nodule, compatible with treated histoplasmosis. |
Generate impression based on findings. | 71 year old male. Reason: patient with history of prostate cancer, currently receiving therapy with enzalutamide. Please assess for disease progression History: met prostate cancer CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Increasing left supraclavicular lymphadenopathy. Reference prevascular lymph node measures 3.3 x 3.6 cm, previously 3.0 x 3.0 cm (axial image 21). No new lymphadenopathy. Coronary artery calcifications. Duplicated SVC.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating hepatic lesions compatible with simple cysts, unchanged. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Increasing left adrenal nodule measures 4.1 x 3.1 cm, previously 2.6 x 2.2 cm (axial image 106).KIDNEYS, URETERS: Renal cysts are unchanged. Nonobstructive left renal calculus.RETROPERITONEUM, LYMPH NODES: Reference para-aortic lymph node conglomerate measures 7.4 x 4.8 cm, unchanged (axial image 121). Aortocaval lymph node conglomerate measures 10.0 x 6.0 cm, previously 8.7 x 4.8 cm (axial image 124).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy and pelvic lymph node dissection.BLADDER: No significant abnormality noted.LYMPH NODES: Stable left pelvic lymph node measures 3.0 x 2.8 cm (axial image 191).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine without suspicious osseous lesions.OTHER: No significant abnormality noted. | 1.Increasing lymphadenopathy. 2.Increasing left adrenal nodule. |
Generate impression based on findings. | 27-year-old male with tonsillar swelling. Evaluate for abscess There is enlargement of the right palatine tonsil with internal linear hypodensity, likely representing striations of edema. There is thickening of the adjacent soft palate and increased density within the right parapharyngeal fat. There is no distinct drainable fluid collection to suggest abscess formation. There is slight confluence of low-density along the superior aspect of the enlarged tonsil. The airway is widely patent. The lingual and adenoid tonsils are unremarkable.There are enlarged cervical lymph nodes, likely reactive to the tonsillar infection. The largest of these, at right level 2a measures 2.6 cm in long axis.There is mild asymmetry of the right laryngeal ventricle which is nonspecific. The hypopharynx, larynx, and subglottic airway are otherwise patent and within normal limits.The cervical vasculature appears patent. The parotid, submandibular, and thyroid glands appear normal.The osseous structures are unremarkable. The neural foramina and spinal cord appears within normal limits.There is mild mucosal thickening of the paranasal sinuses, with maxillary sinus mucus retention cysts. The intracranial contents and orbits are unremarkable. | Enlargement of the right palatine tonsil and adjacent soft tissues, consistent with tonsillitis. There is no fluid collection to suggest abscess formation at this time. There is slight confluence of low-density centrally along the superior aspect of the tonsil, and a very early forming fluid collection cannot be entirely excluded. |
Generate impression based on findings. | Reason: metastatic breast Ca, followup of left lung lesions and liver met History: left anterior chest wall pain CHEST:LUNGS AND PLEURA: Slightly decreased anterior left upper lobe subpleural opacity, likely inflammatory.Left upper lobe reference nodule (image 37/116) mm, 26x26mm on the axial sections and more accurately measured at 29 x 25 mm on coronal sections, not significantly changed from previous.MEDIASTINUM AND HILA: No significant lymphadenopathy.CHEST WALL: Surgical clips in the left breast and left axilla.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Approximately 8 x 12 mm hypodensity in the right lobe of the liver, not significantly changed.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 disease. |
Generate impression based on findings. | Hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Bilobar hepatic cystsSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 7-mm nonenhancing fat focus within the lower pole of the right kidney corresponding to the lesion seen on the recent ultrasound. No other renal lesions appreciated. Unremarkable collecting systems bilaterally.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Nonenhancing fat containing focus arising from the lower pole right kidney corresponding to the echogenic focus seen on the recent ultrasound. Findings consistent with benign angiomyolipoma. No worrisome renal lesion appreciated. |
Generate impression based on findings. | 67-year-old male. EC fistula, perineal fluid collections. Evaluate for interval resolution of peritoneal fluid collections status post drainage. ABDOMEN:LUNG BASES: Bilateral pleural effusions, left greater than right. Bibasilar atelectasis. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A few left renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The superior anterior collection has resolved since the prior examination with a percutaneous drainage catheter in place. (axial image 34, series 3)Inferior small abdominal cavity has resolved and has a percutaneous drain in place. (axial image 84, series 3)BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Posterior bladder wall diverticula with layering stones.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Fibrofatty proliferation of the mesentery. | Interval resolution of superior anterior fluid collection and inferior collection.The percutaneous drainage catheters remain unchanged since the prior exam. |
Generate impression based on findings. | 32 year old male. Clinical stage I testicular cancer. Follow-up for recurrence. Reason: History of testicular cancer, s/p chemo, no RPLND, assess for recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN: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: Subcentimeter para-aortic lymph nodes are not enlarged using CT size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Retrocecal appendix in the right upper quadrant is a normal variant.PELVIS: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 | No evidence of residual or recurrent disease. |
Generate impression based on findings. | 64 year old female. Reason: Pre-Kidney Transplant Evaluation, assess aortic and iliac vessels for transplant History: Pre-Kidney Transplant Evaluation ABDOMEN:LUNG BASES: Numerous centimeter-sized hepatic hypodensities most likely represent simple cysts.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: 1.2 cm curvilinear calcification in the left upper quadrant probably represents a splenic artery aneurysm (image 31, series 3). PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The native kidneys are absent.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a 5 x 8-cm mass, primarily consisting of fatty components, in the right lower quadrant which has characteristics most consistent with an intraperitoneal lipoma. This is seen best on coronal image 55. Diffuse atherosclerotic calcification of the aorta and major branches.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: The urinary bladder is completely decompressed.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis of the descending and sigmoid colon. BONES, SOFT TISSUES: No significant abnormality notedOTHER: There is virtually no calcification of the external iliac arteries and femoral arteries. | Right lower quadrant fat-containing mass may be an intraperitoneal lipoma. Probable splenic artery aneurysm. Absent native kidneys. Minimal vascular calcification in the pelvis. |
Generate impression based on findings. | 33 year old male with metastatic melanoma, on Vemurafenib, recently held therapy for brain surgery, evaluate for progression. History: Met melanoma CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules are unchanged from the prior study. No suspicious pulmonary nodule or mass is seen. No consolidation or pleural effusion.MEDIASTINUM AND HILA: There is a new enlarged pretracheal lymph node that measures 0.8 x 1.7 cm at image 37 of series 3.The heart is normal in size and there is no pericardial effusion. CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenule in the left upper quadrant. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously noted left posterior body wall soft tissue nodule now measures 9 x 5 mm (image 145, series 3).PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Status-post right pelvic lymph node dissection. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue nodule posterior to the left gluteal muscles has grown and is now 2.1 x 3.2 cm (image 168, series 3). Right inguinal postsurgical changes are again noted. | New pretracheal lymphadenopathy. The soft tissue nodule posterior to the left gluteal muscles has significantly increased in size since the prior exam. |
Generate impression based on findings. | Male 51 years old Reason: larynx cancer History: r/o chest mets LUNGS AND PLEURA: Apical scarring and pleural thickening unchanged. No new suspicious lung nodules or masses identified. Mild bronchial wall thickening is present.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. Tracheostomy with cannula in place, unchanged.CHEST WALL: Interval removal of the right chest wall Port-A-Cath. There is no evidence of metastatic disease the osseous structures of the chest.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The hypodense lesion in the right hepatic lobe is less conspicuous on this examination. There is no evidence of retroperitoneal or mesenteric lymphadenopathy. | No evidence of pulmonary metastatic disease, or lymphadenopathy. |
Generate impression based on findings. | 54 year old male. Reason: hematuria; history of transitional cell cancer of the right kidney ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Accessory splenule.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. The left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: Multiple borderline enlarged lymph nodes measuring up to 1.6 cm in the para-aortic region (series 9, image 93).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: Polypoid mass along the posterior wall of the bladder with eccentric right bladder wall thickening.LYMPH NODES: Small pelvic lymph nodes measuring up to 1.0 cm (series 9, image 120).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Polypoid mass of the bladder with eccentric wall thickening compatible with patient's history of TCC.2.Multiple borderline enlarged retroperitoneal and pelvic lymph nodes. |
Generate impression based on findings. | Reason: eval right upper lobe nodule History: smoker, cough, h/o oral cancer LUNGS AND PLEURA: 6 by 8 mm nodule adjacent to a cyst or bulla image 62 series 5, slightly larger than on the prior study, not present 11/8/2011.Other benign appearing pulmonary micronodules are unchanged, at least one calcified.Moderate to severe centrilobular emphysema is present with a mosaic attenuation pattern, unchanged. MEDIASTINUM AND HILA: 18-mm precarinal lymph node unchanged.The main pulmonary artery is 4 cm in diameter consistent with pulmonary arterial hypertension.Coronary calcifications are present.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Stable left adrenal nodule. | 1. Slight enlargement since 3/15/2013 of the right upper lobe nodule adjacent to a bulla, not present 11/8/2011. This is suspicious for an indolent lung cancer. 3 to 6 month follow up is recommended.2. Centrilobular emphysema with stable benign-appearing micronodules unchanged. 3. Pulmonary arterial hypertension, likely the cause of mosaic attenuation. |
Generate impression based on findings. | 58 year old male. Reason: Stage IV colon cancer. Please compare to previous scan and provide index lesion measurements. CHEST:LUNGS AND PLEURA: Stable biapical scarring. Stable emphysema.MEDIASTINUM AND HILA: Minimal nonocclusive thrombus associated with right central venous catheter.CHEST WALL: Right sided venous access device is in the expected position. ABDOMEN:LIVER, BILIARY TRACT: The reference left lobe mass lesion has increased in size as seen on image 85 of series 4, now measuring 9 x 7.6 cm. The other numerous bilobar hepatic metastases have remained relatively stable or moderately increased with respect to size. The reference segment 7 right lobe lesion as seen on image 89 of series 3 measures 2.6 x 3 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable upper pole left renal focus best seen on image 112 of series 3 measuring 1.5 x 1.5 cm.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 change in sigmoid colonic mass.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in size of confluent left hepatic lobe metastatic mass lesion. Other bilobar hepatic metastases are stable or increased in size. |
Generate impression based on findings. | Reason: abnormal finding on CXR, concern for PE History: as above PULMONARY ARTERIES: Technically adequate study, without evidence of pulmonary embolism, pulmonary artery enlargement or right heart strain.LUNGS AND PLEURA: Right lower lobe superior segment consolidation is present, with scattered regions of apparent subsegmental atelectasis in both lung bases. Airspace opacity right sided ground glass opacity extends to the posterior segment of the right upper lobe.MEDIASTINUM AND HILA: Right hilar and subcarinal lymphadenopathy is likely reactive.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism.2. Right lower lobe pneumonia with basilar subsegmental atelectasis bilaterally. |
Generate impression based on findings. | Female 65 years old Reason: COPD History: SOB LUNGS AND PLEURA: There is diffuse pulmonary parenchymal loss consistent with severe centrilobular emphysema. No suspicious nodule or mass is identified. No focal airspace opacity identified.MEDIASTINUM AND HILA: Mild calcifications seen in the walls the coronary arteries as well as in the wall of the thoracic aorta and its branches, consistent atherosclerosis. No mediastinal or hilar lymphadenopathy. CHEST WALL: Mild multilevel degenerative changes seen in the thoracic and cervical spine. Mild superior endplate depression of T10 is present.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous small hypodense lesions are seen scattered throughout the right hepatic lobe. These lesions are incompletely characterized and may represent hepatic cysts. Three punctate calcific foci within the pancreatic parenchyma which may be sequela of chronic pancreatitis. | Severe centrilobular emphysema, with no acute cardiopulmonary disease.Hypodense hepatic lesions which may represent hepatic cysts. |
Generate impression based on findings. | Reason: right buccal cancer, s/p surgery and RT, eval for recurrence History: as above LUNGS AND PLEURA: Upper lower lung zone groundglass opacities with mosaic attenuation, unchanged.Right upper lobe/apical postinflammatory opacities are stable.Scattered benign appearing micronodules are unchanged.Basilar predominant bronchiectasis is unchanged.MEDIASTINUM AND HILA: Aortic and coronary artery calcifications are present.There is no mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cystlike hypodensity in the left lobe of the liver unchanged. | 1. No sign of metastases.2. Groundglass mosaic attenuation with basilar bronchiectasis, unchanged. |
Generate impression based on findings. | Clinical question: Right buccal cancer. Sign and symptoms: Rule out lung metastases. Enhanced neck CT:Limited view of intracranial space remains unremarkable.Bilateral cavernous sinuses, and skull base, bilateral petrous bones in all paranasal sinuses are unremarkable.Unremarkable images through the nasal for exam nasal passage.Unremarkable images through oropharynx, tongue, floor of the mouth, and the salivary gland.There is interval resolution of previously noted small fluid-like collection overlapping the right right masseter muscle under the graft. Redemonstration of postoperative changes of right buccal mucosa with overlapping subcutaneous fat stranding and placement of a graft. There is a thin linear enhancement along the surface of the right buccal mucosa (best appreciated on coronal reformatted images) which could represent superficial scarring/mucosal enhancement. There is apparent adjacent thickening of buccal mucosa which could represent postoperative scarring however, possibility of mass cannot be entirely excluded. This appearance is not significantly different than prior study. This finding also as well is better appreciated on coronal reformatted images.There is revisualization of the postoperative changes of bilateral neck surgery for removal nodes.There is no evidence of cervical adenopathy by CT size criteria. This is a similar observation is prior study. | 1.There is no convincing evidence of recurrence of tumor or cervical adenopathy by CT size criteria.2.Interval complete resolution of small focus of fluid-like accumulation at the level of graft. |
Generate impression based on findings. | 80 year old male. Reason: history of prostate cancer, rising PSA, assess for metastases. Fatty liver, chronic thrombocytopenia and alcohol use. ABDOMEN:LUNG BASES: Coronary artery calcifications. No acute infiltrates or effusions. LIVER, BILIARY TRACT: Cirrhotic morphology. SPLEEN: Autologous splenorenal shunt with varices in the left upper quadrant. Splenomegaly. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Focal nonobstructing calcification in the left lower pole. Left lower pole simple cyst. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Diffuse atherosclerotic calcifications. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Status post bilateral total hip replacements with the prostheses in expected position. There is metal streak artifact between the prostheses in the pelvis which limits evaluation of adjacent structures.OTHER: No significant abnormality noted | No definite metastatic disease. Hepatic cirrhosis. Splenorenal shunt. Splenomegaly. |
Generate impression based on findings. | Reason: hx NSIP/UIP autoimmune ILD, follow-up study History: hx NSIP/UIP autoimmune ILD, follow-up study LUNGS AND PLEURA: Patchy upper and lower lung zone reticular opacities with honeycombing and traction bronchiectasis are unchanged.Upper lung zone predominant ground glass opacities have regressed.No specific evidence of infection or failure.MEDIASTINUM AND HILA: Slightly large mediastinal lymph nodes are seen, consistent with interstitial lung disease.The main pulmonary artery diameter is 4.2 cm consistent with pulmonary arterial hypertension.Moderate to severe coronary calcifications are unchanged.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Left renal cystlike hypodensity grossly stable without contrast. | 1. Interstitial lung disease with reticular opacities and honeycombing unchanged.2. Mild regression of upper lobe predominant ground glass opacities. |
Generate impression based on findings. | Clinical question: Stroke. Signs and symptoms: Stroke. Unenhanced head CT:Summation demonstrates an acute right thalamic hematoma measuring 24 x 28 x 27-mm in size. There is evidence of dissection of hemorrhage into the ventricular system with resultant extensive blood in the right lateral ventricle and minimally in the third ventricle. There is minimal surrounding vasogenic edema. There is approximately 5 mm leftward deviation of midline.No evidence of ventriculomegaly.The CSF cisterns remain patent.There are moderate periventricular and subcortical patchy foci of low attenuation consistent with age indeterminate. Small less ischemic strokes. There is also a focus of encephalomalacia in the left inferior frontal lobe along the floor of anterior cranial fossa, of unknown etiology, | 1.Acute right thalamic hematoma measuring 24 x 28 x 27-mm with evidence of dissection into the ventricular system with significant right lateral ventricular blood and minimally in the third ventricle.2.No ventriculomegaly.3.Approximately 5 mm midline shift to the left.4.Moderate age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Reason: h/o lung cancer s/p chemo check response History: doe CHEST:LUNGS AND PLEURA: Right upper lobe scar like opacities continue to decrease in intensity.Right upper lobe small ground glass nodule image 30 series 4 is consistent with atypical adenomatous hyperplasia.Mild scarring right lung base.MEDIASTINUM AND HILA: New low right paratracheal lymphadenopathy is present, with an 18 x 26 mm node image 35 series 3.Other slightly large lymph nodes are stable.Severe coronary artery calcification is present.A right jugular central line terminates at the SVC/RA junction level.Small hiatal hernia present.CHEST WALL: Degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Small accessory splenule 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: Degenerative abnormalities are present in the lumbar spine.OTHER: No significant abnormality noted. | New right paratracheal lymph node consistent with recurrent disease. |
Generate impression based on findings. | Clinical question: Fall. Signs and symptoms: Headache. Nonenhanced head CT:There is no evidence of acute posttraumatic intracranial, calvarial or soft tissues of the scalp. Findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF, cisterns, and gray -- white matter differentiation.There is anatomical variation of partially empty sella.There is mild prominence of cerebellar vermian folia for patient's stated age of 53.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.All paranasal sinuses and bilateral mastoid air cells and medullary cavities are well pneumatized. | No acute posttraumatic findings. Please see above comments. |
Generate impression based on findings. | 59-year-old male status post liver transplant presenting with nausea and vomiting ABDOMEN:LUNG BASES: Moderate right small left sided pleural effusion and dependent atelectasis. Extensive varices in the posterior mediastinum.LIVER, BILIARY TRACT: Hepatic vasculature is patent. There is mild periportal edema. No evidence of biliary dilatation. No focal liver lesions. Small amount of fluid around the liver likely postsurgical. Periportal adenopathy.SPLEEN: Splenomegaly, unchanged.PANCREAS: Interval thrombosis of the softs of varices within/around the pancreas. Otherwise pancreas is unremarkable.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites. Proximal small bowel dilatation measuring up to 3.5-cm. Distal small bowel loops are collapsed. These findings may be compatible with a mild partial small bowel obstruction.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Findings suggestive of mild partial distal small bowel obstruction. Changes secondary to liver transplant. |
Generate impression based on findings. | Relapsed rhabdomyosarcoma. Pre-therapy evaluation. Back pain. CHEST:LUNGS AND PLEURA: No focal opacity is present. No pleural effusion is identified.MEDIASTINUM AND HILA: Heart size is normal. Left hilar lymph node is no longer appreciated.CHEST WALL: Right chest port tip is in right atrium. Left paraspinal soft tissue has almost completely resolved.ABDOMEN:LIVER, BILIARY TRACT: Normal enhanced min. No biliary dilatation. Gallbladder is normal in appearance.SPLEEN: Normal in appearance.PANCREAS: Soft tissue mass adjacent to tail of pancreas now measures 2.2 x 1.9 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric enhancement. No pelvicaliceal dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenojejunal junction is normally positioned. No dilated bowel is seen.BONES, SOFT TISSUES: No free peritoneal air or fluid is present.OTHER: Retroaortic left renal vein is present, normal variant anatomy. Prominent mesenteric vessels are again visualized.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: Multiple lumbar Schmorl's nodes are identified.OTHER: A small amount of pelvic free fluid is present. | Decrease in size of mass adjacent to tail of pancreas. Almost complete resolution of left paraspinal mass. |
Generate impression based on findings. | 79-year-old female with stage IV metastatic melanoma. Reason: Re-evaluate disease status following completion of systemic therapy; compare to previous scan and provide bi-dimensional measurements. History: Stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Right apical reference nodule (series 4 image 16) is not changed in size and measures 0.8 x 0.9 cm.MEDIASTINUM AND HILA: Right paratracheal lymph node (series 3, image 32) measures 1.1 x 1.0 cm, not significantly changed. Small amount of pericardial effusion or thickening is new. CHEST WALL: No change in thyroid nodules. No other significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Benign cysts are unchanged. Status post cholecystectomy. 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: Enlarged left periaortic lymph nodes with reference node (series 3, image 116) measures 1.7 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant change is noted -- small atrophic uterus and left adnexal calcifications unchanged.BLADDER: No significant abnormality noted.LYMPH NODES: Slightly enlarged left external iliac lymph nodes are noted again unchanged. No other significant lymph node enlargement is seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Stable right upper lobe lung nodule. 2. Stable left retroperitoneal periaortic lymph node.3. No new lesions. |
Generate impression based on findings. | Reason: History of synovial sarcoma on treatment, evaluate for response and extent of disease History: History of synovial sarcoma on treatment, evaluate for response and extent of disease LUNGS AND PLEURA: Reference right middle lobe nodule (series 5 image 49) 11 x 11 mm, not significantly changed from 10 x 11 mm previously.Superior segment left lower lobe nodule (series 5 image 34) 22 x 25 mm, increased from 15 x 25 mm previously.Other nodules slightly increased or not significantly changed.Surgical staples bilaterally.MEDIASTINUM AND HILA: No significant lymphadenopathy.Catheter tip in the SVC.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. | Slight increase in size of several pulmonary nodules, consistent with metastases. |
Generate impression based on findings. | 71 year-old female. Abdominal distention. Evaluate for SBO. Reason: Ov Ca, disease progression History: increasing abdominal distention ABDOMEN:LUNG BASES: Moderate right and small left pleural effusions have slightly decreased since 9/14/2013. Bibasilar atelectasis. Coronary artery calcifications. LIVER, BILIARY TRACT: Cholecystectomy clips. Hypodense segment 6 liver lesion is not significantly changed (series 3, image 41). Calcified peritoneal disease on the liver surface, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Unchanged exophytic hypodense lesion in right lower pole of kidney, not significantly changed and likely a cyst. RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta. Ectatic proximal celiac artery measuring up to 1.2 cm in diameter (series 3, image 47), similar to prior exam. BOWEL, MESENTERY: Diffuse dilatation of small and large bowel without a distinct transition point, suggests ileus. Mesenteric lymphadenopathy is not significantly changed.Extensive calcification within the peritoneum likely reflects treated metastatic disease, including perihepatic, perisplenic, mesenteric, and paracolic gutter calcifications, not significantly changed. BONES, SOFT TISSUES: Sclerotic lesion in T11 vertebral body (coronal image 32), not significantly changed. Mixed lytic/sclerotic appearance of the left ischium and inferior pubic ramus, similar to prior exam. A few sclerotic foci in the right ilium are not significantly changed. OTHER: Infrarenal IVC filter. PELVIS:UTERUS, ADNEXA: Surgically resected. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diffuse dilatation of small and large bowel without a distinct transition point, consistent with an ileus. Calcification of the rectosigmoid mesentery.BONES, SOFT TISSUES: Sclerotic lesion in T11 vertebral body (coronals, image 28), not significantly changed. Mixed lytic/sclerotic appearance of the left ischium and inferior pubic ramus, similar to prior exam. A few sclerotic foci in the right ilium are not significantly changed.OTHER: Calcified pelvic mass appears stable in size on image 121 series 3. | 1. Diffuse small and large bowel dilatation suggests persistent ileus.2. Extensive peritoneal calcified disease, not significantly changed. Stable pelvic calcified mass.3. Segment 6 liver lesion is unchanged. 4. No significant interval change in bone lesions.5. Smaller right and small left pleural effusions. |
Generate impression based on findings. | 55 year old male. Reason: Assess vasculature to support transplant. History: Pre-kidney transplant evaluation ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenomegaly. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Minimal to no aortic calcifications. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Decompressed urinary bladder. LYMPH NODES: Bilateral pelvic lymphadenopathy. Nodes up to 2 cm in long axis are present in bilateral internal and external obturator regions and adjacent to the external iliac arteries. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Bilateral small fat-containing inguinal hernias | Minimal to no significant calcification of major vessels in the pelvis. Pelvic lymphadenopathy. Atrophic kidneys and decompressed urinary bladder. |
Generate impression based on findings. | 52 yo M with h/o glioblastoma on Avastin, one day of sharp pleuritic chest pain, developed new onset atrial flutter, rule out PE. PULMONARY ARTERIES: There is an acute pulmonary embolus in the distal right main pulmonary artery which extends into all right lobar arteries. Pulmonary emboli are also noted in the left lower lobar artery extending into segmental branches. Mildly enlarged main pulmonary trunk diameter is suggestive of pulmonary arterial hypertension.LUNGS AND PLEURA: Small bilateral pleural effusions, with overlying peripheral left lower lobe consolidation which may represent infarct and/or hemorrhage. Minimal right lower lobe atelectasis/consolidation is also noted. No suspicious pulmonary nodules or masses. MEDIASTINUM AND HILA: Mild cardiomegaly. An enlarged right heart and mild flattening of the interventricular septum are suggestive of right heart strain. No pericardial effusion. No evidence of intracardiac thrombus. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel degenerative disease of the visualized spine. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Extensive acute pulmonary emboli extending from the distal right main pulmonary artery into most lobar arteries as described above. 2.Areas of peripheral left basilar consolidation, consistent with infarct and/or hemorrhage. 3.Findings suggestive of pulmonary hypertension and right heart strain. |
Generate impression based on findings. | Metastatic prostate carcinoma CHEST:LUNGS AND PLEURA: Stable right lower lobe nodule best seen on image 59 of series 4 measuring 0.8 x 0.6 cm; other micronodules also stable.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Stable sclerotic bony metastatic fociABDOMEN:LIVER, BILIARY TRACT: No significant change in bilobar low attenuation foci. Reference segment 7 lesion best seen on image 90 of series 3 measures 3.2 x 1.7 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable sclerotic bony metastatic fociOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable metastatic sclerotic foci within the right pubic ramusOTHER: No significant abnormality noted | Stable examination |
Generate impression based on findings. | 50 year old female. Reason: Severe iron deficiency anemia, r/o small bowel source History: as above; EGD/colon negative. ABDOMEN:LUNG 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: Nonspecific left kidney hypodense foci likely represent simple cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Satisfactory distension of the bowel. Heterogeneous material in the gastric antrum. No evidence of hemorrhage or mass in the bowel. The bowel wall is normal in appearance. No free fluid in the abdomen/pelvis.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. | No source of hemorrhage in the bowel. |
Generate impression based on findings. | Male 48 years old Reason: left lower rib mass vs soft tissue? History: left lower rib mass vs soft tissue? LUNGS AND PLEURA: Numerous pulmonary micronodules and granulomas, likely post infectious in etiology. Reference 11-mm (image 81, series 4) left lower lobe nodule with diffuse internal calcification consistent with granuloma. MEDIASTINUM AND HILA: Enlarged calcified hilar and mediastinal lymph nodes consistent with prior granulomatous disease.CHEST WALL: Mild degenerative changes of the thoracic and cervical spine. No abnormal soft tissue mass identified within the chest wall as clinically questioned.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Calcific foci seen in the hepatic and splenic parenchyma consistent with prior granulomatous disease. | No abnormal osseous or soft tissue mass identified as clinically questioned. Evidence of prior granulomatous disease. |
Generate impression based on findings. | Rectal carcinoma CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable low attenuation focus within segment 7 of the right lobe of the liver best seen on image 85 of series 3 measuring 0.5 x 0.7 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable duodenal diverticulum.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: Nonspecific thickening of the rectal wall associated with perirectal soft tissue infiltrationBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Nonspecific thickening of the rectal wall associated with peri-rectal soft tissue infiltration; favor post therapeutic changes rather than metastatic disease. Otherwise stable examination. |
Generate impression based on findings. | 71 year old male. Reason: Eval for leak from gastrectomy site and for resolution of infected fluid collections in chest abdomen and pelvis with attention to pancreas History: S/P Partial Gastrectomy and Pancreatic Pseudocyst drainage / Fluid Collections of chest and abdomen - suspected to be infectious CHEST:LUNGS AND PLEURA: Left pleural effusion is unchanged.MEDIASTINUM AND HILA: Stable mediastinal fluid collection measures 10.0 x 2.5 cm (series 3, image 54), previously 9.5 x 2.5 cm. Postsurgical changes compatible with orthotopic heart transplant are again seen.CHEST WALL: Small fluid collection anterior to the sternum measures 14 x 10 mm, previously 19 x 11 mm (series 3, image 20). Decrease in body wall anasarca.ABDOMEN:LIVER, BILIARY TRACT: Hepatic vasculature appears patent. No intra-or extrahepatic biliary ductal dilatation.SPLEEN: Decreasing splenic ascites.PANCREAS: A percutaneous catheter is in place with its tip in the region of previously seen pancreatic fluid collection, which has resolved.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive stones bilaterally.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes.BOWEL, MESENTERY: No evidence of obstruction. Decreasing free intraperitoneal air, is likely postprocedural. No new drainable fluid collection is evident. A gastrostomy tube is in place. Status post partial gastrectomy. No evidence of leak from gastrectomy site. BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.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. | 1.No evidence of leak from gastrectomy site.2.Resolution of pancreatic fluid collection.3.Stable mediastinal fluid collection.4.Decreasing fluid collection anterior to the sternum. |
Generate impression based on findings. | Reason: h/o HNC, compare to previous, measurements pls, h/o CRT History: none LUNGS AND PLEURA: Mild basilar scarring. No suspicious nodules.MEDIASTINUM AND HILA: Moderately enlarged high right paratracheal lymph node measuring 7 mm in short axis, unchanged.No other significant lymphadenopathy.Tracheostomy tube in place.CHEST WALL: Focal sclerosis in the T12, unchanged and likely benign.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Gastrostomy tube in place. | No evidence of metastases. |
Generate impression based on findings. | Male; 57 years old. Reason: r/o metastases, evaluate for coronary calcifications History: active on the liver transplant waiting list, HCV/ETOH cirrhosis, HCC. LUNGS AND PLEURA: No new or suspicious pulmonary nodules are identified. No focal air space opacity or pleural effusion. Scattered micronodules, some of which are calcified, appear unchanged since the prior study. Mild, predominantly paraseptal emphysema is unchanged. MEDIASTINUM AND HILA: There are mild coronary calcifications, with at least one calcified plaque visualized in the region of the left anterior descending artery (series 4, image 54). However, it should be noted that this study is not gated and thus not optimal for the detection of coronary artery calcifications. No mediastinal or hilar lymphadenopathy. A calcified right hilar lymph node is compatible with prior granulomatous disease and unchanged. Normal heart size without pericardial effusion. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Nodular liver contour with partially radiopaque lesions in the peripheral right lobe and near the gallbladder fossa s/p ablation procedures. Cholelithiasis. | 1.No evidence of metastatic disease. 2.Mild coronary calcifications with at least one discrete plaque visualized in the LAD, although this study is non-gated and thus not optimal for coronary calcium detection. 3.Primary liver lesions presumably representing HCC s/p ablation as described above. |
Generate impression based on findings. | 78-year-old male with history of IBD and admitted with multiple abscesses on outside CT ABDOMEN: LUNG BASES: Bilateral small pleural effusions, decreased in size compared to previous study.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: No significant abnormality noted.BOWEL, MESENTERY: There is an abscess measuring 5.5 by 4.4-cm image number 95, series number 3 in the left lower quadrant. The abscess is adjacent to the sigmoid colon. More inferiorly there is another collection adjacent to the sigmoid colon on the left side measuring 6.4 by 4.4-cm image number 118, series number 3.A third abscess on the right side of the sigmoid colon more inferiorly measures 4.3 x 2.6 cm image number 180, series number 3. The wall of the sigmoid colon this thickened. Adjacent small bowel loops also demonstrate mild wall thickening without evidence of obstruction. There are smaller interloop collections between the small bowel loops.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: Please see the discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Multiple abscesses adjacent to the sigmoid colon between the small bowel loops in the lower abdomen and in the pelvis, most on the left side. Adjacent small bowel loops and sigmoid colon demonstrate mild wall thickening consistent with inflammation. |
Generate impression based on findings. | Recurrent ascites. Evaluate IVC ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypodense lesions in the liver are unchanged from previous study. Their etiology is unknown.SPLEEN: Small infarct is unchanged. PANCREAS: Dilated pancreatic duct throughout its course is unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Numerous cysts and atrophic kidneys are unchanged.RETROPERITONEUM, LYMPH NODES: IVC and common iliac veins are patent. Diffuse atherosclerotic changes involving the entire abdominal aorta iliac arteries and major vessels of the aorta, unchanged.BOWEL, MESENTERY: Significant amount of ascites and peritoneal carcinomatosis, unchanged.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: Changes secondary to end-stage kidney disease.OTHER: No significant abnormality noted | Findings consistent with end-stage renal disease.Small hypodense lesions in the liver, small splenic infarct, ascites and carcinomatosis are unchanged.Diffuse atherosclerotic changes involving the aorta and its major branches. IVC and iliac veins are patent. |
Generate impression based on findings. | Pancreas cancer CHEST:LUNGS AND PLEURA: Bilateral scattered micronodules. An index nodule in the right lower lobe measures 3 mm on image number 53, series number 10. These nodules are suspicious for metastatic disease.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: A 2.9 x 1.9 cm hypodense lesion in the caudate lobe of the liver in image number 17, series number 12, suspicious for metastatic disease. There is another more inferior lesion invading the right diaphragmatic cruise again consistent with metastatic disease. There are also other perihepatic peritoneal deposits consistent with peritoneal carcinomatosis.SPLEEN: No significant abnormality noted.PANCREAS: Patient's known pancreatic body mass is unchanged measuring 3.5 by 3.2 cm on image number 98, series number 12. Pancreatic ductal dilatation is unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Metastatic retroperitoneal adenopathy, again noted and measures 3.7 by 3.5-cm image number 119, series number 12, not significantly changed from previous study.BOWEL, MESENTERY: Peritoneal carcinomatosis, again noted. Index nodule around the liver is increased in size and now measures 1..3 x 0.9 cm on image number 109, series number 12.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: Peritoneal carcinomatosis. Index lesion underneath the abdominal wall now measures 9-mm in diameter image number 159, series number 12. Second index nodule now measures 1.2-cm in diameter image number 169, series number 12, increased in size compared to previous study.BONES, SOFT TISSUES: UnremarkableOTHER: No significant abnormality noted. | Interval increase in the peritoneal carcinomatosis. Patient's known pancreatic body mass, unchanged. Liver metastases and lung metastases. |
Generate impression based on findings. | 69-year-old male with fluid collection are real transplant and sepsis The study is limited due to lack of IV contrast.ABDOMEN:LUNG BASES: Patchy air space opacities in the lung bases and bilateral large pleural effusions, again noted. These may represent early pneumonia.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Atrophic kidneys.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Generalized anasarca.OTHER: Right iliac fossa transplanted kidney. No evidence of collection around the transplant kidney. No evidence of hydronephrosis.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small amount of ascites. Generalized anasarca.OTHER: No significant abnormality noted | Limited study due to lack of IV contrast. No evidence of peritransplant fluid collection.Large bilateral pleural effusion and bilateral airspace opacities at the lung bases, not significantly changed from the dedicated chest CT performed on 9/25/2013 |
Generate impression based on findings. | History of lymphoma CHEST:LUNGS AND PLEURA: Biapical scarring.MEDIASTINUM AND HILA: Small mediastinal lymph nodes. Index pretracheal node measures 1.2 by 0.7 cm on image number 35, series number 3.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: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Small bilateral pelvic lymph nodes. Index right inguinal node measures 1 cm in diameter image number 195, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Small mediastinal and pelvic lymph nodes as described above. |
Generate impression based on findings. | History of surgery for polymorphic adenocarcinoma. Evaluate for recurrence. There is significant mucosal thickening and enhancement within the fluid-filled right maxillary sinus. The enhancing component is somewhat thickened, though is uniform circumferential. A stable postoperative bony defect is demonstrated at the inferior/posterior aspect of the sinus extending along the alveolar ridge from the anterior aspect of the lateral pterygoid to the level of the right canine. The remaining paranasal air sinuses are unremarkable.There are a few prominent level 3 nodes bilaterally, but these are within normal limits by strict size criteria and are unchanged from the prior exams. There is no supraclavicular lymphadenopathy. The oro-, naso-, and hypopharynx are normal. The larynx and subglottic airways are normal. The epiglottis, vallecula, puriform sinus and vocal cords are normal.The orbits, skull base and visualized intracranial structures are unremarkable. The parotid, submandibular and thyroid glands are unremarkable. The carotid and jugular veins are patent. | 1.Postsurgical findings within the floor of the right maxillary sinus.2.Significant enhancing component of thickening with right maxillary sinus. This is prominent, though there are no aggressive features and this is felt to represent benign mucosal thickening.3.No CT evidence of lymphadenopathy or obvious tumor spread. |
Generate impression based on findings. | Gross hematuria CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM 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: Subcentimeter right renal cyst. Otherwise unremarkable kidneys without evidence for mass, inflammation, or stone. Unremarkable collecting systems bilaterallyRETROPERITONEUM, 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: Enlarged prostateBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No GU related abnormality. Enlarged prostate. No evidence for acute, inflammatory, or neoplastic process |
Generate impression based on findings. | 55 year old female. Reason: r/o perforation History: increasing abdominal distention and pain ABDOMEN:LUNG BASES: Small pleural blebs. Trace amount of fluid along the major fissure in the upper portion of the lung.LIVER, BILIARY TRACT: Cirrhotic liver morphology. Cholelithiasis with sludge in a distended gallbladder. No evidence of gallbladder wall thickening or ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small subcentimeter renal cyst in the right kidney. Small subcentimeter cyst in left kidney. Calcified, nonobstructing stone in the left kidney. Redemonstration of the partially exophytic hypodense lesion in left kidney, unchanged compared to prior exam.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: NG tube. Moderate amount of ascites. Moderately dilated, predominately fluid filled colon. The right colon is predominantly fluid-filled. The left colon is relatively decompressed. No free intraperitoneal air. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Foley catheter.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of intra-abdominal free air to suggest perforation.2.Moderately distended, predominately fluid filled right colon with a relatively more decompressed left colon. These findings are suggestive of colonic ileus.3.Cholelithiasis with sludge in a distended gallbladder without evidence of gallbladder wall thickening or ductal dilatation to suggest acute cholecystitis.4.Cirrhotic liver with a moderate amount of ascites. |
Generate impression based on findings. | Female, 44 years old, history of Graves' and HIV with diplopia and proptosis, os>od. The right optic nerve looks full. Question interval change in muscle size, apex crowding. Visual field testing is normal. The globes are proptotic, again left greater than right, but unchanged compared to the prior examination. The globes are round and symmetric. The lenses are normal in position. No abnormalities of the intraconal or extraconal orbital fat are demonstrated.The left superior, lateral and inferior recti muscles demonstrate a very slight increased caliber and slight hypodensity relative to their right-sided counterparts. This finding has not significantly changed. Despite this mild size discrepancy, the caliber of the extra-axial muscles as a whole still falls within normal limits.The right optic nerve-sheath is slightly fuller than the left. This difference is on the order of 1 mm or less, and again, has not substantially changed. Please note that CT cannot distinguish whether this reflects prominence of the nerve sheath, expansion of the nerve, or a combination of both. Furthermore, the significance of this finding is uncertain as some degree of asymmetry can be normal. | Very mild prominence of the left-sided extraocular muscles, along with mild hypodensity of the left-sided muscles, is a stable finding and suggests the sequela of prior inflammation, perhaps related to the patient's known Graves' disease. The globes remain proptotic.Very mild prominence of the right optic nerve sheath complex relative to the left, is also unchanged. The significance of this finding remains uncertain. |
Generate impression based on findings. | 46-year-old male with history of left retromolar trigone squamous cell cancer status post radiation and surgery. Postsurgical changes of a left-sided mandibulectomy and partial maxillectomy with flap placement are again seen. The soft tissue thickening along the left neck extending to the left inferotemporal fossa and parotid space is similar to the prior exam. The submandibular glands are absent. A tracheostomy tube is in place.The nodule posterior to the right thyroid gland is similar to prior, measuring 9 mm (7/68), previously 10 mm. The nodule at the right tracheoesophageal groove is similar to prior, measuring 12 x 6 mm (7/75), previously 12 x 10 mm. Additional small paratracheal nodules are unchanged. No cervical lymphadenopathy is otherwise seen, by CT size criteria.The cervical vasculature appears patent. The parotid and thyroid glands appear normal.The nasopharynx, oropharynx, oral cavity, hypopharynx, larynx, and subglottic airway are patent and within normal limits.Periapical lucencies at multiple teeth are again seen. The osseous structures are otherwise unremarkable, without destructive lesions seen. There is no spinal canal stenosis.The intracranial contents and orbits are unremarkable.The maxillary retention cysts, largest on the left, are similar to prior. The left sided mastoid air cell opacification is unchanged.The visualized lung apices are unremarkable. | Post-operative changes, without definite evidence of disease recurrence or cervical adenopathy |
Generate impression based on findings. | 81 year old female. Reason: r/o cad History: chest pressure Height: 5'6"Weight: 154 lbsBSA: 1.8 m^2BMI: 25 kg/m^2Cardiac Morphology:Left Ventricle:EDV: 116 ml The left ventricle is normal in size, shape, wall thickness, and volume. Right Ventricle:EDV: 107 ml The right ventricle is normal in size, shape, wall thickness, and volume. Left Atrium: The left atrial volume minus the pulmonary veins is 128 cc. There are four distinct pulmonary veins which drain normally into the left atrium.Right Atrium: The right atrial volume is within normal limits. The right atrium is structurally normal. Cardiac Veins: The coronary sinus is normal.Cardiac Valves: There are no aortic calcifications. There is no mitral annular calcification.Great Vessels: Aorta: The aortic arch is left sided. The brachiocephalic vessels branch normally from the arch. Visualized portions of the aorta demonstrate no evidence of dissection or aneurysm. Largest dimensions of the thoracic aorta are as follows:Sinuses of Valsalva: 32 mm Ascending: 31 mm Sinotubular Junction: 25 mm Descending: 21 mmPulmonary Artery: There is extrinsic narrowing of the main PA by a thrombosed aneurysm in the LCx bypass graft. Main PA: 16 mmRight PA: 21 mmLeft PA: 22 mmVena Cavae: The SVC is normal in size and without structural abnormality. The IVC is normal in size and without structural abnormality.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Calcium Score:LM: 0LAD: 286.7LCx: 410.1RCA: 258.88Total: 955.7, This represents the 93% for this patient's age and gender.Coronary Artery Anatomy:LM: The left main coronary artery arises normally from the left sinus of valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no significant plaque in the left main.LAD: The LAD gives rise to the diagonal and septal branches. There is dense calcification in the LAD which precludes accurate assessment of stenosis severity.LCx: The left circumflex artery gives rise to the obtuse marginal branches. There is dense calcification in the LCx which precludes accurate assessment of stenosis severity.RCA: The RCA arises normally from the right sinus of valsalva. It is the dominant coronary artery giving rise to the posterior descending artery and a posterolateral branch. There are dense calcifications in the RCA precluding accurate assessment of stenosis severity.CORONARY ARTERY BYPASS GRAFTS:There are 3 patent aorto-coronary bypass grafts. All originate on the ascending aorta and connect to the distal RCA, LAD and LCX coronary arteries. There is a partially thrombosed aneurysm near the LCx bypass anastomosis that measures 3 cm in diameter. EXTRACARDIAC CHEST | 1. Status post coronary artery bypass grafts to RCA, LAD and LCx. All CABGs are patent. Extensive calcific coronary artery disease limits detailed evaluation of coronary anatomy.2. Normal ventricular volume and morphology.3. Calcium score 955.7; This represents the 93% for this patient's age and gender.4. Partially thrombosed 3 cm aneurysm near the LCx bypass graft anastomosis. |
Generate impression based on findings. | Left sided nasal congestion The frontal sinuses, frontal-ethmoid recesses, anterior/posterior ethmoids, and sphenoid sinuses are well developed and clear. There is minimal mucosal thickening at the floors of the maxillary sinuses. There is clearing of the previously-seen paranasal sinus hemorrhage.The nasal septum is midline. There is minimal mucoid debris in the left nasal cavity, without significant narrowing of the nasal airway. The osteomeatal complexes are normal with intact uncinate processes and patent infundibuli.The cribriform plate, fovea ethmoidalis and lamina papyraceae appear normal. The osseous structures are unremarkable.The visualized portions of the mastoid air cells are clear. Limited view of the intracranial structures is unremarkable. There is a punctate focus of high density near the medial aspect of the right globe anterior chamber, suspicious for a foreign body. The retro-orbital spaces are unremarkable. | 1. No evidence of active sinus disease2. Interval clearing of the previously-seen paranasal sinus hemorrhage. |
Generate impression based on findings. | Male, 65 years old, with cervical and lumbar radiculopathy. C-spine:Surgical changes demonstrated in the cervical spine, new from the prior MRI, most suggestive of laminoplasty from levels C3 through C7. There are small defects in the lamina bilaterally at these levels which are bridged by plate and screw devices. No obvious hardware consultations are seen on this exam.Since the prior MRI, the patient has developed reversal of the normal cervical lordosis. There is also a grade 1 anterolisthesis of C3 relative to C4. Vertebral body heights are grossly preserved. There is no evidence of acute fracture.Degenerative disk and endplate change is demonstrated at all levels. Uncovertebral hypertrophy is evident at almost every level. There are posterior disk osteophyte complexes as well at most levels. At no point is there any high grade narrowing of the bony spinal canal, though please note that CT is insensitive for evaluation of intracanalicular soft tissue such as disk material or ligamentous thickening.Foraminal narrowing is noted as follows:C2-3: Moderate bilateral.C3-4: Severe bilateral.C4-5: Moderate bilateral.C5-6: Moderate bilateral.C6-7: Severe left, mild right.C7-T1: No significant narrowing.L-spine:Overall vertebral body height is grossly preserved. Very mild retrolisthesis of L3 relative to L4 is noted. No acute fractures are seen.Degenerative disk and endplate changes are evident at all levels which will be discussed by level as follows:T12-L1: Mild facet hypertrophy. Schmorl's node deformities. Mild bulging disk. No significant canal compromise. Mild bony and soft tissue foraminal encroachment.L1-2: Moderate facet and ligamentum flavum hypertrophy. Mild loss of disk height. Schmorl's node deformities, one of which is quite deep involving the superior endplate of L2. Mild bulging disk. Borderline canal compromise. Significant bony and soft tissue foraminal encroachment.L2-3: Mild facet hypertrophy. Schmorl's node deformities. Mild bulging disk. Borderline spinal canal compromise. Significant bilateral bony and soft tissue foraminal encroachment. L3-4: Moderate facet and ligamentum flavum hypertrophy. Severe degenerative disk disease with loss of disk height, very bulky left anterolateral osteophyte formation, and severe endplate irregularity/sclerosis. Mild bulging disk. No significant spinal canal compromise. Severe bony and soft tissue encroachment upon the bilateral foramina. L4-5: Severe facet and moderate ligamentum flavum hypertrophy. Schmorl's node deformities. Mild bulging disk. Mild compromise of the spinal canal. Significant bilateral soft tissue and bony foraminal encroachment.L5-S1: Moderate bilateral facet and ligamentum flavum hypertrophy. Mild bulging disk. Significant bilateral bony and soft tissue foraminal encroachment.Aortoiliac atherosclerotic calcifications noted. A left kidney is not present and there are surgical clips within the left renal bed suggesting nephrectomy. Several likely cystic lesions are noted in the right kidney. | 1. Postoperative change in the cervical region is seen consistent with laminoplasty, a new finding when compared to the MRI examination from 2006.2. There does not appear to be any significant narrowing of the bony spinal canal in the cervical region, but please note that CT is insensitive for soft tissue processes which may result in encroachment such as disk herniations or ligamentous thickening.3. Scattered foraminal narrowing in the cervical region most severe at C3-4 and C6-7. 4. Extensive degenerative changes involving every level of the lumbar spine. These are most severe at L1-2 and L3-4 where there is significant loss of disk height and advanced endplate degeneration/irregularity as well as deep Schmorl's node defects.5. At most mild encroachment upon the lumbar spinal canal is seen at several levels as detailed above. Significant foraminal narrowing affects most levels in the lumbar region. |
Generate impression based on findings. | Female 64 years old. Reason: cholangiocarcinoma; please evaluate for extent of disease progression. History: ascites; pain CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Percutaneous cholecystostomy and biliary stent in place with expected pneumobilia. No intrahepatic or extrahepatic biliary dilatation. SPLEEN: No significant abnormality notedPANCREAS: No evidence of calcifications or hemorrhage. No ductal dilatation. No peripancreatic fat stranding or fluid.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multifocal small calcifications consistent with nephrolithiasis in the left upper and left lower pole. Mildly malrotated right kidney with no evidence of nephrolithiasis.No evidence of hydronephrosis or hydroureter. No evidence of perinephric fat stranding.RETROPERITONEUM, LYMPH NODES: Scattered small retroperitoneal nodes.Atherosclerotic changes in the aorta. No evidence of aneurysm.BOWEL, MESENTERY: No evidence of bowel wall thickening or dilatation. No free loculated intraperitoneal fluid. Scattered small nodes. BONES, SOFT TISSUES: Subcutaneous injection sites.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Subcutaneous injection sites.OTHER: No significant abnormality noted | Biliary stent in place with expected pneumobilia. Decompressed gallbladder with cholecystostomy. The cholecystitis seen on the prior exam may have resolved. Minimal inflammatory changes surround the gallbladder. Nephrolithiasis of left kidney without obstruction.No ascites. |
Generate impression based on findings. | 49-year-old male. Reason: Eval for hematoma or abscess following lap chole. Hx of klebsiella bacteremia. Hx LVAD. History: RUQ pain and elevated WBC. CHEST:LUNGS AND PLEURA: Small pleural effusions have resolved. Ground glass opacities and septal thickening consistent with pulmonary edema.MEDIASTINUM AND HILA: Multiple small and prominent mediastinal lymph nodes, not significantly changed from 2012 CT. Cardiomegaly. LVAD produces significant streak artifact obscuring adjacent structures. Coronary artery calcifications.CHEST WALL: Median sternotomy. Mild compression deformities of T6 and T7 vertebral bodies. ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesion. Status post cholecystectomy. The cholecystostomy tube has been removed. Increased perihepatic fluid at the inferior right lobe. New loculated/drainable collection is identified in the gallbladder fossa and inferior liver that may be due to a biloma. Surgical clips in the right upper quadrant. Prehepatic percutaneous surgical drain. SPLEEN: Status post splenectomy. Splenule is noted. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality noted. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the abdominal aorta. No retroperitoneal lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No loculated fluid collection or abscess is identified. Trace ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality noted. No bowel obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Small bilateral fat containing inguinal hernias. No loculated fluid collection or abscess is identified. | 1. The cholecystostomy tube and gallbladder have been removed since the prior exam.2. New large loculated fluid collection extends from the gallbladder fossa, suspicious for biloma. This collection may be infected. 3. Diffuse ground glass opacities and septal thickening consistent with pulmonary edema are stable. Small pleural effusions have resolved. |
Generate impression based on findings. | 6-year-old male with a floor of mouth mass. There is a 3.6 x 1.4 cm tubular fluid-filled structure in the left sublingual space, superior to the mylohyoid muscle. There is no surrounding inflammatory change. This is most compatible with a simple ranula.No cervical lymphadenopathy is seen.The cervical vasculature appears patent. The parotid, submandibular, and thyroid glands appear normal.The nasopharynx, oropharynx, oral cavity, hypopharynx, larynx, and subglottic airway are otherwise patent and within normal limits.The osseous structures are unremarkable. The neural foramina and spinal cord appears within normal limits.The intracranial contents and orbits are unremarkable.There is moderate frothy mucosal thickening of the maxillary sinuses. | 1. 3.6 cm tubular fluid filled structure in the left sublingual space, most compatible with a simple ranula.2. Frothy mucosal thickening of the maxillary sinuses. Correlation with symptoms of acute sinusitis is recommended. |
Generate impression based on findings. | Male 48 years old; Reason: s/p radiolunate fusion History: s/p radiolunate fusion. Plate and screws affix the distal radius to the lunate. The alignment is near anatomic. No hardware complications are evident. Fragments of fusion products from an attempted fusion are visualized adjacent to the radiolunate articulation. A soft tissue density structure about the radial aspect of the distal wrist is indeterminate but may be related to a dilated venous structure, possibly a dialysis fistula. | No evidence of hardware complication following a radiolunate fusion. |
Generate impression based on findings. | 35-year-old female Reason: achondroplasia w/ R knee OA - evaluate for preop planning History: as above. There is shortening of the femur with flaring of the metaphysis. Severe joint space narrowing and tricompartmental osteophytes compatible with severe osteoarthritis is noted about the knee joint. There is anterior compartment muscle atrophy in the lower extremity as well as mild hamstring muscle atrophy. No fracture or effusion is evident. | Severe tricompartmental osteoarthritis of the right knee with changes from achondroplasia. |
Generate impression based on findings. | Male, 51 years old, history of larynx cancer status post surgery. Postsurgical change is redemonstrated consistent with laryngectomy, tracheostomy and left pectoralis flap reconstruction. No new soft tissue mass or pathologic enhancement is demonstrated in the surgical region to suggest recurrent disease.There are no definite pathologic lymph nodes in the neck by size criteria. A right level 1b lymph node has mildly increased in size measuring 1.4 x 1.0 cm (image 49 series 5), previously 1.2 x 0.9 cm. This slight interval change may simply be reactive, but continued attention to this area should be paid on subsequent exams.The salivary glands are free of focal lesions. The right thyroid lobe is unremarkable. The left thyroid lobe and isthmus have been excised.The cervical vessels are patent and unremarkable. Lung apices show no significant abnormality.No concerning bony changes are seen. Anterior fusion hardware is redemonstrated at C4 through C6. | No definite evidence of recurrent disease. Very mild interval increase in the size of a right level Ib lymph node is seen which may simply be reactive. Continued attention to this site on follow up exams is suggested. |
Generate impression based on findings. | Large right popliteal DVT. PULMONARY ARTERIES: Multiple bilateral subsegmental clots are present, sparing the upper lobes.LUNGS AND PLEURA: No focal opacity is identified. A pleural effusion is not seen.MEDIASTINUM AND HILA: Heart size is normal. No mass is identified.CHEST WALL: Normal in appearance.UPPER ABDOMEN: Normal in appearance. | Multiple subsegmental pulmonary emboli. |
Generate impression based on findings. | New large deep venous thrombosis. ABDOMEN:LUNG BASES: No focal opacity is seen.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 enhancement. No pelvicaliceal dilatation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Duodenojejunal junction is normally placed.BONES, SOFT TISSUES: Minimal anterior wedging of T12 is seen.OTHER: No free air or free fluid is present.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 significant abnormality noted | Normal examination of the abdomen and pelvis. |
Generate impression based on findings. | Reason: IVH History: IVH Atherosclerotic calcifications are present along the distal internal carotid arteries.There is intraventricular blood present involving the lateral ventricles , the third ventricle and fourth ventricle but no sulcal effacement.A ventriculostomy tube courses through the right frontal lobe into the right lateral ventricle with tip in region of foramen of Monro in stable position relative to the prior exam. Biventricular diameter on coronal imaging at the level of the entry point of the ventriculostomy tube is currently 31 mm and was previously 31 mm. A small air bubble is present in the right lateral ventricle which was not present on the prior exam.Some subarachnoid blood products are present in the posterior fossaNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrates a mucus retention cyst in the left maxillary sinus and minor opacities in the right ethmoid air cells and right maxillary sinus. No osteoma is present in the left frontal sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is redemonstration of intraventricular blood some posterior fossa subarachnoid blood and ventriculostomy tube all of which are stable since the prior exam. The lateral ventricles have not changed in size and are nondilated currently.2.A small air bubble is present in the right lateral ventricle which was not present on the prior exam. |
Generate impression based on findings. | Reason: evaluate for mass lesion History: Right eye proptosis CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift.Atherosclerotic calcifications are present along the distal internal carotid arteries.Periventricular and subcortical white matter hypodensities of a mild degree are present.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. The eyeball lenses are thin.CT orbits:The orbits are intact with no abnormal mass lesions in either orbit. There is no abnormal enhancement of the optic nerves. The visualized eyeballs are intact lacrimal glands are unremarkable. Extraocular muscles are intact. The suprasellar cistern is unremarkable.Visualized portions of the mastoid air cells and middle ears are clear. The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary sinus associated with a bony wall thickening. The visualized intracranial structures are within normal limits. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is mucosal thickening present in the left maxillary sinus which is probably inflammatory in nature and related to chronic sinusitis |
Generate impression based on findings. | Reason: increasing size of abdominal soft tissue infection, r/o worsening infection History: pain ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: There is no evidence of intrahepatic ductal dilatation or focal mass lesion. The hepatic vasculature appears patent and there is no evidence of cholelithiasis. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild mesenteric fat stranding adjacent to the periumbilical the collection and soft tissue inflammation without evidence of bowel involvement or intraperitoneal fluid collection.BONES, SOFT TISSUES: There is periumbilical subcutaneous fat stranding with extension posteriorly to the rectus abdominis muscle. Redemonstration of a fluid collection, now with new foci of air, measuring 2.1 x 4.0 cm, previously measuring 1.9 x 4.0 cm. OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Redemonstration of a heterogenous, partially cystic lesion in the right adnexa containing a calcified focus. Increased attenuation of the endometrial cavity.BLADDER: No significant abnormality notedLYMPH NODES: Scattered inguinal lymph nodes bilaterally.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval worsening of sub-cutaneous abscess extending to the rectus abdominis muscle with intraperitoneal fat stranding. 2.Redemonstration of a heterogeneous, partially cystic lesion in the right adnexa but a calcified focus. Pelvic ultrasound is recommended.3.Hyperattenuation of the endometrial cavity. Pelvic ultrasound is recommended. |
Generate impression based on findings. | Left hip pain, unable to bear weight, evaluate for fractureEXAMINATION: CT hips without intravenous contrast 9/26/2013 1748 BONES AND SOFT TISSUES: Sclerotic/lytic lesions are seen throughout the pelvis, sacrum, and proximal femurs have not significantly changed when compared with the prior study. A lytic lesion in the left acetabulum extends to the articular surface and is unchanged from the prior study. Periosteal reaction is now seen along the left iliac wing and left proximal femur. Well corticated ossific fragment measuring 9 x 3mm just medial to the left lesser trochanter is unchanged when compared with the prior study and may be from chronic avulsion. No acute dislocation. No joint effusion.PELVIS: No bowel obstruction or free intraperitoneal air. The bladder appears normal. The prostate and seminal vesicles are within normal limits for the patient's age. | 1.Multiple osseous metastases throughout the pelvis and proximal femurs. 2.New periosteal reaction along the iliac wing and left proximal femur. |
Generate impression based on findings. | 79-year-old male with history of neck pain. Evaluate for fracture or dislocation. Loss of the normal cervical lordosis is likely due to patient positioning normal spasm. Examination shows no evidence of a fracture or acute subluxation. Multilevel degenerative cervical spondylosis is present with bulky ventral and dorsal uncovertebral osteophytes, and inferior/superior endplate sclerosis, most pronounced at C4-C5 through C6-C7. Mild effacement of ventral aspect of the thecal sac at these levels with associated mild to moderate central canal stenosis, most pronounced at C5-C6 and C6-C7. Additionally there is moderate to severe bilateral neural foraminal stenosis at these levels. Atherosclerotic calcification at the bifurcation of the left common carotid artery is noted. Note is made of surgical clip along the right carotid space.The prevertebral soft tissues are within normal limits. | Severe degenerative disease which is unchanged without acute fracture or dislocation. |
Generate impression based on findings. | Male 65 years old Reason: 65 y/o M w/ metastatic CRC s/o percutaneous liver bx today now with SOB, and 3g Hb drop over <10 hours. please evaluate for an intraparenchymal bleed. History: pain The following observations are made given limitations of an unenhanced study.ABDOMEN:LUNG BASES: Subsegmental atelectasis at both lung bases with minimal effusions.LIVER, BILIARY TRACT: Innumerable liver lesions are again evident throughout the liver. There is no evidence of perihepatic or intrahepatic hemorrhage.SPLEEN: There is a round lesion adjacent to the medial aspect of the spleen, which likely represents a splenule, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are multiple subcentimeter retroperitoneal lymph nodes as noted previously.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No evidence of metastasis to the osseous structures of the abdomen or pelvis.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: There are multiple subcentimeter lymph nodes adjacent to the cecal lesion.BOWEL, MESENTERY: Presumed cecal mass with adjacent adenopathy again noted. Unchanged right inguinal hernia. There is no evidence of bowel strangulation within the hernia sac.BONES, SOFT TISSUES: No evidence of metastasis to the osseous structures of the abdomen or pelvis.OTHER: No significant abnormality noted | No substantial change compared to prior. No evidence of intra-abdominal hemorrhage. |
Generate impression based on findings. | Male; 56 years old. Reason: r/o PE History: hypoxia. PULMONARY ARTERIES: There is no evidence of pulmonary embolus. LUNGS AND PLEURA: Two right-sided chest tubes terminate in the apex. Severe predominantly upper zone centrilobular and paraseptal emphysema. Bibasilar ground glass opacities may represent edema. Small right pleural effusion with associated atelectasis. Left lower lung atelectasis is also present.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. There are mildly enlarged high prevascular, AP window, right paratracheal, and right hilar lymph nodes. Mild interval increase in size of subcarinal lymph node which measures 15 mm, previously 12 mm (series 7, image 143). Mild coronary artery calcifications. No evidence of left atrial appendage thrombus. CHEST WALL: Postsurgical changes and right chest wall deformity compatible with median sternotomy and right pectoralis flap reconstruction, with the flap bridging a stable area of diastasis between separated sternal fragments. Increased sclerosis of the separated medial sternal margins is possibly secondary to prior osteomyelitis. Associated surgical clips and surgical mesh which abuts the anterior pericardium. The anterior pericardium demonstrates discontinuous areas of thickening, which are adherent to the pectoral flap and retrosternal space. Subxiphoid mediastinal drain is in place, without evidence of an anterior mediastinal fluid collection. A large hyperdense lesion in the right chest wall measures 13.7 x 7 cm, and while incompletely imaged is compatible with a layered hematoma. Subcutaneous edema and emphysema are also noted. There is a healing left posterior rib fracture and displaced right posterior rib fractures, likely secondary to recent pectoralis reconstructioin. Mild axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. Kidneys are visualized through the superior poles and appear unchanged since the prior CT. | 1.No evidence of pulmonary embolus.2.Postsurgical changes s/p median sternotomy and right pectoralis flap reconstruction as described above, with several healing/displaced posterior rib fractures and large right chest wall hematoma. 3.Lower lung zone opacities compatible with edema and bibasilar atelectasis. |
Generate impression based on findings. | History of perforation. Evaluate for abscess. ABDOMEN:LUNG BASES: Moderate left pleural effusion with overlying compressive atelectasis. Small right pleural effusion. Ill-defined opacities at the right lung base could be followed as they are nonspecific.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measures 2.1 x 1.6 cm. This is nonspecific and could be better evaluated with a dedicated adrenal CT or MRI exam.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of free air or fluid collection identified in the upper abdomen. The small bowel appears somewhat edematous but there is no evidence of obstruction or significant dilatation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There is irregular, heterogeneous soft tissue density in the central portion of the uterus there is a nonspecific finding on CT but should be further evaluated with either ultrasound or MR. Pelvic varices may reflect venous congestion syndrome; correlate clinically.BLADDER: Small amount of air in the bladder presumably from recent instrumentation.LYMPH NODES: Left external iliac lymph node measures 1.9 x 1.1 cm (image 134; series 3).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Is free fluid and a small focus of air in the pelvic cul-de-sac. This measures approximately 9.4 x 3.3 cm (image 135; series 3). This currently does not exhibit mass effect and therefore is unlikely to represent an abscess at the current time. | 1. Indeterminate left adrenal mass. Suggest further evaluation with either dedicated adrenal CT or MRI. 2. Indeterminate uterine mass. Suggest further evaluation with either gynecologic ultrasound or pelvic MRI.3. Small amount of air and fluid in the cul-de-sac. Fluid does not appear loculated at the current time however follow-up scanning may be beneficial to confirm resolution.4. Bilateral pleural effusions (left greater than right) with overlying compressive atelectasis and ill-defined opacities at the right lung base.5. Small bowel edema.Findings discussed with clinical service (pager 3452) dictation. |
Generate impression based on findings. | Male 66 years old; Reason: 66 yo M with etoh cirrhosis c/b varices, scheduled for TIPS 9/27, needing CT abdomen liver protocol prior to procedure, please evaluate patency of vasculature History: etoh cirrhosis c/b esophageal, gastric, and rectal varices ABDOMEN:LUNGS BASES: Median sternotomy.LIVER, BILIARY TRACT: Liver contour: Liver contour is slightly nodular.Status post cholecystectomy.Features of portal hypertension: Trace perihepatic ascites and enlarged spleen.Portal vein: Portal vein is patent. Hepatic veins: Hepatic veins are patent.Hepatic artery: Conventional hepatic arterial anatomy.Lesions: Focal hyperenhancement in segment 5 of the liver without washout most likely a perfusion phenomenon. No suspicious hepatic lesions. SPLEEN: SplenomegalyPANCREAS: 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: Trace ascites.Mild right colonic wall thickening, probably related to portal hypertension.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Cirrhotic liver without suspicious hepatic lesion.2.Patent hepatic vascular.3.Portal hypertension with splenomegaly and trace ascites. |
Generate impression based on findings. | Male 75 years old; Reason: 75M POD1 s/p APR for rectal ca now with new O2 requirement and AFib w/ RVR History: O2 requirement, afib ABDOMEN:LUNGS BASES: Bibasilar lung atelectasis and consolidation.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: Postoperative changes with a left lower abdominal colostomy. Gas-filled loops of small bowel and mild distention of the stomach.BONES, SOFT TISSUES: Post operative changes in the right rectus muscle. Gas in the fascial planes of the body wall. AOTHER: No drainable fluid collections in the abdomen. Scattered trace left pericolonic fluid.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: Decompressed by Foley catheter.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post operative changes. Mobilization of the right rectus muscle to the pelvis.OTHER: Small fluid in the pelvis. | 1.Post operative changes, no drainable fluid collections.2.Gas-filled small bowel loops suggests ileus. |
Generate impression based on findings. | Female 57 years old; Reason: s/p hernia repair and bowel resection, now with epigastric abdominal pain History: epigastric pain ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: The liver is unremarkable for unenhanced technique. Gallbladder is mildly distended. There is pericholecystic fluid and possible trace surrounding inflammationSPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Post operative changes near the cecumBONES, SOFT TISSUES: Midline abdominal scarOTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified mass in the pelvis most likely representing a fibroid, suboptimally evaluated without contrast.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.Finding suspicious for for gallbladder pathology. Clinical correlation for right upper quadrant pain is recommended.2.Suboptimal evaluation due to the lack of intravenous and enteric contrast. |
Generate impression based on findings. | Male 41 years old; Reason: obstruction, ileus, perforation, cholecystitis, pancreatitis History: Worsening abdominal pain, distension, emesis in a patient with CML ABDOMEN:LUNGS BASES: Median sternotomy, gynecomastia, right anterior pleural thickening with fluid. Atelectasis in the right lower lung.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: SplenectomyPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst suboptimally evaluatedRETROPERITONEUM, LYMPH NODES: IVC filter. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Small bowel obstruction with the mobile small bowel loops dilated up to 4.0-cm. Small bowel feces sign in the pelvis with a transition point adjacent to the sigmoid colon as seen on image 128/series 4. Trace surrounding fluid.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: Probable post biopsy changes in the left ilium.OTHER: Trace pelvic fluid | 1.Small bowel obstruction with a transition point in the pelvis. The presence of fluid indicates indicates higher level of obstruction. The lack of intravenous contrast limits evaluation for ischemia. This is most likely on the basis of adhesions.2.Follow up is recommended. |
Generate impression based on findings. | Female 44 years old; Reason: eval stone History: L flank pain, microscopic hematuria 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: No nephrolithiasis or hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. Abdominal aorta is normal in caliber.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Catheters and wire hardware implants in the left body wall.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Absent or atrophicBLADDER: No distal ureteral or bladder calculi.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small bowel is normal in caliber. Appendix is unremarkable.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No pelvic fluid collections. | 1.No evident nephrolithiasis or hydronephrosis. Given the persistent pain, recommend triphasic CT, urographic protocol for further evaluation |
Generate impression based on findings. | Reason: look for sources of staph bacteremia or lymphoma in AIDS patient History: fatigue, fevers/chills, malaise, weight loss ABDOMEN:LUNG BASES: Subpleural foci of consolidation with associated bronchiectasis in the lingula. No pleural effusions.LIVER, BILIARY TRACT: Nonspecific heterogeneous lesion in the right hepatic lobe may represent a hemangioma.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 lymphadenopathy.BOWEL, MESENTERY: Short segment circumferential wall thickening of the transverse and descending colon (coronal images 53 and 42 respectively).BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No drainable fluid collection in the abdomen or pelvis.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.Short segment circumferential wall thickening in the transverse and descending colon. Differential etiologies include infectious/inflammatory causes, although neoplasm cannot be excluded. Colonoscopy is recommended for further evaluation.2.Subpleural foci of consolidation with associated bronchiectasis compatible with infection. Findings are better characterized on recent CT chest, 9/23/2013.3.No lymphadenopathy or drainable fluid collection in the abdomen or pelvis. |
Generate impression based on findings. | Male; 75 years old. Reason: Assess for PE History: Afib w/ RVR and hypoxia in post operative patient. PULMONARY ARTERIES: No evidence of pulmonary embolus.LUNGS AND PLEURA: Trace bilateral pleural effusions. Bibasilar dependent opacities, right greater than left, likely represent atelectasis and aspiration pneumonia, given the presence of bronchial wall thickening and scattered lower lobe predominant bronchial mucus plugging/debris. Material is also seen within the bronchus intermedius. No pneumothorax is seen. Moderate centrilobular emphysema. Nodular opacity in the lingula measures 3 mm and is unchanged since the prior CT, possibly representing an intrapulmonary lymph node (series 12, image 94). MEDIASTINUM AND HILA: Mildly enlarged AP window lymph nodes may be reactive in nature. Heart size within normal limits. No pericardial effusion. Left anterior descending artery stent is noted. No left atrial thrombus. The ascending aorta appears mildly ectatic. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Bilateral subcutaneous emphysema likely secondary to recent abdominal operation. High density material is seen layering in the stomach and refluxing into the mid esophagus. Mild paracaval, periportal, and gastrohepatic lymphadenopathy. Trace perihepatic ascites. Visualized bowel loops are mildly dilated, suggestive of ileus. | 1.No evidence of pulmonary embolus. 2.Pulmonary findings compatible with dependent atelectasis and aspiration pneumonia as described above, right greater than left. GE reflux of high density material into the mid esophagus also supports aspiration diagnosis. |
Generate impression based on findings. | Reason: 61F with fever of unknown origin History: fever ABDOMEN:LUNG BASES: Left greater than right ground glass opacities with extensive bibasilar consolidation. Small right pleural effusion.LIVER, BILIARY TRACT: Hepatomegaly with cirrhotic morphology. Small amount of perihepatic ascites.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Malrotated right kidney. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Shotty retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Enteric tube terminates in the stomach. No evidence of obstruction. No pneumatosis intestinalis or free intraperitoneal air. Prominent upper abdominal mesenteric vessels.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No drainable fluid collection in the abdomen or pelvis.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: A suture line is present at the rectosigmoid junction. Rectal catheter is in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Extensive bibasilar consolidation with ground glass opacities and small right pleural effusion. Findings are compatible with infection/aspiration with possible superimposed edema.2.No drainable fluid collection in the abdomen or pelvis.3.Hepatomegaly with cirrhotic morphology and small amount of ascites. |
Generate impression based on findings. | Male; 43 years old. Reason: infection History: fever, chills. CHEST:LUNGS AND PLEURA: There is moderate bronchial wall thickening, bronchiectasis, and associated ground glass opacities. Findings were present on prior chest CT and are likely secondary to chronic aspirated secretions. Bibasilar scarring/atelectasis is not significantly changed. No focal air space opacity, pleural effusion, or pneumothorax. No suspicious pulmonary nodules or masses. Stable scattered micronodules, some of which are calcified. MEDIASTINUM AND HILA: Postsurgical changes compatible with prior heart transplant, including retrosternal adhesions/stranding and subxiphoid epicardial electrodes. Left central venous catheter tip in the SVC at the level of the azygos vein. Mildly enlarged mediastinal lymph nodes and small pericardial effusion are also unchanged.CHEST WALL: Median sternotomy hardware again noted. Gynecomastia is present. ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. Cholelithiasis. SPLEEN: Mild splenomegaly.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys without evidence of hydronephrosis. PANCREAS: Predominantly cystic lesion in the pancreatic tail with peripheral calcification measures 4.6 x 4.6 cm and is not significantly changed in size since the prior CT (series 4, image 92). The pancreas is atrophic. RETROPERITONEUM, LYMPH NODES: Stable retrocaval, peripancreatic, and gastrohepatic lymphadenopathy. BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild soft tissue anasarca. Mild multilevel degenerative changes in the visualized spine. Multiple injection granulomas in the anterior abdominal wall. OTHER: No significant abnormality noted. | 1.Moderate bronchial wall thickening and bronchiectasis are chronic and likely secondary to aspirated secretions. No specific evidence of pneumonia.2.Stable postsurgical changes s/p cardiac transplant as described above.3.No significant interval change in cystic pancreatic tail lesion, favoring pseudocyst, given the imaging findings and history of tail pancreatitis on CT from August 2012. |
Generate impression based on findings. | Reason: hx H \T\ N ca, post CRT, evaluate dx and compare to previous scan History: as above CHEST:LUNGS AND PLEURA: Scattered micronodules unchanged dating back to 12/14/12. No interval suspicious pulmonary nodule or pleural effusion.MEDIASTINUM AND HILA: Heart size remains normal. No interval mediastinal or hilar lymphadenopathy.CHEST WALL: No axillar lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. Stable large right hepatic lobe subcapsular hemangioma. Hypoattenuating liver foci are again noted without significant change, likely representing cysts.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: Small scattered intra-and retroperitoneal lymph nodes unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Lumbar immobilization hardware partially visualized.OTHER: No significant abnormality noted. | No specific findings of metastatic disease. |
Generate impression based on findings. | Female 42 years old Reason: severe asthma and possible AATD History: sob LUNGS AND PLEURA: Numerous calcified pulmonary micronodules, statistically most likely granulomas though not specific as there is no evidence of granulomatous disease elsewhere. Moderate air trapping seen on the expiratory phase. Very minimal subpleural reticulation on the prone imaging in the dependent lung fields. Subtle foci of basilar emphysema, minimal.MEDIASTINUM AND HILA: No evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: No evidence of axillary lymphadenopathy. Mild multilevel degenerative changes are seen in the cervical and thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No gross signs of cirrhosis. | 1. Diffuse moderate air trapping compatible with obstructive lung disease.2. Minimal basilar emphysema in a distribution suggestive of AATD, though the extent is not typical.3. Minimal subpleural reticulation which may be due to early fibrosis or scarring. 4. Multiple calcified pulmonary micronodules, most likely granulomas though not specific as the patient does not have evidence of granulomatous disease elsewhere. |
Generate impression based on findings. | Female 65 years old Reason: follow pulmonary nodules, super D protocol History: copd LUNGS AND PLEURA: The reference left upper lobe nodular lesion has significantly decreased in size, now measuring 6 x 4 mm (image 72, series 5), previously measuring 10 x 9 mm. Given the marked interval change in size, the nodule is likely post infectious/inflammatory in etiology. Previously described additional 4mm subpleural nodule abutting left major fissure (image 64, series 5) is unchanged. 4-mm irregular density in the right costophrenic angle is new (5/229). The remaining lung parenchyma in the bases is slightly more dense than expected but no septal thickening is identified and the appearance is unchanged.Severe upper lobe predominant centrilobular emphysema, unchanged.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy. Moderate atherosclerotic calcifications of the thoracic aorta and mild coronary artery calcifications appear unchanged. The main pulmonary artery appears normal in caliber.CHEST WALL: Severe compression deformities at T6 and T11 vertebrae appear unchanged. Moderate multilevel degenerative changes are again seen throughout the thoracic and cervical spine. Sclerotic areas of the sternum and right first rib unchanged, likely representing healed fractures. Single right and multiple left healed rib fractures unchanged.Prior bilateral mammoplasty.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Enlarged retrocrural fluid-attenuation nodule now measures 10 mm (image to 59, series 2) previously measuring 10 mm, stable since 2011 and probably an ectatic lymphatic structure. Punctate calcific foci within the splenic parenchyma, likely sequela from prior granulomatous disease. | 1. Marked interval decrease in size of the left upper lobe nodule making infectious or inflammatory etiology most likely.2. No significant change in severe emphysema.3. New 4mm irregular nodular density in the right lower lobe may be followed in 6-12 months by CT to assess for growth or clearance. As it is dependent in location, it could represent scarring or inflammatory change however a small neoplasm cannot be entirely ruled out without follow up. |
Generate impression based on findings. | Reason: Assess for abscess History: Surgical site infection with wound dehiscence - eval extent of inflammation/possible abscess ABDOMEN:LUNG BASES: Basilar scarring.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: Circumaortic left renal vein.RETROPERITONEUM, LYMPH NODES: Prominent para-aortic lymph node measures 16 x 11 mm (series 4, image 55), unchanged. Atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.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: Status post proctocolectomy with right lower quadrant end ileostomy. Small fluid collection in the presacral soft tissues extends anteriorly, contiguous with an adjacent small bowel loop, which demonstrates mild wall thickening (series 4, image 128). A fistulous communication cannot be excluded.BONES, SOFT TISSUES: Mild perineal thickening. Air filled tract extends superiorly, terminating in the fluid collection described above.OTHER: No significant abnormality noted. | Air filled tract extending from the perineum and terminating in a presacral fluid collection contiguous with an adjacent loop of small bowel. Findings are compatible with a developing abscess and possible fistula. |
Generate impression based on findings. | 15 x 15 cm abdominal mass incidentally found one renal ultrasound outside hospital, please evaluate abdominal mass ABDOMEN:LUNG BASES: No consolidation or pleural effusion in the lung bases.LIVER, BILIARY TRACT: No mass lesion or biliary duct dilation. SPLEEN: No focal splenic lesion identified.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Kidneys enhance symmetrically and homogeneously. No hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction or free intraperitoneal air.BONES, SOFT TISSUES: Fluid collection in the left upper quadrant contains the caudal tip of the ventriculoperitoneal shunt catheter and measures 10.1 x 18.2 x 19.5 cm. Several thin septations are seen within this fluid collection.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | Large fluid collection in the left upper quadrant contains the caudal tip of the ventriculoperitoneal shunt catheter is consistent with a CSF pseudocyst. |
Generate impression based on findings. | Reason: Does patient have colitis, diverticulitis, abscess History: Abdominal pain ABDOMEN:LUNG BASES: Minimal dependent basilar atelectasis bilaterally.LIVER, BILIARY TRACT: Status-post cholecystectomy with no intrahepatic ductal dilatation. Small subcentimeter hypodense lesion in the left lobe of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple renal cyst in the upper pole of the right kidney. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: The proximal appendix is prominent measuring 9 mm in diameter (series 3, image 97) but becomes normal in caliber distally. There is no associated wall thickening or fat stranding to suggest appendicitis. There is a long segment of the sigmoid and descending colon with mild wall thickening and increased vascular markings. These findings may be due to under distention but nonspecific colitis cannot be excluded.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites, likely physiologic in premenopausal women.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the pubis.OTHER: No significant abnormality noted | 1.Long segment of sigmoid and descending colon wall thickening with increased vascular markings. These findings may be due to underdistention but colitis cannot be excluded. Follow-up is suggested.2. Small subcentimeter hypodense lesion in the left lobe of the liver is too small to further characterize.3.Prominent appendix without definite evidence of acute cholecystitis. |
Generate impression based on findings. | Reason: ICH History: ICH The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a hemorrhagic focus present in the right thalamus measuring 33 x 22 mm axial dimensions associated with intraventricular blood in the right lateral ventricle. The hematoma is larger on it posterior aspect when compared to the prior exam from 9/26 11:48 am but unchanged since 20:10 pm last night. There is associated mass effect with a shift of the septum pellucidum approximately 7 mm the left of midline which is stable compared to the prior exam. Biventricular diameter at the level of foramina of Monro is approximately 37 mm and previously was the same. The temporal horns of lateral ventricles remain dilated right more than left.The examination is compromised by patient motion.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The patient is status post left-sided craniotomy and frontal bone surgeryThe visualized portions of the paranasal sinuses demonstrate mucus retention cysts in the maxillary sinuses associated with the maxillary sinus wall thickening and decrease in size of the right maxillary sinus suggesting silent sinus syndrome. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is redemonstration of a right thalamic hemorrhage which is stable when compared to prior exam last night but increased in size when compared to the exam from yesterday morning2.There is associated with intraventricular blood also stable since the prior exam3.There is redemonstration of ventriculomegaly which was unchanged since the prior exam from last night but developed since the morning exam from yesterday.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. they are most likely vascular related. 5.Exam is somewhat compromised by motion artifact |
Generate impression based on findings. | Reason: bleed History: left sided weakness Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The posterior communicating arteries are medium-sized. Anterior communicating artery is fenestrated in and medium-sized. There is very mild asymmetry in the A1 segments right slightly larger than left. There is infundibulum at the origin of the right posterior communicating artery. There is an infundibulum at the origin of the left posterior communicating artery. The right posterior inferior cerebellar artery is dominant. The right vertebral artery is larger than the left vertebral artery.CT head:There is a hemorrhagic focus present in the right thalamus measuring 33 x 22 mm axial dimensions associated with intraventricular blood in the right lateral ventricle. The hematoma is larger on it posterior aspect when compared to the prior exam from 9/26 11:48 am. There is associated mass effect with shift of the septum pellucidum approximately 7 mm the left of midline which is increased from 5mm compared to the prior exam. Biventricular diameter at the level of foramina of Monro is approximately 37 mm and previously was 29mm. The temporal horns of lateral ventricles are now dilated right more than left.Periventricular and subcortical white matter hypodensities of a moderate degree are present.The patient is status post left-sided craniotomy and frontal bone surgeryThe visualized portions of the paranasal sinuses demonstrate mucus retention cysts in the maxillary sinuses associated with the maxillary sinus wall thickening and decrease in size of the right maxillary sinus suggesting silent sinus syndrome. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A focus of encephalomalacia is present along the left frontal lobe and there is a defect present along the left cribriform plate. | 1.There is redemonstration of a right thalamic hemorrhage which has increased in size when compared to the exam from earlier today2.There is associated with intraventricular blood also stable since the prior exam3.There is ventriculomegaly which has developed since the morning exam.4.No evidence for cerebral vascular occlusive disease5.there is no evidence for intracranial aneurysm6.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. They are most likely vascular related. 7.there is a defect along the left cribriform plate with encephalomalacia in the adjacent left interior and anterior frontal lobe and s/p adjacent craniotomy. Please correlate with the patient's clinical history. |
Generate impression based on findings. | Male 62 years old; Reason: Distal esophageal cancer s/p CRT. Restaging History: none CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesion. Minimal right lower lobe bronchiectasis. Few scattered centrilobular micronodules in the left lung base may represent aspiration or infection.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. No mediastinal lymphadenopathy.Right chest wall port terminates at the cavoatrial junction. Distal esophageal thickening compatible the patient's known malignancy.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver has a smooth contour. New hypodense lesion in segment 4A of the liver measuring 0.9 x 0.8 cm (image 86/series 3). SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No change in the left adrenal lesion.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Gastrohepatic lymphadenopathy with a gastrohepatic lymph node measuring 1.3 x 1.0 cm (image 91/series 3). Partially calcified portacaval lymph nodes.BOWEL, MESENTERY: Distal esophagus thickening extending into the gastric fundus.BONES, SOFT TISSUES: No ascites. Ventral abdominal hernia containing fat.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: As aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Distal esophageal mass with gastrohepatic lymphadenopathy and subcentimeter suspicious hepatic lesion. |
Generate impression based on findings. | Reason: evaluate for intraabdominal abnormality History: diffuse abdominal pain, history of metastatic melanoma ABDOMEN:LUNG BASES: Multiple metastatic pleural / pulmonary nodules and mediastinal lymphadenopathy. LIVER, BILIARY TRACT: New right hepatic lobe lesions compatible with metastatic disease.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mild left hydronephrosis. RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy. Reference left retroperitoneal lymph node measures 2.3 x 2.3 cm, previously 4.1 x 3.6 cm (series 3, image 65).BOWEL, MESENTERY: No evidence of bowel obstruction. No free intraperitoneal air or pneumatosis intestinalis. Extensive peritoneal carcinomatosis.BONES, SOFT TISSUES: Reference posterior subcutaneous soft tissue nodule measures 1.3 x 0 .8 cm, previously 1.3 x 1.2 cm (series 3, image 83).OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Suprapubic Foley catheter terminates within the ileocecal neobladder.LYMPH NODES: Reference left external iliac node is not visualized on the current examination.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No free fluid in the pelvis is unchanged. | 1.No evidence of acute intra-abdominal process. 2.Extensive metastatic disease with interval decrease in reference measurements.3.New right hepatic lobe lesions suspicious for metastatic disease. |
Generate impression based on findings. | Penetrating soft tissue injury of left thigh on 9/22 which was irrigated and closed primarily. Pre-length drainage and increasing redness wound with wound dehiscence.EXAMINATION: CT left femur with IV contrast material 09/27/13 The skin is disrupted in two areas medial and inferior to the proximal femoral diaphysis. The subcutaneous fat is indurated with stranding. No abscess is identified. Emphysema is seen in the subcutaneous tissues and along the medial borders of the adductor longus and gracilis muscles. Gas is noted along the lateral margin of the adductor longus muscle. No myositis is identified. | No abscess identified. Inflammatory changes. |
Generate impression based on findings. | Male 62 years old; Reason: met CRC restaging on chemo History: met crc CHEST:LUNGS AND PLEURA: No dominant lung lesion. The pleural spaces are clear. Subcentimeter right lower lobe nodules appear stable.MEDIASTINUM AND HILA: Left prevascular node measures 1.4-cm (image 45 / series 3) previously, 0.8-cm.Right hilar lymph node measures 1.2 x 0.7 cm (image 55/series 3) previously, 1.2 x 0.6 cm.CHEST WALL: A right chest wall port terminates at the cavoatrial junction.OTHER: ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic lesions are reference right hepatic lobe lesion measures 4.2 x 2.3 cm (image 113/series 3) previously, 5.0 x 3.5 cm. Multiple other hepatic lesions persist. No biliary ductal dilatation. Portal venous vasculature are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Right adrenal nodule measures 2.8 x 2.1 cm (image 120/series 3) previously, 2.7 x 1.9 cm.Left adrenal nodule measures 1.7 x 1.2 cm (image 114/series 3) previously, 1.6 x 1.0 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive malignant retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: Bladder wall thickening. The bladder is decompressed by a Foley catheterLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Slight decrease in the size of the reference hepatic lesion. |
Generate impression based on findings. | Reason: s/p cervical laminoplasty History: same The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine. Since the prior exam the patient has undergone laminoplasty is from C3 down to C7. There are air bubbles present at the surgical site suggesting recent surgery. The spinal canal appears enlarged. There multilevel disk protrusions presentAt C2-3 there is no significant compromise to the spinal canal. There is narrowing of the left neural foramen at this levelAt C3-4 there is no significant compromise to the spinal canal . There are bilateral vertebral osteophytes present at this level associated with disk material it . There is a bilateral neural foramen encroachment at this level .At C4-5 there is no significant compromise to the spinal canal. There is a disk bulge present at this level. There is a bilateral neural foramen encroachment at this level .At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a bilateral neural foramen encroachment at this level .At C6-7 there is no significant compromise to the spinal canal or neural foramina. Spinal canal is partly obscured by beam hardening artifact from the patient's shoulders .At C7-T1 there is no significant compromise to the spinal canal or neural foramina. Spinal canal is partly obscured by beam hardening artifact from the patient's shoulders . | 1.Status post recent multilevel laminoplasty . There are multilevel degenerative changes present with neural foramen encroachment worse at C3-4. |
Generate impression based on findings. | Reason: Pre-pancreas transplant evaluation. Please evaluate vasculature for transplant. History: Pre-pancreas transplant evaluation. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.VASCULATURE: Moderate calcific atherosclerosis of the abdominal aorta and the origin of the common iliac arteries without aneurysmal dilatation. The external iliac arteries are normal in caliber without calcific atherosclerosis.BOWEL, MESENTERY: Post operative changes of the cecum.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.Moderate calcific atherosclerosis of the abdominal aorta and the origin of the common iliac arteries without aneurysmal dilatation. 2.The external iliac arteries are normal in caliber without calcific atherosclerosis. |
Generate impression based on findings. | Reason: Pt with h/o of CLL prior to treatment regimen History: Evaluation of disease status CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Supraclavicular lymphadenopathy. Small mediastinal lymph nodes. Heart size is normal. No pericardial effusion.CHEST WALL: Axillary lymphadenopathy. For reference, a right axillary lymph node measures 3.8 x 3.1 cm (series 3, image 22).ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Splenomegaly with multiple hypoattenuating lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral infiltrative hypoattenuating lesions in the kidneys.RETROPERITONEUM, LYMPH NODES: Porta hepatis, mesenteric, and retroperitoneal lymphadenopathy. For reference, a mesenteric lymph node measures 4.9 x 2.8 cm (series 3, image 138).BOWEL, MESENTERY: Jejunal-jejunal intussusception of unclear etiology, small bowel lymphoma not excluded.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: Pelvic lymphadenopathy. For reference, a right obturator lymph node measures 5.3 x 2.5 cm (series 3, image 194).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ill-defined lytic lesions of the right sacrum.OTHER: No significant abnormality noted. | Lymphadenopathy in the chest, abdomen, and pelvis with involvement of the spleen, kidneys and possibly the small bowel. |
Generate impression based on findings. | Reason: kidney stone? History: R 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: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality noted. Septation within the fundus of the gallbladder. No evidence of cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small left renal calculus in within the pelvis without evidence of hydronephrosis or hydroureter. Right kidney with large calcified renal calculus in the upper pole 1.1 cm and small calcified calculus in the lower pole, both non obstructing without evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bilateral non obstructing renal calculi, largest measuring 1.1-cm in the right kidney. No evidence of hydronephrosis or hydroureter bilaterally to suggest obstruction. |
Generate impression based on findings. | Malignant neoplasm of base of tongueRadiotherapy follow-up examinationChemotherapy follow-up examination Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. The patient is status post anterior fusion from C3 through C5 | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy |
Generate impression based on findings. | Male 65 years old; Reason: recurrent UTI's History: recurrent UTI"s 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: No nephrolithiasis or hydronephrosis in either kidney. The ureters are normal in caliber and course.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease of the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Post operative changes in the anterior -abdominal wall. Calcification along the fascial planes.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No distal ureteral or bladder calculi. No evident bladder mass.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate fascial calcifications involving subcutaneous tissues of the pelvis.OTHER: No significant abnormality noted. | 1.No focal renal mass; no nephrolithiasis, hydronephrosis or bladder calculi.2.Soft tissue calcifications. Differential considerations include scleroderma , dermatomyositis, collagen vascular diseases. |
Generate impression based on findings. | Reason: hx of bladder cancer, please evaluate with delayed imaging, CT urogram History: none ABDOMEN:LUNG BASES: Basilar scarring/atelectasis.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 right hydronephrosis. A right nephroureteral stent is in place. Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy. Abdominal aortic aneurysm with stent graft.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Brachytherapy seeds in the prostate bed.BLADDER: Mild eccentric posterior wall thickening without discrete mass.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality noted. | 1.Mild eccentric bladder wall thickening without discrete mass. 2.No evidence of metastatic disease. |
Generate impression based on findings. | Male; 87 years old. Reason: hemoptysis History: history of Stage IB NSCLC 3 years s/p lung resection, now with recent hemoptysis. CHEST:LUNGS AND PLEURA: Postsurgical changes compatible with lingular resection. Several small pulmonary nodules are noted, some of which are associated with adjacent bronchial wall thickening and bronchiectasis. Findings suggest a bronchiolitis pattern. Right upper lobe nodule measures 5 mm and has decreased in size since the prior study, previously 7 mm (series 5, image 52). However, there are no suspicious pulmonary nodules or masses. Scattered calcified granulomas. No focal airspace opacity or pleural effusion. MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Dense aortic valve calcifications. Cystic structure anterior to the ascending aorta is unchanged and may represent a pericardial cyst or prominent pericardial recess. CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal 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: Mild multilevel degenerative disease in the visualized spine.OTHER: Dense abdominal aortic calcifications. | 1.Several small pulmonary nodules, some of which are associated with bronchial wall thickening and bronchiectasis resembling a bronchiolitis pattern. 2.No suspicious pulmonary nodules or evidence of metastatic disease. 3.Minor contrast extravasation event- see details in technique section above. |
Generate impression based on findings. | Reason: 49M with necrotizing pancreatitis 4/2012 s/p drainage/necrosectomy with recurrent pancreatic body/tail pseudocyst 5.8 x 9.1cm s/p pancreatic stent/IR drainage for follow-up History: pain, early satiety ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Redemonstration two subcentimeter hypodense lesions in the left lobe of the liver too small to further characterize. Distended gall bladder without evidence of gallbladder wall thickening or cholelithiasis. SPLEEN: No significant abnormality notedPANCREAS: Left-sided drain with the tip in the prior site of a pancreatic tail pseudocyst. There has been significant resolution of the previously noted pancreatic body/tail pseudocyst and is now not discernible. Majority of the pancreatic tail and body is necrotic. There is thrombosis of the splenic and superior mesenteric veins with venous collaterals, unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Redemonstration of bilateral hydronephrosis, right greater than left.RETROPERITONEUM, LYMPH NODES: Right-sided retroperitoneal fluid collection overlying the right psoas muscle remains grossly unchanged in size.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild levoscoliosis of the lumbar spine. L1 mild compression deformity, unchangedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Scattered bilateral inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval resolution of the previously noted pancreatic body/tail pseudocyst extended down into the left retroperitoneum. Majority of the pancreatic tail and body is necrotic.2.Right-sided retroperitoneal fluid collection overlying the right psoas muscle remains grossly unchanged in size.3.Redemonstration of bilateral hydronephrosis, right greater than left. |
Generate impression based on findings. | Female 56 years old Reason: pt with lung ca s/p multiple chemotherapies History: doing well now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Stable centrally necrotic right upper lobe lesion now measures 2.4 x 4.0 cm (image 37 series 3), previously measuring 4.3 x 3.4 cm. The previously described separate nodules now appear confluent with the dominant mass. There is complete collapse of the right upper and middle lobes with associated narrowing of the right upper lobe and right middle lobe bronchi near their origin, secondary to tumor/lymphadenopathy compressing the respective bronchi. There has been slight interval increase in the trace right pleural effusion and resolution of the previously seen left pleural effusion. The right lower lobe nodule now measures 8 mm (image 58, series 4), previously measuring 5 mm.MEDIASTINUM AND HILA: Right upper paratracheal node unchanged (image 14, series 3). Lower right paratracheal lymph nodes unchanged. Subaortic lymph node contralateral to the right upper lobe mass has decreased in size now measuring 9 mm (image 27, series 3), previously measuring 13 mm. Retrotracheal lymph node unchanged (image 13, series 3). Persistent confluent tumor/lymphadenopathy posterior to the right mainstem bronchus causing distortion of the upper and middle lobe bronchi lumen.Moderate pericardial effusion appears unchanged since the prior examination. The pericardial fluid attenuation is higher than simple fluid and may represent metastatic disease or blood products. Multichamber cardiomegaly unchanged. Aberrant right subclavian artery, representing normal anatomic variant. Moderate calcification of the walls of the thoracic and abdominal aorta as well as mild calcification of the coronary arteries.CHEST WALL: Upper normal sized left axillary lymph nodes, unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: There is no evidence of focal mass lesion within the hepatic parenchyma. There is cholelithiasis without evidence of cholecystitis.SPLEEN: Splenule near the splenic hilum.ADRENAL GLANDS: Bilateral adrenal gland thickening unchanged.KIDNEYS, URETERS: Bilateral renal lesions unchanged in size and extent. These lesions do not measure simple fluid density and are incompletely characterized on this examination. Additional fluid density lesions unchanged, likely representing renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple small lymph nodes seen in the retroperitoneum and mesentery, unchanged. Significant atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: There is no evidence of metastatic disease to the osseous structures of the chest and abdomen.OTHER: No significant abnormality noted. | 1. Grossly stable right upper lobe mass with associated collapse of the right upper and middle lobes.2. Interval increase in size of the right lower lobe nodule.3. Stable high-density pericardial effusion suspicious for metastatic disease.4. Interval resolution of the left pleural effusion, and slight interval increase in size of the trace right pleural effusion.5. Stable mediastinal and hilar lymphadenopathy.6. Stable renal lesions which are incompletely characterized on this examination.7. No new metastatic foci identified. |
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