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Generate impression based on findings. | 81-year-old male with small cell lung cancer diagnosed in 2007, status post chemoradiation therapy and PCI. CHEST:LUNGS AND PLEURA: The reference right lower lobe pulmonary nodule is unchanged at 0.7 x 0.6 cm (series 5, image 207) compared to 4/2/13. No new nodules or masses are seen.Post surgical changes are again seen in left upper lobe. Severe biapical centrilobular and paraseptal emphysema.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Atherosclerotic disease of the coronary arteries, aorta, and its branches. The aneurysmal dilatation of the ascending aorta is unchanged at 4.1 x 4.0 cm (series 4, image 63). No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hepatic calcified granulomata, likely from prior granulomatous disease. No significant abnormality noted otherwise.SPLEEN: Splenic calcified granulomata, likely from prior granulomatous disease. No significant abnormality noted otherwise.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Unchanged hypodense focus within the pancreatic body.RETROPERITONEUM, LYMPH NODES: The crescentic mural thrombus in the aneurysmal infrarenal abdominal aorta and dissection of the left common iliac artery appear similar to the prior exam.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. | Right lower lobe pulmonary nodule, without interval change since 4/2/13, though significantly increased in size since 2010, likely representing malignancy. |
Generate impression based on findings. | Female 56 years old; Reason: left shoulder pain; neuropathic shoulder; preop assessment; include entire scapula History: pain. Again seen is marked deformity and fragmentation of the humeral head and glenoid.The humeral head is subluxed inferiorly relative to the glenoid. The glenohumeral joint is distended and measures predominately fluid density with ossific debris consistent with neuropathic arthropathy. Also seen again is moderate osteoarthritis affecting the acromioclavicular joint as well as well as subchondral cysts throughout the humeral head. | Findings compatible with neuropathic arthropathy. |
Generate impression based on findings. | Reason: Patient with chronic sinusitis, eval for anatomic abnormalities, evidence of disease History: Patient with chronic sinusitis, eval for anatomic abnormalities, evidence of disease The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated. Incidental note is made of concha bullosa bilaterally.The frontal sinuses are clear.Maxillary sinuses are clear. Ethmoid air cells are clear . Sphenoid sinuses are clear. Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits.Calcifications present in the left temporalis muscle. This is of unknown significance | CT of the paranasal sinuses is within normal limits. No evidence for paranasal sinus obstructive disease |
Generate impression based on findings. | 70 year-old female with pancreatic cancer, evaluate for disease progression. CHEST:LUNGS AND PLEURA: Multiple pulmonary throughout both lungs are increased in size with the reference lesion measuring 1.6 x 2.5 cm (image 46, series 9) and previously measuring 0.7 x 1.7 cm. The reference nodule is now confluent with the adjacent nodule.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia is again noted. Interval removal of cholecystostomy tube with likely postprocedural change around the gallbladder. The common bile duct stent is unchanged in position. No focal hepatic lesions.SPLEEN: Stable splenomegaly. The splenic vein is obliterated and there are extensive perigastric and perisplenic varices.PANCREAS: Large heterogeneous solid and cystic pancreatic mass replacing the pancreas measures 7.2 x 6.1 cm (image 102 series 11) and previously measured 8.5 x 6.6 cm, mildly decreased in size.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right hypodensity, too small to characterize, is unchanged.RETROPERITONEUM, LYMPH NODES:There is narrowing of the hepatic IVC and and and intraluminal filling defect in the left common iliac vein indicating a thrombus. Unchanged retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Extensive peritoneal carcinomatosis.BONES, SOFT TISSUES: New enhancing lesions in the body wall at the site of cholecystostomy compatible with metastases.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. Progression of metastatic disease as described above.2. Left common iliac vein and IVC thrombus. Findings discussed with Dr. Walker by Dr. Thomas at 12.30pm |
Generate impression based on findings. | T1N2B right tonsillar cancer status post CRT. There are stable post-treatment findings in the right neck without evidence of recurrent tumor. There is no evidence of significant lymphadenopathy. The major salivary glands and thyroid gland are unchanged. The upper aerodigestive tract is patent. There is unchanged degenerative spondylosis of the cervical spine. The major cervical vessels are patent. The imaged portions of the intracranial structures and orbits are unremarkable. There is unchanged scarring at the lung apices and a subcentimeter calcified granuloma at the left lung apex. Refer to the separate chest CT report for additional details. | No evidence of locoregional tumor tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: Stage IVA NSCLC with pleural disease/effusion/scarring and adenopathy- but asymptomatic, indolent growth, History: please compare with film from 12 and 4 months ago to assess trajectory CHEST:LUNGS AND PLEURA: Surgical scarring with a loculated right pleural effusion and right basilar pleural thickening with atelectasis is unchanged. Nodular pleural thickening throughout the right in the thorax has not significantly changed. Scattered small punctate micronodules and prior right lower lung zone resection are stable.MEDIASTINUM AND HILA: Previously measured low right paratracheal lymph node now 15 mm image 41 series 3, 13 mm.Other mediastinal lymph nodes, especially in the right cardiophrenic angle region, appear larger, although the previously measured node is 14 mm image 77 series 3, previously 15 mm. Nodes in this region appear more confluent, however. CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic cyst like hypodensity.Cholecystectomy clips are present.SPLEEN: Calcified splenic granuloma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing renal oculi and slight hypodensities. The right renal hypodensity image 134 series 3 is not of water density, however, and should be evaluated on a dedicated renal protocol CT if clinically indicated.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. | Pleural thickening and mediastinal lymphadenopathy, the latter slightly progressed. Possible renal lesion discussed above for which a dedicated renal protocol CT is recommended. |
Generate impression based on findings. | Hypoxia. History of scleroderma. Evaluate for interstitial lung disease LUNGS AND PLEURA: Diffuse bilateral centrilobular groundglass opacities, slightly more predominant in the upper lobes, with areas of mosiac attenuation. Septal thickening at the right lung base, likely representing scarring. There is no evidence of bronchial wall thickening, honeycombing, fibrosis, or air trapping. Scattered calcified and noncalcified micronodules, likely representing prior granulomatous disease. Multiple nodules are similar compared to 2/11/13.MEDIASTINUM AND HILA: Marked aortic and coronary artery calcifications. Normal size heart without pericardial effusion. Subcentimeter mediastinal lymph nodes. No mediastinal or hilar lymphadenopathy. Large main pulmonary artery diameter.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Fluid density right renal lesion and hyperattenuating left renal lesion, which are not fully evaluated on this exam.Cholelithiasis without evidence of cholecystitis.Atherosclerotic calcification of the abdominal aorta. | Diffuse bilateral centrilobular groundglass opacities, which may represent hypersensitivity pneumonitis or respiratory bronchiolitis, or less likely NSIP. Pulmonary arterial hypertension is also present, which can account for the lung findings. |
Generate impression based on findings. | 62 year-old female with history of gastric GIST status post resection CHEST:LUNGS AND PLEURA: Bibasilar scarring is again noted. Scattered micronodules are unchanged.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the right hepatic lobe is unchanged. Prominent portal caval lymph nodes are again noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS:. Hypodense lesions are too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of partial gastrectomy.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 metastatic disease evident. |
Generate impression based on findings. | Reason: CVA History: CVA The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for early detection of nonhemorrhagic CVA |
Generate impression based on findings. | Reason: hx of BOT ca, s/p CRT, eval for dz, compare to previous History: as above CHEST:LUNGS AND PLEURA: Stable apical scarring.Calcified granulomas in the right lung base.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Calcified mediastinal lymph nodes compatible with prior granulomatous disease.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Degenerative changes of the thoracic spine with stable mild anterior wedging of several midthoracic vertebrae.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Multiple calcifications compatible with prior granulomatous disease.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: Spondylosis at L5-S1OTHER: No significant abnormality noted. | No evidence of metastatic disease. No significant interval change. |
Generate impression based on findings. | Reason: Pt is a 28 y/o male with h/o met seminoma, evaluate for recurrence History: met seminoma CHEST:LUNGS AND PLEURA: Nonspecific right lower lobe pulmonary micronodules, new from prior exam, likely postinfectious.MEDIASTINUM AND HILA: Anterior mediastinal soft tissue density measures 2.5 x 1.4 cm (series 3, image 35), slightly more prominent than the prior exam. No lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Status post right orchiectomy. | 1.No convincing evidence of disease. 2.Slightly more prominent anterior mediastinal soft tissue mass with imaging characteristics that favor thymic tissue.3.Nonspecific pulmonary micronodules, likely postinfectious. |
Generate impression based on findings. | BOT ca, s/p CRT. Head: There is no evidence of intracranial mass effect, cerebral edema, or abnormal enhancement to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are unremarkable. The ventricles are stable in size and configuration. The paranasal sinuses and mastoid air cells are clear. The orbits are unremarkable. Neck: There are stable posttreatment findings in the right neck, including mild mucosal and salivary gland hyperemia, thickening of the epiglottis, and a small retropharyngeal effusion. There is evidence of tumor recurrence in the treatment bed. Likewise, there is no significant lymphadenopathy in the neck by CT size criteria. The upper aerodigestive track is patent. The thyroid is unremarkable. The major cervical vessels are patent. The osseous structures are unchanged. Scarring within the lung apices is unchanged. Refer to the concurrent chest CT report for additional details. | 1.Stable posttreatment findings in the neck without evidence of locoregional tumor recurrence or significant lymphadenopathy.2. No intracranial metastatic disease. |
Generate impression based on findings. | Female 49 years old; Reason: eval for disease progression in pt with metastatic melanoma History: eval for disease progression in pt with metastatic melanoma CHEST:LUNGS AND PLEURA: The pleural spaces are clear. Minimal atelectasis in the right middle lobe. No dominant lung lesion.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Small but abnormal by number left axillary lymph nodes. A left axillary node measures 1.1 x 1.0 cm (image 23/series 10). Additional left small body wall nodule (image 63).ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Stable left hepatic lobe hypodensity (image 88).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: There are multiple small retroperitoneal lymph nodes. A reference lesion in the left para-aortic and region measures 2.3 x 1.4 cm (image 113/series 10) previously remeasured at, 1.8 x 1.3 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Left posterior lateral body wall with cystic and solid components measures 16.0 x 9.7 cm (image 130/series 10) previously, 13.3 x 7.5 cm.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Large right pelvic adnexal mass.BLADDER: No significant abnormality noted.LYMPH NODES: Post operative changes in the left inguinal area. Hyperenhancing node measures 2.2 x 0.8 cm (image 196/series 10) previously remeasured, 1.9 x 1.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Slight increase in the left posterior lateral body wall lesion. |
Generate impression based on findings. | Reason: Head and Neck cancer with metastasis to the lungs, evaluate progression, results post RT History: lung nodules CHEST:LUNGS AND PLEURA: Right middle lobe nodules are not identified on the current exam. There is now noted to be groundglass opacities within the right middle lobe compatible with post radiation changes.Stable postsurgical changes in the right lower lobe with surgical sutures.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of pericardial effusion.Severe coronary artery calcification.Stable small saccular aneurysm and/or penetrating ulcer of the aortic arch.Moderate-sized sliding no hernia.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cysts unchanged.Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic changes of the aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: The grade 2 spondylolisthesis of L5 on S1 with severe degenerative disk disease and facet arthropathy at this level.OTHER: No significant abnormality noted. | 1.Interval resolution of the right middle lobe nodules. No new nodules identified.2.Groundglass opacities throughout right middle lobe compatible with radiation changes. |
Generate impression based on findings. | Weakness. Stroke symptoms. CT head:There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally in the midline is intact. Orbits, paranasal sinuses and mastoid air cells are unremarkable.CTA neck:The left common carotid originates from the right brachiocephalic artery. The left subclavian demonstrates a normal branching pattern. There is mild atherosclerotic calcification at the left carotid bifurcation without significant stenosis. The right carotid bifurcation does not demonstrate any significant stenosis or calcification. Intracranially, there is a normal circle of Willis. All arteries of the anterior circulation opacify normally and no aneurysm or steno-occlusive lesion is demonstrated. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. Vertebral arteries are diminutive bilaterally. Emphysematous changes and apical blebs are demonstrated within the lungs. There is heterogeneity of the thyroid with a stable hypoattenuating nodule demonstrated in the right lobe. There are degenerative changes present in the cervical spine worse at C5-6 where there are some endplate and uncovertebral osteophytes CTA brain:There are is an extracranial origin of the right PICA. The left PICA, AICA, SCA and basilar arteries are normal. There are bilateral fetal origins of the PCAs. No aneurysm or steno-occlusive lesion is demonstrated within the posterior circulation. The anterior communicating artery is medium sized. The P1 segments are medium-sized | 1.No evidence of infarct. CT is insensitive for the early detection of nonhemorrhagic CVA.2.Mild atherosclerotic changes involving the left carotid bifurcation without significant stenosis. 3.No aneurysm or steno-occlusive lesions demonstrated. 4.Incidental note of emphysematous changes of the lung apices and thyroid heterogeneity which could be better assessed on designated imaging.5.There is a stable lesion in the right thyroid gland lobe.6.There is bilateral neural frontal encroachment at C5-6 due to uncovertebral osteophytes . |
Generate impression based on findings. | Metastatic right maxillary sinus adenoid cystic carcinoma after completing 50 Gy in 10 fractions to a RML metastasis. Previous treatment has included resection of her primary (2/2004) and adjuvant RT. There are stable postoperative findings related to right hemi-maxillectomy, including resection of the entirety of the right maxillary sinus, the inferior floor of the orbit, the right hard palate and right nasal turbinates. There is an unchanged screw that traverses left hard palate and projects into the left inferior turbinate. There is unchanged diffuse soft tissue thickening along the right orbital floor, the lateral nasal cavity, reconstructed soft palate, and right pterygopalatine fossa. There is no new soft tissue mass or pathologic enhancement to suggest recurrent tumor. In addition, there is no significant pathologic adenopathy in the neck. The aerodigestive tract is patent. The salivary glands and thyroid are free unchanged. The cervical vasculature is patent with atherosclerotic calcification affecting the common carotid arteries and aortic arch. The right common carotid artery pursues a severely retropharyngeal course. There is unchanged diffuse sclerosis of the right skull base, which is likely related to radiation therapy. There are no focal lytic or blastic lesions. There is partial opacification of the right sphenoid sinus with mucosal thickening and neo-osteogenesis. The imaged intracranial structures are unremarkable. There are bilateral lens implants. There are partially imaged ground glass opacities in the lungs. Refer to the concurrent chest CT for additional details. | Stable postsurgical findings without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | Reason: lung cancer s/p 4 cycles of chemo. please evaluate for disease and compare with previous scans History: lung cancer CHEST:LUNGS AND PLEURA: New 20 x 16-mm focal lesion in the lingula, image 57 series 6.Unchanged right lower lobe volume loss with scarring in the superior segment extending into the base.Groundglass opacity in the right lung base could be focal atelectasis.MEDIASTINUM AND HILA: Right lobe thyroid cyst unchanged.Left hilar lymphoid tissue stable.Left jugular catheter, tip in SVC.CHEST WALL: Right chest wall Port-A-Cath.Several sclerotic vertebral lesions are grossly unchanged.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous hepatic metastases have enlarged or are new. The previously measured right hepatic lobe lesion is not easily identified. However, a 29 x 30 mm right hepatic lobe lesion image 82 series 4 previously was 20 x 25 mm.Scattered regions of intrahepatic biliary ductal dilatation are present.A new perihepatic or subcapsular fluid collection is seen.The gallbladder is not identifiable.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal irregular scarring and focal collecting system dilatation unchanged. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Scattered retroperitoneal lymph nodes are overall within normal size limits.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Lumbar spine and iliac sclerotic metastases are unchanged.OTHER: No significant abnormality noted. | 1. New focal lingular opacity, conceivably atelectasis but this is likely tumor.2. Progression of hepatic metastases with new and larger lesions as well is a new perihepatic or subcapsular.3. Stable skeletal metastases. |
Generate impression based on findings. | 61-year-old female with pancreas cancer. CHEST:LUNGS AND PLEURA: Stable scattered, calcified and noncalcified micronodules compatible prior granulomatous disease. No new nodules, infiltrates or masses. No pleural abnormality seen.MEDIASTINUM AND HILA: Stable appearance with unchanged peripherally calcified, round lesion adjacent to left main pulmonary artery, likely a calcified lymph node from prior granulomatous disease. No new masses or lesions seen. No adenopathy.CHEST WALL: Right chest wall Port-A-Cath with catheter tip in the proximal right atrium.ABDOMEN:LIVER, BILIARY TRACT: No parenchymal mass lesion seen to suggest metastases. Portal and hepatic veins appear normal. Pneumobilia is seen with biliary stent unchanged in position through head of pancreas.SPLEEN: No significant abnormality noted.PANCREAS: Decrease in size of the reference mass in head of pancreas and extending cephalad encasing hepatoduodenal ligament vessels. Masses continue to decrease in size subjectively, but difficult to measure due to its infiltrating nature around vessels. Current dimensions (series 8, image 42) measures 3.5 x 1.7 cm, while unchanged from previous, subjectively, appears improved. Pancreatic parenchyma otherwise appears normal and no pancreatic ductal dilatation is seen. Portal vein is patent throughout without intraluminal thrombus or significant narrowing. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No enlarged, lymph nodes or retroperitoneal mass is seen.BOWEL, MESENTERY: No significant abnormality noted. Specifically, no evidence of peritoneal carcinoma, lesions now seen in marked contrast to the examination of 5/28/13.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroid in uterus -- no other abnormalities.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Stable measurements to pancreatic head tumor size, but subjectively continued slight decrease in volume of tumor. 2. No peritoneal metastasis seen in contrast to 5/28/13 exam. 3. No new lesions seen. 4. Patent biliary stent. |
Generate impression based on findings. | Reason: r/o growth of lung lesion History: h/o ground glass lung lesion. Outside pulmonologist would like follow-up CT scan LUNGS AND PLEURA: Unchanged approximately 5 mm right upper lobe ground glass opacity, image 89 series 5.Scattered stable benign appearing micronodules are present.Lingular cyst or bulla unchanged. MEDIASTINUM AND HILA: Status post thyroidectomy.There is no mediastinal or hilar lymphadenopathy.Aortic root and coronary calcifications are moderate to severe.Stable lipomatous hypertrophy of the intra-atrial septum noted. CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Large renal cysts are stable. An accessory splenule is noted. Vascular calcifications are seen throughout the abdomen. | Unchanged 5-mm right upper lobe ground glass nodule. This could represent a very indolent adenocarcinoma in situ or atypical adenomatous hyperplasia. Follow-up by CT in two years is recommended. |
Generate impression based on findings. | Reason: evaluate lung nodule History: lung nodule LUNGS AND PLEURA: Lobulated 23 x 12 mm left upper lobe nodule image 37 series 4 is consistent with primary lung cancer. Several small satellite lesions in the accompany this.Mild lower lung zone linear scarring is present.MEDIASTINUM AND HILA: A nonspecific 10-mm anterior mediastinal lymph node is present, no other lymphadenopathy identified.Severe aortic calcifications are present, and the patient has undergone anterior mediastinal surgery.There is slight aneurysmal dilatation of the left lateral aspect of the aortic arch.CHEST WALL: Degenerative abnormalities affect the thoracic spine.Median sternotomy scar and sutures identified.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Cholecystectomy clips are present. | Left upper lobe nodule consistent with primary lung cancer. PET imaging is recommended for further follow-up. |
Generate impression based on findings. | Reason: evaluate right tongue lesion for growth; h/o radiation/chemo for left buccal cancer History: none The patient is status post left neck surgery with removal of the left submandibular gland appeared a number of surgical clips are present along the left neck. The left sternocleidomastoid muscle is low but smaller than the right.A right-sided lesion in the right tongue base measures 12 x 5 mm on the current exam and previously measured 13 x 7 mm.The erosion at the left maxilla along the alveolar ridge present on the prior exam and has not changedWithin 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 demonstrate left maxillary sinus mucosal thickening associated with thickening of the walls of the left maxillary sinus.Atherosclerotic calcifications are present at the carotid bifurcations. The mastoid air cells are clear.The parotid and the right submandibular glands appear intact. The left submandibular gland is absent. The left parotid gland is fatty replacedThe 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. There are endplate tortuosity thoracic present at C5-6 and C6-7 narrowing of neural foramina. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.A lesion in the right tongue base remains stable and compared to prior exam.3.Postsurgical changes at the left alveolar ridge is stable4.Chronic sinusitis involving the left maxillary sinus |
Generate impression based on findings. | Male 43 years old; Reason: evaluate for disease progression. History: metastatic leiomyosarcoma. CHEST:LUNGS AND PLEURA: No suspicious lesions. The pleural spaces are clear.MEDIASTINUM AND HILA: Right chest wall port is at the cavoatrial junction. No mediastinal lymphadenopathy.CHEST WALL: Right body wall mass measures 1.7 x 1.3 cm (image 26 series 10211) previously, 2.1 x 1.7-cmnew right malignant appearing lymphadenopathy with a dominant lymph node measuring 3.0 x 2.0 cm (image 22/series 10211). OTHER: ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left suprarenal soft tissue measures 2.1 x 0.9 cm (image 95/series 10211) previously, 1.7 x 0.7 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple new enhancing retroperitoneal masses , adjacent to the right kidney in the left iliac fossa and adjacent to the left kidney. New retroperitoneal lymph nodes.A new reference left iliac mass measures 4.7 x 4.3 cm (image 132/series 10211). BOWEL, MESENTERY: New mesenteric lymphadenopathy on image 107.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: Soft tissue adjacent to the left ischium measures 3.3 x 2.1 cm (image 166/series 10211) previously, 3.5 x 2.3 cm.OTHER: No significant abnormality noted | 1.Decrease in size of some of the reference lesions however, dramatic increase in the size and number of right axillary, intra-abdominal mesenteric and retroperitoneal disease. |
Generate impression based on findings. | Female 38 years old; Reason: evaluate for perforation or free air History: abdominal pain after EGD. 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 significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from gastric bypass. No fluid collections or free air.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction. Scattered colonic diverticula.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Status-post gastric bypass surgery. No evidence for perforation. No free air or fluid. |
Generate impression based on findings. | Prostate carcinoma CHEST:LUNGS AND PLEURA: Stable micronodulesMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Stable left lobe low attenuation foci. Stable cholelithiasisSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable enlarged retroperitoneal lymph nodes. Reference left para-aortic lymph node best seen on image 126 of series 3 measures 2.4 x 1.5 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable reference right external lymph node best seen on image 162 of series 3 measuring 1.6 x 1.2 cm. Stable reference right external iliac lymph node best seen on image 182 of series 3 measures 0.6 cm in diameter.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination |
Generate impression based on findings. | 62 year-old female with small cell lung cancer and Eaton-Lambert syndrome status post three cycles of chemotherapy CHEST:LUNGS AND PLEURA: No suspicious mass is seen in the lungs. Linear opacities at the left lung periphery likely represent scarring. Scattered pulmonary micronodules. Right middle lobe granuloma.MEDIASTINUM AND HILA: The previously-hypermetabolic precarinal lymph nodes seen on PET now measure 0.6 cm in short axis (series 2, image 36), previously 1.5 cm on 8/15/13. Normal sized heart without pericardial effusion. Moderate coronary artery and aortic calcifications.CHEST WALL: No mass seen in the trachea or mainstem bronchi.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: 1.2 x 1.1 cm hypodense lesion in the right kidney (series 3, image 92). This lesion does not measure simple fluid density. Simple appearing left renal cysts. Left renal arterial calcifications.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: A long segment intramural thrombus is seen in the celiac axis and its branches. A long segment intramural thrombus is seen in the SMA.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: There is anterolisthesis of the L5 on S1.OTHER: No significant abnormality noted. | 1. No definite evidence of intrathoracic malignancy. No lymphadenopathy by CT criteria.2. 1.2-cm hypodense renal lesion, which does not measure simple fluid density. In the setting of a known malignancy, this may represent metastasis. Dedicated renal imaging may be helpful in differentiating this.3. Long segment intramural thrombi in the celiac axis and SMA. |
Generate impression based on findings. | Reason: eval appendicitis History: vague periumbilical pain, just started ABDOMEN:LUNG BASES: Nonspecific left lower lobe pulmonary micronodule (series 4, image 4). No pleural effusions.LIVER, BILIARY TRACT: Focal hypoattenuating focus in segment IVb suggest a focal perfusion defect.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: The appendix is not definitively visualized. There is a nondistended tubular air-filled structure in the right lower quadrant, which may correlate with the appendix. There is mild mesenteric fat stranding adjacent to this tubular structure (series 3, image 74).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: There is a small amount of free fluid in the pelvis, which is abnormal in a young male patient.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Nonspecific mesenteric fat stranding without additional findings to support diagnosis of appendicitis -- in addition, the pelvic free fluid may support diagnosis of an inflammatory process, although not necessarily appendicitis. No loculated fluid collections. |
Generate impression based on findings. | Reason: rule out appendicitis History: right sided abdominal pain ABDOMEN:LUNG BASES: Left lower lung base scarring. Mild scarring along the fissure in the right lung base.LIVER, BILIARY TRACT: No evidence of cholelithiasis. No gallbladder wall thickening . No evidence of intrahepatic or extrahepatic ductal dilatation. No suspicious focal liver lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: Scattered mesenteric lymph nodes.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There are bilateral cystic adnexal masses, left greater than right. The left cystic lesion measures 4.4 x 4.0 cm. The right cystic lesion measures 2.5 x 2.0 cm.BLADDER: No significant abnormality notedLYMPH NODES: Scattered inguinal lymph nodes bilaterally.BOWEL, MESENTERY: There is an appendicolith at the tip of the appendix with no associated distention, surrounding fat stranding or pelvic fluid collections. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of appendicitis.2.Bilateral cystic adnexal lesions, left greater than right. |
Generate impression based on findings. | 60 year-old male with malignant neoplasm of kidney -- restaging scans prior to starting new systemic therapy. CHEST:LUNGS AND PLEURA: The prior noted right upper lobe reference lesion is increased in size and now measures 1.5 x 1 .2 cm (series 5, image 50), previously measuring 1.0-cm. While this is a moderate increase in size, there has been a dramatic increase in the tumor burden throughout the lung parenchyma, with innumerable nodules, ranging in size from several millimeters to the largest aggregate collection of nodules, measuring 4.8 x 5.0 cm (series 5, image 55.Increasing size of left pleural effusion and new right pleural effusion with multiple pleural-based nodules (series 3, image 66. Right lung base).MEDIASTINUM AND HILA: There is been interval marked increase in size of mediastinal lymphadenopathy -- for example, right paratracheal lymph node (series 3, image 31) now measures 1.9 x 1 .7 cm, previously measured 1.2 x 1.1 cm. Similarly, large, lymph nodes are seen in the subcarinal space, markedly increased from prior examination.CHEST WALL: Expansile, sclerotic lesion of the right clavicle is again seen. Multiple lytic and sclerotic lesions are again seen throughout the bony skeleton of the chest without change in distribution or overall appearance.ABDOMEN:LIVER, BILIARY TRACT: Multiple, bilobar hepatic hypoattenuating lesions are again seen, compatible metastases. These have increased in size, number, and CT attenuation. Previously, many of these lesions would near water density indicating necrosis and now have returned to soft tissue attenuation (see series 3, image 94, where right lobe lesion is increased in size to 2.8 x 2.7 cm compared with previous 2.0 x 1.7 cm and has dramatically increased. Its attenuation diffusely. New lesions are also seen throughout the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal mass with mixed solid and cystic enhancing components consistent with known renal cell carcinoma has substantially increased in size and increased. It soft tissue nodule enhancement. Reference measurement previously of 10.8 x 12.2 cm has now increased in size to 13.0 x 15.5 cm (series 3, image 106.RETROPERITONEUM, LYMPH NODES: Marked increase in the periaortic retroperitoneal adenopathy is seen and now confluent with the renal mass itself and other extensive adenopathy. Best estimate of reference lymph node mass in the left periaortic space (series 3, image 114) now measures 6.0-cm by 8.9-cm compared with previous 6.3 cm x 3.9 cm.BOWEL, MESENTERY: Orally administered contrast traverses through normal appearing stomach, small bowel to the right lower quadrant without intrinsic abnormality or evidence of obstruction. The colon is filled with feces throughout and shows no diagnostic abnormalities. Scattered free mesenteric fluid is seen in dependent pelvis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Calculus again seen -- no otherLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Orally administered contrast traverses through normal appearing stomach, small bowel to the right lower quadrant without intrinsic abnormality or evidence of obstruction. The colon is filled with feces throughout and shows no diagnostic abnormalities. Scattered free mesenteric fluid is seen in dependent pelvis.New mass is seen in the dependent pelvis mesentery measuring 5.0 x 3.3 cm (series 3, image 190).BONES, SOFT TISSUES: Diffuse lytic and sclerotic lesions are seen throughout the bony skeleton without change in overall appearance and distribution or extent. Evidence of prior vertebro-plasty at L3, unchanged.OTHER: No significant abnormality noted | 1. Marked increase in size of left renal mass and associated retroperitoneal adenopathy. 2. No pelvic mesenteric mass and associated mesenteric fluid. 3. Marked increase in liver metastases size and number. 4. Dramatic increase in size and extent of pulmonary parenchymal metastatic disease and new mediastinal lymphadenopathy. 5. Stable appearance to diffuse skeletal metastatic disease. 6. Prior noted duodenal and proximal small bowel abnormalities, not seen. |
Generate impression based on findings. | Reason: esophageal ca s/p 2 cycles of chemo please assess response to therapy and compare to previous imaging History: esophageal ca CHEST:LUNGS AND PLEURA: Several unchanged micronodules, a few of which are calcified, compatible with previous infection, and 3 mm micronodule in the right middle lobe, and a subpleural location, most likely an intrapulmonary lymph node. Further follow-up is recommended to confirm stability.MEDIASTINUM AND HILA: Moderate dilation of the upper and mid esophagus with an air-fluid level. Thickening of the distal esophagus measuring 25 mm in total diameter (series 6 image 80) not significantly changed from 28 mm previously.Small adjacent lymph nodes, unchanged.Calcified nodes consistent with previous infection.CHEST WALL: Healed rib fractures on the right.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Poorly defined hypodensity in the right lobe (series 6 image 19) measuring 25 mm in maximum diameter, more conspicuous and questionably larger than previous. Other smaller nonspecific hypodensities have not appreciably changed.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Cortical scarring on the left. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly enlarged nonspecific upper abdominal lymph nodes, unchanged.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Distal esophageal thickening consistent with carcinoma.2. Nonspecific patchy hypodensities which are indeterminate but somewhat concerning for metastasis. The apparent differences in size and conspicuity it could be explained by hemangiomas with differences in contrast phase. MRI or multiphase dedicated abdominal CT scan could be performed for more accurate evaluation. |
Generate impression based on findings. | Reason: s/p fall in room History: s/p fall in room There is a right pleural based in the right fourth rib . The mass in the posterior aspect of the right chest wall which is a stable when compared to the prior exam. The inferior aspect is not included on this exam.There is redemonstration of a enlargement of the right thyroid gland which measures approximately 40 8 x 55 mm axial dimensionsThere is redemonstration of multiple lytic lesions scattered throughout the cervical spine.There is redemonstration of a biconcave compression fracture of T3 associated with lytic lesions.The cervical vertebral bodies are appropriate in overall alignment and height. No acute fractures are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There are small uncovertebral osteophytes present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present at this level as well as endplate osteophytes with narrowing of the spinal canal and bilateral neural frontal encroachment of the exiting nerve roots. There is bilateral neural frontal encroachment exiting nerve roots at this level.At C6-7 there is loss of disk space height, disk bulge and endplate osteophytes as well as bilateral uncovertebral joint osteophytes.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.There is redemonstration of periapical lesions present throughout the patient's dentition as well is a numerous dental caries.The eyeball lenses are thin. | 1.No acute cervical spine fracture.2.There are multiple lytic lesions in the cervical spine which were also identified on the prior exam and have not changed substantially.3.There are degenerative changes present in the cervical spine worst at C5-6 and C6-7 where there is bilateral neural foramen encroachment with suspected spinal stenosis at C5-64.There is a compression fracture at T3 associated with underlying lytic lesions which is stable when compared to prior exam5.there is a right chest wall mass present which is stable compared to the prior exam6.there is enlargement of the right thyroid gland which is stable compared to prior exam. Please correlate with clinical history |
Generate impression based on findings. | Reason: CIRRHOSIS PROTOCOL: Please evaluate for extent of HCC including multifocal disease, extrahepatic spread or vascular invasion History: 54 yo M with NASH cirrhosis and HCC with high AFP CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Nonspecific prominent mediastinal lymph nodes, measuring up to 2.4 x 1.1 cm in the precarinal region (series 11, image 37).CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Arterially enhancing left hepatic lobe mass with portal venous washout measures 4.3 x 4.8 cm (series 9, image 36). Additional arterially enhancing lesion in the superior left hepatic lobe demonstrates portal venous washout, measuring 2.0 x 1.9 cm (series 9, image 16). Probable right hepatic lobe simple cyst. No ascites.SPLEEN: Splenomegaly. Accessory splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific retroperitoneal lymphadenopathy in the setting of chronic liver disease. Reference aortocaval lymph node measures 1.9 x 1.6 cm (series 11, image 122).BOWEL, MESENTERY: Large gastrohepatic venous collaterals.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Two left hepatic lobe masses which meet the AASLD criteria for HCC.2.No evidence of metastatic disease.3.Cirrhosis with portal hypertension.4.Nonspecific lymphadenopathy in the setting of chronic liver disease. |
Generate impression based on findings. | Clinical question: Status post fall, on Plavix. Signs and symptoms: Evaluate for bleed. Nonenhanced head CT:There is no detectable acute intracranial process. CT Homer is insensitive for detection of acute non-hemorrhagic ischemic strokes.There are moderate periventricular and subcortical patchy foci of white matter low attenuation in bilateral cerebral hemispheres grossly similar to prior exam and consistent with age indeterminate small vessel ischemic strokes.Mild vascular calcification of bilateral cavernous carotid and bilateral vertebrals are noted. Cortical sulci and ventricular system are unremarkable and stable since prior MRI exam.Calvarium and soft tissues of the scalp are unremarkable and without evidence of acute post traumatic findings.Unremarkable images through the orbits.With the exception of a small left maxillary sinus retention cyst the paranasal sinuses are unremarkable.Bilateral mastoid air cells and middle ear cavities are well pneumatized | 1.No detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.2.Moderate age indeterminate small muscle ischemic strokes as detailed.3.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells and bilateral orbits. |
Generate impression based on findings. | Reason: eval nodules seen on prior CT History: abnl CT of chest- LUNGS AND PLEURA: Benign-appearing micronodules, some calcified, are unchanged in very likely benign and postinflammatory.Previously seen pleural effusions and basilar interstitial edema have resolved.MEDIASTINUM AND HILA: Right lobe thyroid enlargement and cyst formation unchanged.There is no mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Thickening of the GE junction region, unchanged. | 1. Benign-appearing pulmonary micronodules unchanged.2. Resolution of prior CHF related abnormalities.3. He junction thickening. If the patient has symptoms of dysphasia an esophagogram is recommended. |
Generate impression based on findings. | Reason: 61y/o with AML and h/o prior allogeneic stem cell transplant, h/o presumed fungal pneumonia and worsening infiltrates on last Chest CT; on antifungal therapy, please evaluate CXR for infiltrate. History: abnormal chest CT LUNGS AND PLEURA: Groundglass/solid opacities may have slightly improved as there is less of a solid component in the right upper and right lower lobe opacities. Mild lower lung zone bronchial wall thickening is stable.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Aortic root and coronary calcifications are moderate to severe.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Extensive vascular calcifications are seen. | Slight improvement in pulmonary opacities consistent with resolving atypical infection. |
Generate impression based on findings. | Clinical question: Evaluate intracranial hemorrhage. Signs and symptoms: Alteration of mental status. Nonenhanced head CT:No detectable acute intracranial process. CT ovaries intensity and an acute nonhemorrhagic ischemic strokes.Examination demonstrates extensive periventricular and subcortical patchy foci of white matter low-attenuation without any gross interval change since prior exam from May of 2013. Finding consistent with age indeterminate small vessel ischemic strokes. There is mild prominence of the supratentorial ventricular system similar to prior exam and likely ex vacuo in origin. Moderate bilateral cavernous carotid and vertebral artery calcification is noted. Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits. All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized and stable since prior exam | Grossly stable extensive periventricular and subcortical low attenuation of white matter consistent with age indeterminate small vessel ischemic strokes. No CT evidence of acute intracranial process. |
Generate impression based on findings. | Papillary thyroid carcinoma with recurrences, the last surgery of which was a left neck dissection in October 2012. Radiation was completed in January 2013. There are post-treatment findings related to total thyroidectomy, neck dissection, and radiation therapy. There has been interval decrease in size of a nodular focus adjacent to the left thyroid surgical bed, which now measures 3 mm, previously 6 mm. Otherwise, there is no evidence of residual tumor in the resection bed and no evidence of significant cervical lymphadenopathy. There is unchanged asymmetric sclerosis of the left cricoid cartilage. There is unchanged mucosal with effacement of the left piriform sinus. There is hyperdense material within the left vocal cord, which likely corresponds to augmentation material. There are bilateral palatine tonsilloliths. The major salivary glands appear unchanged. There is a stable sclerotic focus in the left third rib at the costovertebral junction, which likely represents an enostosis. There is mild calcified plaque in the bilateral proximal carotid arteries. The imaged intracranial structures are unremarkable. There are bilateral lens implants. The paranasal sinuses and mastoid air cells are clear. The imaged upper lungs are clear. Refer to the separate chest CT report for additional details. | 1.Interval decrease in size of the nodular focus adjacent to the left thyroid surgical bed, which now measures 3 mm, previously 6 mm. Otherwise, there is no evidence of residual tumor in the resection bed and no evidence of significant cervical lymphadenopathy. 2.Persistent obscuration of the left piriform sinus is likely related to mucosal edema.3.Soft tissue in the region of prior sclerosis involving the left cricoid cartilage. Findings may represent posttreatment change/biopsy change however, continued close follow up is recommended. |
Generate impression based on findings. | Reason: ct of abdomen post embolization of right portal vein History: cto of abdomen post embolization of right portal vein, history of metastatic adenocarcinoma of the colon. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple metastatic lesions throughout the right lobe liver, largest located in segment 6, measuring 2.3 x 2.3 cm. The lesions overall remain grossly unchanged. There is no significant change in the volume of the left lobe of the liver. There is evidence of right portal vein embolization with metallic coils. There is no evidence of biliary ductal dilatation. Hepatic arteries and hepatic veins are patent. Main portal vein and left portal vein are patent. There is thrombosis of the right posterior branch of the portal vein with poor visualization of the anterior branch air. There is a hepatic cyst in segment 4 of the liver.SPLEEN: No significant abnormality notedPANCREAS: There is evidence of pancreatic divisum.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small renal cyst in the mid left kidney. Small renal cyst in the lower pole of the right kidney.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: Scattered, subcentimeter inguinal lymph nodes bilaterally.BOWEL, MESENTERY: Redemonstration of rectal wall thickening that remains relatively stable. There is an interval increase in size and number of perirectal chain of lymph nodes (series 11, image 87).BONES, SOFT TISSUES: Cystic lesions in the right femoral head.OTHER: No significant abnormality noted | 1.Multiple space-occupying lesions in the right little are consistent with metastatic disease, unchanged in size and appearance.2.Status post coiling of right portal vein with thrombosis of the posterior branch and poor visualization of the anterior branch. There is no evidence significant change in volume of the left lobe.3.Relatively stable rectal wall thickening with increase in size and number of perirectal chain of lymph nodes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | GIST tumor CHEST:LUNGS AND PLEURA: Scattered micronodules, several calcifiedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval appearance of multiple right lobe metastatic lesions. A representative segment 8 mass best seen on image 79 of series 3 measures 6.8 x 6.4 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: Dramatic interval increase in size and number of extensive confluent bulky mesenteric mass lesions. A representative anterior mesenteric mass best seen on image 122 of series 3 measures 15 by 12.8 cm; this is in comparison to 3.6 x 3.4 cm on 2/13/2013.A new representative right mesenteric mass best seen on image 131 of series 3 measures 7.2 x 8.1 cm.BONES, SOFT TISSUES: Probable umbilical hernia with mesenteric tumor mass extension through the hernia defect.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval appearance of extensive bulky confluent mesenteric mass lesions. A representative pelvic mesenteric mass best seen on image 169 of series 3 measures 7.1 x 4.6 cm.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Dramatic interval increase in size and number of hepatic and bulky mesenteric metastatic disease |
Generate impression based on findings. | 65-year-old female with adenocarcinoma of the lung LUNGS AND PLEURA: The spiculated right middle lobe mass now measures 2.3 x 1.3 cm (series 5, image 52), previously 4.0 x 2.0 cm. No new suspicious nodules or masses are seen. Mild centrilobular emphysema. Scattered pulmonary micronodules.MEDIASTINUM AND HILA: The reference right hilar lymph node measures 0.6 cm in short axis (series 3, image 45), previously 1.0 cm. No hilar or mediastinal lymphadenopathy by CT criteria. Normal sized heart without pericardial effusion. Moderate coronary artery and aortic calcifications.CHEST WALL: Subcentimeter axillary lymph nodes. Mild to moderate degenerative disease affects the thoracic spine. Unchanged left Bochdalek hernia.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The small non-enhancing fat-containing mass with peripheral calcifications at the dome of the liver is unchanged from 1/30/2012. This is possibly a benign gallstone granuloma. Scattered small peritoneal calcifications are again seen. | Decreased size of the right middle lobe mass and right hilar lymph node compared to 7/26/13 |
Generate impression based on findings. | Female 75 years old Reason: pt with lung ca s/p 6 weeks chemo and Rt after surgical resection History: doing well now needs disease evaluation compare to previous scans and comment CHEST:LUNGS AND PLEURA: Postoperative changes consistent with left upper lobectomy. Slight interval decrease in a small left anterior loculated pleural effusion and pleural fluid in the left costophrenic angle.Right lower lobe lower lobe micronodule (image 48, series 5) unchanged and likely benign in etiology. Small ground glass subpleural nodular opacity in the right lower lobe (image 26 series 5) without appreciable change, but recommend long-term follow-up to assess for interval change. Linear density in the right lower lobe (image 50, series 5) unchanged.MEDIASTINUM AND HILA: Homogeneous fluid-filled structure contiguous with the posterior right lobe of the thyroid, likely representing a thyroidal cyst without appreciable change.Mediastinal lymphadenopathy unchanged, reference para-aortic lymph node measures 10 mm (image 29, series 3) and previously measured 11 mm.Filling defect seen in the left atrial appendage, which may represent thrombus or postsurgical changes.Severe atherosclerotic disease of the aorta and coronary arteries.CHEST WALL: Right chest wall Port-A-Cath with the tip in the right atrium. Multinodular goiter.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Patient is status post cholecystectomy. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right nonobstructive nephrolithiasis. Simple fluid density lesion seen in the left renal sinus consistent with a simple renal sinus cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Severe atherosclerosis of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Multiple small bowel anastomoses.BONES, SOFT TISSUES: Calcified soft tissue nodules in the subcutaneous tissues of the lower back unchanged.OTHER: No significant abnormality noted. | 1. Unchanged mediastinal lymphadenopathy.2. Small ground glass nodular opacity in right lower lobe unchanged, but recommend long-term follow-up to confirm stability. |
Generate impression based on findings. | Reason: stage IV lung cancer with liver metastases, received 3 cycles of chemotherapy- reimaging exam History: none CHEST:LUNGS AND PLEURA: A previously solid left upper lobe nodule has become cystic and now measures 27 mm in maximum diameter compared to 36 mm previously.A right upper lobe ground glass nodule with cystic components measures 27 x 21 mm, minimally decreased from 28 x 23 mm previously.An additional non-solid nodule with cystic or bronchiectatic components measures 12 mm and is not appreciably changed.Focal scarring at both lung bases, not significantly changed.MEDIASTINUM AND HILA: No significant lymphadenopathy.Severe and extensive coronary artery calcification.CHEST WALL: Lytic lesions in the thoracic spine at the level of T1 and T6, compatible with metastases slightly increased in extent.Left posterior rib fracture, which may be pathological, new since previous.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Hypodense lesion in the right hepatic lobe measuring 25 x 14 mm, decreased from 40 x 29 mm previously. Two smaller metastases in the left lobe have also markedly decreased in size. Additional small sclerotic lesions, not significantly changed.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Enlarged right adrenal gland measuring 17 mm in transverse diameter, decreased from 22 mm previously.KIDNEYS, URETERS: Exophytic left renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Marked decrease in hepatic and adrenal metastases. 2.Slight decrease and interval cavitation of left upper lobe nodule, and a presumed second primary lesion in the right upper lobe.3. Skeletal metastases, some of which have slightly increased in extent. |
Generate impression based on findings. | 84-year-old female with history of colocutaneous fistula status post plugging UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A radiodense plug in the left hemicolon is noted. A 7.7 cm x 8 mm tract extends from the colon to the pelvic wall and contains fluid and gas. Inflammatory changes are noted in the abdominal/pelvic wall and a small subcutaneous fluid collection with gas is also noted. Postoperative changes of the right hemicolon are also partially visualized.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: Atherosclerotic calcifications of the abdominal aorta. | Left colonic plug device and tract extending to the abdominal wall containing fluid and gas as described above. |
Generate impression based on findings. | Malignant melanoma CHEST:LUNGS AND PLEURA: Stable micronodulesMEDIASTINUM 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: Stable bilateral renal cystsRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable negative examination. No evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Male 65 years old; Reason: pre op eval for right reverse TSA History: right shoulder arthritis. There is severe narrowing of the glenohumeral joint. Osteophytes are seen along with sclerosis and a ring of subchondral cysts surrounding the humeral head. There is narrowing of the acromiohumeral interval and retraction of the supraspinatus tendon consistent with chronic rotator cuff tear. There is severe atrophy of the supraspinatus muscle and also atrophy of the infraspinatus muscle and teres minor. Again seen is acromioclavicular separation. | Marked osteoarthritic changes and chronic rotator cuff tear of the right shoulder. |
Generate impression based on findings. | Reason: evaluate for bleed History: altered mental status with history of SAH in 90s The patient is status post left-sided craniotomy for aneurysm clip placement along the distal left internal carotid artery. There is encephalomalacia involving the left inferior frontal gyrus part of left orbital gyrus and a part of the left anterior temporal lobe. There is encephalomalacia involving the left cerebellar hemisphere which is also stable since the prior exam.There are new foci of hypodense foci associated with ex vacuo affect along the left and right basal ganglia as well as the left pons.There is redemonstration and no change of a hyperdense focus in the left thalamus .Periventricular and subcortical white matter hypodensities of a moderate degree are present. These have developed since the prior exam thereThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema. CT is insensitive for the early detection of nonhemorrhagic CVA2.Findings are compatible with lacunar infarcts involving basal ganglia, pons and in the left thalamus. Most of these are new since the prior exam. The possibility that one of these is acute cannot be excluded.3.Periventricular and subcortical white matter signal changes of a mild to moderate degree are present which are nonspecific. They are most likely vascular related, however they could also be related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 4.There are foci of encephalomalacia in the left frontal lobe, left temporal lobe and left cerebellar hemisphere which are stable. |
Generate impression based on findings. | Reason: Eval for HCC History: abdominal pain CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Left basilar scarring.MEDIASTINUM AND HILA: Prominent cardiophrenic lymph node measures 2.1 x 1.4 cm (series 10, image 54). Heart size is normal. No pericardial effusion. Coronary artery calcifications.CHEST WALL: No significant abnormality.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Innumerable foci of faint arterial enhancement predominately in the left hepatic lobe, some of which demonstrate washout on portal venous phase. There is a dominant right hepatic lobe segment VIII lesion, which measures 4.1 x 3.9 cm (series 3, image 30). The portal vein and branches are occluded by thrombus extending to the portosplenic confluence. Consequent arterio-portal shunting of blood is present, visualized in the left hepatic lobe. Mild intrahepatic biliary ductal dilatation. Cholelithiasis without CT evidence of cholecystitis.SPLEEN: Perisplenic venous collaterals.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple left renal cyst.RETROPERITONEUM, LYMPH NODES: Prominent retroperitoneal and portocaval lymph nodes are nonspecific in the setting of chronic liver disease. Atherosclerosis of the abdominal aorta and its branches. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Innumerable foci of faint enhancement, predominately in the left hepatic lobe, with portal venous washout, many of which meet the AASLD criteria for HCC, including a dominant lesion in the right hepatic lobe.2.Tumor invasion of the main, left and right portal veins with extensive peripheral involvement in liver.3.Cirrhosis and portal hypertension. |
Generate impression based on findings. | Metastatic colorectal carcinoma CHEST:LUNGS AND PLEURA: No significant change in bilateral pulmonary nodules. Reference right lower lobe nodule best seen on image 50 of series 5 measures 1 x 0.7 cm. Reference pleural-based right anterior middle lobe focus as seen on image 74 series 3 measures 1.4 x 1.2 cm.New small bilateral pleural effusionsMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Significant interval increase in size and number of extensive confluent bilobar hepatic metastatic lesions. Reference segment 8 hepatic dome lesion as seen on image 78 series 3 now measures 5 x 4.5 cm; this is in comparison to 3.3 x 2.9 cm on 9/24/2013.Pneumobilia again noted. Biliary wall stent unchanged in position. Probable thrombosis of the right portal vein and narrowing of the main portal vein unchanged unchanged.SPLEEN: No significant abnormality notedPANCREAS: Prominence of pancreatic duct unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Interval increase in ascites which is now moderately large in quantity. Reference mesenteric lesion at the level of the SMA origin best seen on image 129 of series 3 measures 3.5 x 2.3 cm; this is comparison of 3.3 x 2.2 cm on 6/24/2013. Centrally located reference mesenteric mass best seen on image 116 of series 3 measures 2.7 x 3.9 cm. However, other mesenteric mass lesions have increased in the interval. Omental nodularity slightly increased.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: Interval increase in ascitesBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval increase in size and confluence of extensive bilobar hepatic metastatic disease associated with interval increase in degree of ascites and increase in size of mesenteric metastatic lesions and omental nodularity. |
Generate impression based on findings. | Male; 21 years old. Reason: Malignant melanoma to left neck, s/p neck dissection and XRT. Surveillance scanning History: Melanoma The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage, or abnormal contrast enhancement. The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Interval postsurgical changes of left neck dissection. A reference left level II node is no longer discretely identifiable. Previously seen prominent right level II and bilateral level I lymph nodes are grossly unchanged. No lymphadenopathy by CT size criteria in the neck or supraclavicular regions.Previously seen left dorsal cutaneous nodule is no longer evident.The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable. Limited view of the chest is unremarkable. | 1. No evidence of intracranial metastasis.2. Interval postsurgical changes of left neck dissection with no evidence of residual or recurrent disease. |
Generate impression based on findings. | Reason: history of nephrolithiasis, recurrent pain History: abd pain The lack of IV contrast limits evaluation of solid organ pathology.ABDOMEN:LUNG BASES: Hepatic lobe nonspecific hypodensities, likely benign.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: Nonobstructive 4-mm left lower pole calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS: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. | Nonobstructive 4-mm left lower pole calculus without hydronephrosis. |
Generate impression based on findings. | Reason: 69 M with hx of NSCLC and esophageal ca, evaluate for residual or new disease History: None LUNGS AND PLEURA: Interval clearing of consolidation and atelectasis in the right lung.Residual extensive postsurgical abnormalities with pleural thickening, calcification, and a very small loculated pneumothorax.Left upper lobe part cystic groundglass lesion measuring 17 mm in diameter, unchanged or slightly increased since 2010, suspicious for indolent adenocarcinoma.Another anterior groundglass lesion in the left upper lobe has resolved, presumably inflammatory.An approximately 10 mm peripheral left upper lobe ground glass opacity is unchanged since 2010.MEDIASTINUM AND HILA: Marked interval decrease in right upper paratracheal lymph nodes which measured up to 12 mm on the previous scan, now 6 mm.Moderate coronary artery calcification.Status post gastric interposition procedure.CHEST WALL: Postsurgical chest wall deformity on the right.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Interval resolution of extensive consolidation in the right hemithorax with residual pulmonary and pleural scarring and minimal pneumothorax. 2. Marked decrease in mediastinal lymphadenopathy.3. Suspicious left upper lobe ground glass and cystic nodule, stable since the previous scan but slightly increased since 2010, most consistent with memory adenocarcinoma in situ or minimally invasive. |
Generate impression based on findings. | History of sagittal craniosynostosis status post total cranial vault reconstruction 10/2012. There has been a significant degree of bony remodeling since the prior examination which followed surgery for scaphocephaly. There has been restoration of a rounded contour of the posterior aspect of the skull where there was previously a more angulated configuration. There has been restoration of a more normal overall AP:transverse ratio as well. There are a few areas where there is persistent focal thinning or bony defect including bilateral parasagittal parietal defects measuring 1.5 (right) and 1.3 (left) cm near the vertex (coronal series 80516 image 75). There is an additional more subtle thinning/defect measuring 5 mm along the left paramedian apex on series 80516 image 59 and series 80517 image 49.There is a focal bony prominence near the midline at the expected location of the medial right coronal suture (sagittal series 80517 image 37) which measures 1.6 cm in diameter and 5 mm in thickness. A very tiny focal defect is present just to the right of this on series 80517 image 31.There are no intracranial abnormalities including mass, fluid collection, hydrocephalus or herniation. There has been interval decreased prominence of the ventricles, likely relating to resolving benign enlargement of subarachnoid spaces as the anterior subarachnoid spaces are also now not as apparent. Gray-white differentiation is appropriate for the patient's age. The midline is intact. Paranasal sinuses conform to an expected degree of aeration, with mild mucosal thickening in the maxillary sinuses. | 1. Significant bony remodeling subsequent to prior craniosynostosis surgery. A few small areas of bony thinning or defect primarily demonstrated near the vertex with an overall improvement in the now rounded contour of the calvarium, especially along the posterior aspect of the skull. Restoration of a more normal AP: Transverse ratio of the skull.2. Interval decreased prominence of ventricles and anterior subarachnoid spaces, consistent with resolved benign enlargement of subarachnoid spaces of infancy. |
Generate impression based on findings. | 68-year-old female with cough and dyspnea LUNGS AND PLEURA: Minimal biapical centrilobular emphysema with scattered upper lobe nodular subpleural opacities, similar to 11/17/11. These opacities are nonspecific, though their stability suggests a benign or indolent process. No specific evidence of interstitial lung disease. Scattered calcified and noncalcified pulmonary micronodules. No suspicious pulmonary masses are seen.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion. Mild coronary artery and aortic calcifications.CHEST WALL: Mild to moderate degenerative changes of the thoracic spine. No axillary lymphadenopathy. Bilateral breast implants.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Mild calcification of the abdominal aorta and splenic artery. No significant abnormality noted otherwise. | Minimal centrilobular emphysema. Apical subpleural opacities could be from prior granulomatous disease, including sarcoidosis, but also suggestive of pulmonary fibroelastosis. |
Generate impression based on findings. | Female 76 years old Reason: Patient s/p 6 cycles carboplatin/alimta. Reevaluation for NSCLC. History: NSCLC CHEST:LUNGS AND PLEURA: Spiculated/lobulated right upper lobe nodule now measures 23 x 15 mm (image 26, series 7), previously measuring 23 x 15 mm.Unchanged scattered bilateral pleura micronodules, some of which are calcified and are compatible with prior infection.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Small calcified mediastinal and hilar lymph nodes consistent with prior granulomatous disease. Normal sized right hilar lymph node, which may represent a hypermetabolic node seen on the PET scan dated 5/30/2013 is unchanged in size.Moderate/severe aortic and coronary artery calcifications unchanged.CHEST WALL: There is no evidence of axillary or supraclavicular lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesion in the left kidney likely represents a simple renal cyst. Nonobstructive left nephrolithiasis.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Marked atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable spiculated right upper lobe nodule compatible with primary adenocarcinoma.2.No evidence of metastatic disease. |
Generate impression based on findings. | Reason: CIRRHOSIS PROTOCOL: Please evaluate for extent of HCC including multifocal disease, extrahepatic spread or vascular invasion History: 54 yo M with NASH cirrhosis and HCC with high AFP CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Nonspecific prominent mediastinal lymph nodes, measuring up to 2.4 x 1.1 cm in the precarinal region (series 11, image 37).CHEST WALL: Gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic morphology of the liver. Arterially enhancing left hepatic lobe mass with portal venous washout measures 4.3 x 4.8 cm (series 9, image 36). Additional arterially enhancing lesion in the superior left hepatic lobe demonstrates portal venous washout, measuring 2.0 x 1.9 cm (series 9, image 16). Probable right hepatic lobe simple cyst. No ascites. Portal vein is patent.SPLEEN: Splenomegaly. Accessory splenules.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Nonspecific retroperitoneal lymphadenopathy in the setting of chronic liver disease. Reference aortocaval lymph node measures 1.9 x 1.6 cm (series 11, image 122).BOWEL, MESENTERY: Large gastrohepatic venous collaterals.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Two left hepatic lobe masses which meet the AASLD criteria for HCC.2.No evidence of metastatic disease.3.Cirrhosis with portal hypertension.4.Nonspecific lymphadenopathy in the setting of chronic liver disease. |
Generate impression based on findings. | Reason: history of metatatic renal cancer on therapy History: renal cancer LUNGS AND PLEURA: Increased interstitial opacity with septal lines consistent with edema, and small pleural effusions, new since previous. Large central pulmonary artery consistent with pulmonary hypertension. Image quality is degraded by marked respiratory motion artifact at the lung bases.MEDIASTINUM AND HILA: A large mass at the thoracic inlet on the right producing compression of the tracheal lumen, and inseparable from the right lobe of the thyroid gland. The internal texture is inhomogeneous and the upper extent is not completely imaged on the scan. It is at least questionably increased since the previous scan.Increased right paratracheal lymphadenopathy, measuring up to 15 mm in short axis diameter in the lower right paratracheal area.Markedly enlarged main pulmonary artery consistent with pulmonary hypertension.Marked cardiomegaly with a small pericardial effusion.Moderate coronary artery calcifications.Moderately ectatic descending aorta compatible with history of aortic dissection.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Partially visualized large exophytic left renal mass consistent with renal cell carcinoma, probably increased in size. | 1. Pulmonary edema with small pleural effusions consistent with CHF.2. Increasing mass at the thoracic inlet which may be secondary to metastatic disease, or thyroid carcinoma, with increased mediastinal lymphadenopathy. 3. Severe cardiomegaly and pulmonary hypertension. |
Generate impression based on findings. | Reason: evaluate for lymphadenopathy, malignancy, interstitial lung disease History: cough, shortness of breath, abnormal PFTs LUNGS AND PLEURA: Very mild basilar subpleural reticulation is present with moderate traction bronchiectasis.There is no honeycombing, groundglass opacities or air trapping. Scattered calcified granulomata are present. MEDIASTINUM AND HILA: There are no significantly enlarged mediastinal or hilar lymph nodes, but scattered upper normal size nodes are of slightly increased attenuation likely from light calcification.Proximal aortic calcifications are seen.CHEST WALL: Degenerative abnormalities of thoracic spine, with mild endplate depression at T 6 and 10.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. Numerous splenic and hepatic granulomata are present.Large renal cyst like hypodensity. | 1. Mild fibrosis with traction bronchiectasis, not characteristic of any of the common idiopathic interstitial pneumonias. This could represent early UIP or connective tissue disease, however. 2. Prior granulomatous disease probably histoplasmosis. |
Generate impression based on findings. | Male 43 years old; Reason: Must use water only for oral contrast prep. Must include arterial phase Chest and Upper Abdomen. IRB12-2221, call HIRO for questions 2-9172, please compare to previous History: stage IV metastatic melanoma CHEST:LUNGS AND PLEURA: Bilobar pulmonary metastatic disease. Reference right middle lobe lesion measures 4.8 x 3.7 cm (image 59/series 11), previously measures 4.6 x 4.1 cm.Post operative changes in the right lower lobe. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. Multiple right hilar lymph nodes. Reference right hilar node adjacent to the right lower lobe airway measures 1.3 x 0.6 cm (image 46/series 9). CHEST WALL: No evident axillary lymphadenopathy. Chronic right rib fractures.OTHER: ABDOMEN:LIVER, BILIARY TRACT: No suspicious hepatic lesions. Hepatic and portal veins are patent.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Bilobar pulmonary metastatic disease. 2.Right hilar lymphadenopathy |
Generate impression based on findings. | Clinical question: Rule out subarachnoid hemorrhage. Signs and symptoms: Altered mental status. Nonenhanced head CT:Images through supratentorial space redemonstrate subarachnoid hemorrhage in patchy noncontiguous pattern. There is a slight interval decrease in the subarachnoid hemorrhage since prior exam in particular on the right side.Minimal hemorrhage in the left lateral ventricle is again identified without definitive change since prior exam.Minimal subarachnoid hemorrhage along the dorsal -- inferior aspect of the right cerebellum is again noted.There is no detectable foci of parenchymal low attenuation/edema.Stable normal size of ventricular system since prior exam.Mild to moderate bilateral cavernous carotid vascular calcification.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | 1.Slight interval decrease in subarachnoid hemorrhage since prior exam.2.Residual blood both the supratentorial and infratentorial space still identified.3.No evidence of ischemic changes since prior study.4.Stable normal size of ventricular system since prior exam.5.Stable minimal hemorrhage in the left lateral ventricle since prior exam. |
Generate impression based on findings. | Testicular carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable exam. No evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Reason: Any sign of remote dissection in vertebrals, particularly right vertebral. History: Neck pain, headache, thalamic stroke 6/29/2013 There is redemonstration of a hypodense focus centered in the left subfrontal lobule but also involving left inferior parietal lobule , lateral aspect of the left post central gyrus measuring 30 x 43 mm axial dimensions it and involving both gray and white matter. It is associated with a small hyperdense focus which has gradually decreased in density and size since prior exams.Punctate hypodensities are scattered in the basal ganglia.Microcatheter ventricular CTAtherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Continued evolution of an infarction with hemorrhagic conversion involving a small portion of the left parietal lobe extending so a portion of the subcentral lobule and insular cortex associated with the small amount of a hemorrhagic conversion. There is no new hemorrhage appreciated.2.Multiple lesions in the right basal ganglia and right centrum semiovale and pons most likely represent lacunar infarcts and remain unchanged.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.CT is insensitive for the early detection of acute ischemic infarction. |
Generate impression based on findings. | Reason: new left sided neck mass History: painless neck mass on left There is a well circumscribed left neck mass measuring 24x25mm axial dimensions and 46x24mm coronal dimensions which is located lateral to the left carotid space and medial to the left parotid gland and the . It has a heterogeneous appearance with an irregularly shaped central hypodensity suggestive of necrosis. It compresses the left jugular vein anteromedially and displaces the left internal and external carotid arteries anteromedially. Its superior tip is immediately behind the styloid process at the C1 level whereas its inferior tip is at the level of the hyoid bone. It compresses the left sternocleidomastoid muscle postero-laterallySubmandibular space lymph nodes measure 8mm short axis dimensions bilaterally.Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the left lobe of the thyroid gland appears large and contains a 19mm heterogenous lesion. The right lobe is absent.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. There are endplate and uncovertebral osteophytes at C4-5 and C5-6 with encroachment of exiting nerve roots at C5-6 bilaterally. | 1.There is a large left upper neck mass present between the left carotid and the left parotid gland. Differential considerations include schwannoma, possibly lymphadenopathy or less likely paraganglioma. 2.There is a 2cm heterogenous lesion in the left thyroid gland lobe. CT is not accurate in the evaluation of thyroid lesions. Please correlate with clinical history and findings. |
Generate impression based on findings. | Clinical question: The without acute injury or hemorrhage. Signs and symptoms: Mechanical fall with loss of consciousness. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Extensive periventricular and subcortical low attenuation of white matter grossly similar to prior exam from August of 2013 and representing age indeterminate extensive small vessel ischemic strokes.Postoperative changes of a right frontal -- temporal craniotomy with minimal underlying right temporal lobe encephalomalacia.Unremarkable images through orbits, paranasal sinuses, mastoid air cells and middle ear cavities. | Advanced age indeterminate small muscle ischemic strokes. No acute posttraumatic findings. |
Generate impression based on findings. | Clinical question: Rule out TIA/stroke. Signs and symptoms: Blurred speech x 20 minutes. Nonenhanced head CT:No detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation.Unremarkable calvarium and soft tissues of the scalp.All visualized paranasal sinuses and bilateral mastoid air cells are well pneumatized and unremarkable.Unremarkable images through the orbits. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status post fall with blunt head trauma. Nonenhanced head CT: There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Minimal periventricular low attenuation of white matter considering patients age likely representing age indeterminate small vessel ischemic strokes.Cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation is otherwise within normal for patient's stated age of 97. Mild to moderate bilateral intracranial vertebral artery and bilateral cavernous carotid vascular calcification is noted.There is anatomical variation of partially empty sella.Limited images through the orbits and paranasal sinuses are unremarkable. | Minimal age indeterminate small vessel ischemic strokes. No detectable acute posttraumatic findings. |
Generate impression based on findings. | Headache. Evaluate SDH. The previously described bilateral acute subdural fluid collections overlying the frontal and parietal lobes have demonstrated no significant interval change in dimension, though there is layering of blood products on today's exam. The left and right collections measure up to 14 and 13 mm in depth on coronal images (previously 16 and 15 mm). Again there is local mass effect including gyral and sulcal effacement. On this examination there has been interval development of subtle ventricular effacement bilaterally which is also in keeping with mass effect. There is no transtentorial or uncal herniation. Low-lying cerebellar tonsils (3 mm) with foreman magnum crowding are again demonstrated.No evidence of hydrocephalus, acute ischemia. Orbits, paranasal sinuses and mastoid air cells are unremarkable. There are no visualized bony fractures. | 1.No significant increase in size, though interval layering of blood products within the bilateral acute subdural hematomas. 2.Low lying cerebellar tonsils. |
Generate impression based on findings. | Headache 4 days and left hand numbness. There are extra axial fluid collections overlying the frontal and parietal lobes bilaterally. Both demonstrate a crescentic configuration measuring 15 and 16 mm (left and right respectively) in maximum depth on coronal images. There is local mass effect on the underlying sulci and gyri without significant midline shift or transtentorial/uncal herniation. There is no significant effacement of the ventricular system bilaterally. There are no overlying skull fractures.Cerebellar tonsils are low-lying (3 mm below basion-epistion line). The gray-white differentiation is normal bilaterally and there is no evidence of ischemia. Orbits, paranasal air sinuses and mastoid air cells are unremarkable. | 1.Bilateral acute subdural hematomas. 2.Low lying cerebellar tonsils. |
Generate impression based on findings. | Evaluate for obstruction. Abdominal pain and vomiting. ABDOMEN:LUNG BASES: Previously described bibasilar atelectasis with consolidation has nearly completely resolved.LIVER, BILIARY TRACT: Status post cholecystectomy. No focal hepatic lesions evident.SPLEEN: Unchanged nonspecific splenic hypodensity.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomy. Status post ileostomy takedown. No evidence of bowel obstruction. Normal bowel wall thickness and enhancement. No loculated fluid collections.BONES, SOFT TISSUES: Midline abdominal staples.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Bladder is well distended and grossly normal in contour.. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Status post colectomy with ileostomy takedown. No evidence of bowel obstruction. Normal bowel wall thickness and enhancement. No loculated fluid collections to suggest abscess formation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant fluid collections identified | Postsurgical changes without evidence of complication. No acute CT findings to account for the patient's symptoms. Resolution of previously described bibasilar atelectasis and consolidation. |
Generate impression based on findings. | Clinical impression: Evaluate subdural hematoma. Signs and symptoms: Altered mental status. Nonenhanced head CT:There is no detectable acute new findings since prior exam in particular no evidence of new hemorrhage. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Stable residual blood in the dependent portion of bilateral occipital horns without significant change.Stable dilated (left greater than right) lateral ventricles and the ventricular catheter.Revisualization of minimal high density/blood in the right posterior temporal -- occipital region at the site of entry of the ventricular catheter.Revisualization of aneurysm clips in the right sylvian fissure.Stable extensive periventricular (left greater than right) low attenuation of white matter with suggestion of extra to dilatation of the left frontal horn. Stable mildly dilated third ventricle.Stable expected postoperative changes of a left-sided craniectomy. | 1.No evidence of any new acute intracranial process in particular hemorrhage since prior exam.2.Residual stable blood along the course of ventricular catheter.3.Stable dilated supratentorial ventricular system and a right-sided ventricular catheter.4.Stable blood in the dependent portion of bilateral occipital horns.5.Grossly stable diffuse periventricular white matter low attenuation (left greater than right) since prior exam. |
Generate impression based on findings. | Female 77 years old; Reason: eval extent of fx History: eval fx Transverse fracture through the surgical neck of the humerus with anterior and superior displacement of the distal fracture fragment by 1 shaft width. There is also anterior vertex angulation. A comminuted fracture is seen of the distal humerus involving the medial and lateral humeral condyles with intra-articular extension. Oblique fracture through the distal radial diaphysis with posteroinferior displacement of the distal fracture fragment by 8 mm. The distal ulnar diaphysis is also fractured with minimal posterior displacement of the distal fragment. Again seen is a old radial styloid fracture. The bones of the hand to not appear to be involved. Within the left upper abdomen is a complex fluid collection with high density layering material in the area of the expected left adrenal gland measuring 4.7 x 5.7 cm (series 3, image 218). Note is made of a aneurysmally dilated abdominal aorta up to 4.2 cm in diameter (series 3, image 209). Aortobiiliac atherosclerotic calcifications are also seen. | 1.Acute fractures through the surgical neck of the left humerus, distal humerus, distal radius and distal ulna as described above.2.Complex fluid collection with high density material in the left hemiabdomen in the area of the expected left adrenal gland. Adrenal hemorrhage is suspected. CT of the abdomen and pelvis is recommended for further evaluation.3.Aneurysmal dilation of the abdominal aorta up to 4.2 cm in diameter.These findings were discussed with the Orthopedic surgery resident on call, Dr. Kimberly Devine (pager 5539) at the time of this dictation by Dr. Michael Veronesi on 10/2/2013 at 0832 hours. |
Generate impression based on findings. | Clinical question: Stroke. Signs and symptoms: Stroke. Nonenhanced head CT:Findings consistent with a chronic left pica and left superior cerebellar artery territory ischemic stroke without change since prior exam.Stable left posterior temporal -- occipital ischemic stroke since prior study.A previously noted left MCA frontal lobe subacute ischemic stroke is more conspicuous on the current exam representing further evolution of stroke however without hemorrhagic conversion or change in size/extent.Revisualization of a stable patchy foci of low attenuation in the right frontal cortex and subcortical white matter consistent with subacute stroke. Stable small focus of hemorrhage in the right frontal lobe at the site of subacute ischemic stroke. Measuring approximately 6 times 4 mm sized on axial image 20. This finding was present on prior study on axial image 36. | 1.No detectable acute new finding since prior exam from 10 -- 1 -- 13. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.2.Stable multiple chronic ischemic strokes in supratentorial and infratentorial spaces.3.Stable multiple foci of subacute stroke with very minimal associated mass effect.4.Stable small focus of hemorrhage in the right frontal ischemic stroke measuring a 6 x 4-mm since prior exam.5.Stable normal size of ventricular system and maintained midline. |
Generate impression based on findings. | 72 year-old female status post MVR and TVR in ICU with right upper and lower extremity weakness. There is focal ex vacuo dilatation of the left frontal horn adjacent a well-defined region of hypoattenuation within the superior/middle aspect of the left putamen and external capsule representing encephalomalacia from a chronic stroke, likely hemorrhagic. No intra-cranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact.Orbits and paranasal sinuses are unremarkable. There are no bony abnormalities demonstrated. | Chronic sequela of stroke within the left basal ganglia without CT findings suggesting acute ischemia. Note that CT is suboptimal in its sensitivity for acute ischemia, and if concern persists MRI exam could be considered. |
Generate impression based on findings. | Headache and blurry vision with papilledema on ophthalmologic examination. There is no intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. Gray-white matter differentiation is maintained bilaterally and the midline is intact. This mucosal thickening within the sphenoid sinuses, sinusitis could be considered. Orbits and mastoid air cells are unremarkable. There are no visualized bony abnormalities. | Sphenoid sinus mucosal thickening which could represent sequelae of sinusitis. No other acute abnormalities demonstrated. |
Generate impression based on findings. | Reason: 61 F with cirrhosis who is being worked up for liver/kidney transplantation, please also eval for shunting in the portal system and iliac vessels in the context of possible kidney transplant. History: liver tx eval ABDOMEN:LUNG BASES: Bilateral basilar atelectasis or airspace disease, improved on the right and worsened on the left.LIVER, BILIARY TRACT: Enlarged liver with mottled appearance and irregular contours. Enlargement of the caudate and left lobe of the liver. Mild amount of ascites. There are two small subcentimeter hypodense lesions in the left lobe of the liver, segment 4a. Gallbladder sludge within the gallbladder. Hepatic arteries, hepatic veins, and portal veins are patent. SPLEEN: Portosystemic collaterals are visualized around the spleen. Borderline enlarged spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter lymph nodes. There is mild atherosclerotic calcifications of the aorta and iliac arteries at the aortoiliac bifurcation. There are no calcifications of the iliac arteries distally, bilaterally. Iliac veins are patent.BOWEL, MESENTERY: Nasogastric tube. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Collapsed bladder.LYMPH NODES: Bilateral scattered, subcentimeter inguinal lymph nodes.BOWEL, MESENTERY: Rectal tube is visualized. Postsurgical changes of the rectum.BONES, SOFT TISSUES: Sclerotic focus in the right sacral alae may represent a bone island.OTHER: No significant abnormality noted | 1.Enlarged liver with irregular contours in heterogeneous, mottled appearance is consistent with provided history. Hepatic vasculature is patent.2.Mild amount of ascites surrounding the liver.3.Mild atherosclerotic calcifications of the posterior portion of the aorta and iliac arteries at the aortoiliac bifurcation. Iliac arteries and veins are patent. |
Generate impression based on findings. | Gunshot wound, arterial injuryEXAMINATION: CTA of the lower extremities and CT of the abdomen/pelvis was performed after intravenous contrast administration of 90 mL of Omnipaque 350. No pre-contrast CT was performed in this pediatric patient to reduce radiation dose. 10/1/2013 2354 ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The kidneys enhance homogeneously and symmetrically. No hydronephrosis or perinephric stranding.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No free intraperitoneal air or bowel obstruction.BONES, SOFT TISSUES: No ascites.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No free intraperitoneal air or bowel obstruction.BONES, SOFT TISSUES: No pelvic free fluid.LOWER EXTREMITIES:Comminuted fracture of the left femoral diaphysis with subcutaneous air and bullet fragments. Low-density material within the left quadriceps muscle likely represents an intramuscular hematoma.The right leg vasculature is normal in appearance. The left common femoral and proximal/mid left superficial femoral arteries are normal in appearance. The entire left distal SFA is attenuated and appears irregular however no active contrast extravasation is seen. No left leg vasculature is seen distal to the popliteal artery. | 1.Distal left superficial femoral artery is attenuated and irregular. While there is no active contrast extravasation, arterial injury to this area cannot be excluded. Alternatively vasospasm may have a similar appearance.2.No left leg vasculature is seen distal to the popliteal artery which is likely due to phase of contrast and vasospasm/arterial injury to the distal left superficial femoral artery.3.Comminuted fracture of the left femoral diaphysis is again seen with left quadriceps intramuscular hematoma. |
Generate impression based on findings. | Clinical question: Evaluate for acute process. Signs and symptoms: Headache. Unenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic stroke.There is mild degradation of images due to motion artifact which makes detection of subtle findings difficult. This correlates with clinical exam and if concern for acute ischemic stroke is high consider an MRI exam.The cerebral cortical sulci, ventricular system and the CSF spaces remain normal. The gray -- white matter differentiation is preserved.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, visualized paranasal sinuses and bilateral mastoid air cells. | No acute intracranial process. Consider MRI if clinical concern for stroke is high. |
Generate impression based on findings. | Headache. Evaluate for elevated ICP. Interval removal of the left sided ventriculostomy catheter which was demonstrated on the prior exam. There are sequela of multiple prior ventriculostomy devices including bilateral frontal burr holes and tracts of encephalomalacia within bilateral frontal lobes. There are no acute abnormalities including intracranial mass, fluid collection, hemorrhage, hydrocephalus or evidence of acute ischemia. There are differentiation is maintained bilaterally the midline is intact. There are bilateral ocular prostheses with no intraorbital mass. Paranasal air sinuses mastoid air cells are unremarkable. | Interval removal of ventriculostomy catheter. No CT evidence of hydrocephalus at this time. |
Generate impression based on findings. | 55 M, altered, in respiratory distress, rule out intracranial process. There is a 9 mm diameter hypoattenuating focus in the left hemi-pons. There is also moderate scattered cerebral white matter hypoattenuation. There is no evidence of acute intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. There is partially imaged mild right maxillary sinus opacification. The skull and extracranial soft tissues are unremarkable. | 1. Hypoattenuating focus within the left hemipons may represent an infarct of indeterminate age. MRI and head/neck vascular imaging is recommended for further evaluation.2. Moderate nonspecific cerebral white matter hypoattenuation, which may represent small vessel ischemic disease or indeterminate age. 3. No evidence of acute intracranial hemorrhage. |
Generate impression based on findings. | Abdominal pain, right lower quadrant and midline. Appendicitis versus ovarian cyst. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a 2.3 x 2.0-cm enhancing nodule at the dome of the liver (image 16; series 3). Given patient age and lack of known malignancy, this probably represents a benign hemangioma but can be further characterized with a dedicated liver MRI as clinically indicated.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Basic appendix appears normal and air-filled. Distal appendix not easily visualized. No periappendiceal inflammation identified.PELVIS:UTERUS, ADNEXA: 2.6-cm right adnexal cystic structure. Suggest further evaluation with gynecologic ultrasound.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. 2.6-cm right adnexal cystic structure; suggest further evaluation with gynecologic ultrasound. 2. No definite evidence of appendicitis although the appendix is suboptimally visualized. 3. Enhancing liver mass; benign hemangioma is favored as described above but consider further evaluation with dedicated liver MRI. This finding was discussed with Dr. Babcock in the Emergency department at the time of dictation. |
Generate impression based on findings. | Clinical question: rule-out bleed. Signs and symptoms: Blown pupils. Portable nonenhanced head CT:Significantly degraded images due to portable technique as well as motion artifact. Subtle findings and including subarachnoid hemorrhage cannot be assessed. No evidence of parenchymal or intraventricular hemorrhage.No definitive evidence of mass effect including effacement of cortical sulci, mass effect on the lateral ventricles or midline shift present.The CSF cisterns remain widely patent. Images through posterior fossa demonstrate normal size of the fourth ventricle and in midline position. No convincing evidence of cerebellar parenchymal hemorrhage.Calvarium and soft tissues of the scalp are unremarkable.There is a large air-fluid level in the right maxillary sinus and the sphenoid sinus and minimal mucosal thickening of the other sinuses. Findings likely result of intubation.There is also complete opacification of right mastoid air cells and partially of the right middle ear cavity. Left mastoid air cells and middle ear cavity remains well pneumatized and | 1.Severely limited exam due to motion artifact and portable technique which precludes precise assessment for subtle findings including small focus of parenchymal edema, mass effect or subarachnoid hemorrhage. Consider repeat exam or an MRI study.2.Within this limitation no gross intracranial abnormality is detected.3.Fluid level within the right maxillary sinus and sphenoid sinus likely result of intubation.4.There is complete opacification of mastoid air cells and middle ear cavity on the right and unremarkable on the left. |
Generate impression based on findings. | Male 41 years old Reason: eval opacities/nodules, r/o pe History: new opacities Technically adequate study.PULMONARY ARTERIES: There is a small apparent filling defect in a left lower segmental pulmonary artery branch (image 150, series 7); however, when compared to the coronal and sagittal projections, there is displacement of this vessel representing artifact. No definite filling defect is identified. ALUNGS AND PLEURA: Multiple solid nodules of various sizes and a single mass in the right upper lobe measuring 37 x 35 mm (image 50, series 9), compatible with metastatic disease from the patient's known angiosarcoma.Diffuse bilateral patchy ground glass opacities seen scattered throughout the lung which may represent pulmonary hemorrhage.Small right pleural effusion and trace left pleural effusion.MEDIASTINUM AND HILA: There is a 7.0 x 5.0 cm extracardiac heterogeneous, hypervascular mass contiguous with the superior aspect of the right heart at the level of the aortic root and spreading superiorly to the left innominate vein compatible with local recurrence of the patient's angiosarcoma. The mass encircles the aortic root but spares the left cusp and encircles the ascending aorta greater than 180 degrees. The mass encases the right coronary artery, abuts the coronary sinus and extends into the interatrial septum. The mass extends between the superior vena cava and the aorta, displacing the superior vena cava laterally 28 mm with associated compression, with the SVC measuring 7 mm in diameter (series 7, image 21). The mass also extends anteriorly above the main pulmonary artery and produces mass-effect on the superior left atrium.Bilateral hilar lymphadenopathy, reference left hilar node measures 15 mm (image 112, series 7). There is no evidence of pericardial effusion and there is a small hiatal hernia.Sternal fixation hardware in place.CHEST WALL: There is hypoattenuation of the marrow of the mid thoracic spine consistent with post radiation changes. There is mild bilateral gynecomastia.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolus.2. Multiple pulmonary nodules and a single pulmonary mass consistent metastatic disease3. Large extracardiac mass concerning for local recurrence of patient's angiosarcoma.4. Hilar lymphadenopathy.5. Multiple ground glass opacities suspicious for pulmonary hemorrhage. |
Generate impression based on findings. | Reason: eval for PE History: eval for PE PULMONARY ARTERIES: No evidence of pulmonary embolus. The main pulmonary artery is dilated at 41 mm. In 2007, the main pulmonary artery measures approximately 36 mm transverse. The aorta at the similar level measures 34 mm. LUNGS AND PLEURA: Severe centrilobular emphysema which has progressed since 2007. Small pleural effusions, right greater than left, with associated compressive atelectasis.MEDIASTINUM AND HILA: There is biventricular enlargement. The right ventricle is not dilated greater than that of the left. No pericardial effusion.The left and right brachiocephalic veins are patent and free of filling defect. The superior vena cava is of normal caliber and contains a central line via the right internal jugular vein. The tip terminates within the right atrium. No external compression of the SVC is identified.There are multiple small lymph nodes in the supraclavicular, pretracheal aortopulmonary and right paratracheal locations. A representative aortopulmonary lymph node measures 9 mm in short axis (series 8 image 80), as compared to 6 mm and 2007. A right hilar lymph node has increased in size, now 15 mm, as compared to 8 mm on prior study.There is significant reflux of iodinated contrast into the super and intrahepatic IVC as well as the hepatic veins.CHEST WALL: Small amount of subcutaneous edema. There are multiple collateral veins filling with contrast. He centered low density at the central internal jugular vein may represent nonocclusive thrombus (series 8 image 18). This measures 1.0 x 0.8 centimeters.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Ascites of the visualized upper abdomen. Nasogastric tube is visualized in the stomach at the inferior field of view. | 1.No pulmonary embolus.2.Progressive cardiac enlargement since 2007 with biatrial and left ventricular chamber dilatation. Significant reflux into the supra-and intrahepatic IVC as well as the hepatic veins. Associated ascites visualized in the upper abdomen. Progressive main pulmonary artery dilation. The constellation of findings raises the question of pulmonary arterial hypertension and potential heart failure with tricuspid regurgitation. The patient has clinical stated gastric abscess and prior radiograph reports; however, given the abdominal ascites, reflux hepatopathy is a consideration. If the patient has not had echocardiography (images are not loaded on PACS), recommend cardiac workup.3.Progressive mediastinal lymphadenopathy. If the patient has clinical history of sarcoidosis, this may be a consideration. Otherwise, lymphoma may be considered. |
Generate impression based on findings. | Reason: Patient with ischemic stroke, admitted with hgb of 4. Please eval for small bowel lesion as a source of anemia. History: Anemia. ABDOMEN:LUNG BASES: Small bilateral pleural effusions, left greater than right with overlying compressive atelectasis, unchanged from the prior exam.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Calcified splenic granuloma.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel wall thickening or other abnormality. There is a lobular low-density mass in the cecum, which measures 2.7 x 3.0 x 1.0 cm (series 3, image 59). This finding was not present on the CT performed on 9/28/2013. There is retained contrast throughout the colon. Sigmoid diverticulosis without evidence of diverticulitis.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: Degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1.Lobular low density mass in the cecum not present on the CT exam performed 4 days prior. This finding may represent a blood clot or possibly a hypertrophied ileocecal valve. Malignancy is less likely. Colonoscopy may be helpful. 2.Small bilateral pleural effusions, unchanged. |
Generate impression based on findings. | Reason: rule out PE History: dyspnea on exertion PULMONARY ARTERIES: No evidence of a pulmonary embolus.LUNGS AND PLEURA: Moderate -sized right-sided pleural effusion with underlying atelectasis.Mild bronchial wall thickening.Nodular opacity in right middle lobe (image 73 series) measuring 10 mm increased in size from prior exam measuring 4 mm on that exam.Right apical pleural thickening and previous radiation therapy..MEDIASTINUM AND HILA: Cardiac enlargement without evidence of a pericardial effusion.Severe coronary artery calcification.New right cardiophrenic lymph nodes (image 164 series 7). CHEST WALL: Degenerative changes in the midthoracic spine.Status post right mastectomy. No evidence of axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of a pulmonary embolus.2.Moderate size right pleural effusion.3.Enlarging right middle lobe nodule and new right cardiophrenic lymph nodes concerning for metastatic disease. |
Generate impression based on findings. | Clinical question: Altered mental status. Signs and symptoms: Edema/bleed. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF cisterns and gray to white matter differentiation.New since prior exam from 2012 is evidence of acute hemorrhage in the posterior chamber of the left globe with resultant fluid fluid level. The hemorrhage measures approximately 5 mm in height measured on axial image 6.Calvarium and soft tissues of the scalp are unremarkable.All visualized paranasal sinuses, bilateral mastoid air cells and middle ear cavities are well pneumatized.Findings on this exam were discussed with the emergency department Dr. Christine Babcock #2054 at the time of review of the study. | 1.No acute intracranial process. CT however is insensitive for detection of acute nonhemorrhagic ischemic strokes. Unremarkable intracranial content.2.New since prior exam from 2012 is evidence of acute blood in the posterior chamber of left globe with resultant fluid/blood level as detailed |
Generate impression based on findings. | 49-year-old male. Evaluate vasculature support kidney transplant This study is limited due to lack of IV contrastABDOMEN: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: Atrophic kidneys compatible with patient's known history of chronic renal failureRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications involving the aorta and iliac vesselsBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Atrophic kidneys and mild atherosclerotic calcifications. |
Generate impression based on findings. | Male 29 years old Reason: Acute hypoxia and tachypnea - PE? History: hypoxia and tachypnea Technically adequate study.PULMONARY ARTERIES: No evidence of pulmonary embolism with normal sized pulmonary artery. LUNGS AND PLEURA: Residual streaky bibasilar opacities consistent with atelectasis with resolution of the previously seen ground glass component. Atelectasis of the lateral segment right middle lobe likely related to aspiration. Decreased bilateral lower lobe lung volumes.MEDIASTINUM AND HILA: Retained aspirated secretions in the trachea and bronchi.Small pericardial effusion unchanged. No evidence of mediastinal or hilar lymphadenopathy.The left ventricle is at the upper limit of normal in size.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. Bibasilar atelectasis and volume loss with associated retained aspirated secretions in the trachea and main stem bronchi, consistent with chronic aspiration.3. Unchanged small pericardial effusion. |
Generate impression based on findings. | Reason: 85 yo female with vaginal bleeding/hematuria and gram-neg bacteremia. Poor historian and source of infection unclear - looking for infectious source and/or mass to explain bleeding History: see above The lack of IV contrast limits evaluation of the mediastinum, lymph nodes, and solid organ pathology.CHEST:LUNGS AND PLEURA: Bilateral pleural effusions, right greater than left, with overlying compressive atelectasis. Evaluation of the lung parenchyma is limited by motion artifact.MEDIASTINUM AND HILA: No pericardial effusion. Coronary artery calcifications. Low-density cardiac blood pool is compatible with anemia.CHEST WALL: Body wall anasarca.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of a mildly tortuous abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. Body wall anasarca.OTHER: No significant abnormality noted.PELVIS: Evaluation of the pelvis is limited due to streak artifact of left hip arthroplasty.UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Fluid and air filled collection in the upper pelvis may represent the bladder, although given it's abnormally high location, abscess cannot be excluded. The bladder is not definitively seen, although the evaluation of the pelvis is markedly limited due to streak artifact.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large stool ball in the rectum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small amount of free fluid in the pelvis. | 1.Fluid and air filled collection in the upper pelvis may represent the bladder, although abscess cannot be excluded on this limited study. MRI may be helpful. 2.Bilateral pleural effusions.3.Findings discussed with Dr. Bassi by telephone at the time of dictation. |
Generate impression based on findings. | 38-year-old female with history of right lower quadrant pain. History of colon cancer. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple new hypodense lesions in the liver. The lesions demonstrate lacelike enhancement, suggestive of an abscess, however, metastatic disease given the history of colon cancer cannot be excluded. An index lesion near the dome measures 2.5 by 2-cm image number 8, series number 3.Small hemangiomas, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Slightly malrotated kidney, unchanged.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: The patient is status post hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes involving the pelvis. Small amount of fluid in the pelvis. There is a 4 x 1.8 cm collection with thick walls near the anastomoses on image number 80, series number 3.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New liver lesions which may represent abscesses versus metastatic disease.Pelvic fluid collection suspicious for an abscess near the anastomoses.These findings were corticated with Dr. Hong's nurse Stephanie at the time of dictation. |
Generate impression based on findings. | 73 year-old female with history of CLL. There is extensive diffuse cervical lymphadenopathy, which has overall increased in size since March 2011. For example, a left level 5 lymph node now measures 18 x 28 mm, previously 4 x 6 mm, and a right level 2 lymph node now measures 14 x 18 mm, previously 7 x 10 mm. The upper airways are patent. The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. There is an unchanged right thyroid nodule that measures up to 7 mm. The major salivary glands are unremarkable. The osseous structures are unremarkable. There is calcific atherosclerosis affecting the carotid bifurcations. The paranasal sinuses and mastoid air cells are clear. The imaged intracranial structures and orbits are grossly unremarkable. There is unchanged apical scarring. Refer to the concurrent chest CT for additional details. | Interval increase in diffuse cervical lymphadenopathy since March 2011, indicating progression of CLL. No evidence of airway compromise. Discussed with Dr. Kline at 9:00 AM on 10/2/13. |
Generate impression based on findings. | Reason: Pt with HNSCC on chemo; please evaluate response History: as above CHEST:LUNGS AND PLEURA: Stable small scattered micronodules, some of which are calcified. No suspicious pulmonary nodules or new pleural effusion. Pleural calcification consistent with prior asbestos exposure.MEDIASTINUM AND HILA: The sternum is well approximated with wires. There is evidence of prior coronary artery revascularization with extensive native coronary artery calcification. Aortic valve is mildly calcified.No mediastinal or hilar lymphadenopathy.The heart size is normal. No pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Calcified appendicoliths again identified without inflammation.BONES, SOFT TISSUES: Multilevel degenerative changes of the thoracic and lumbar spine. Fusion of L2-3, stable. Extensive atherosclerotic disease involving the abdominal aorta. OTHER: The urinary bladder is markedly distended, extending into the inferior abdomen. | No evidence of metastases. |
Generate impression based on findings. | Reason: 66F w/ CD and intraabdominal abscess s/p IR drainage now with persistent leukocytosis; assess for resolution History: persistent leukocytosis, hx intraabdominal abscess The lack of IV contrast limits evaluation of lymph nodes and solid organ pathology.ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Cholecystectomy clips.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive left mid pole calculus measures 4 mm.RETROPERITONEUM, LYMPH NODES: Atherosclerosis of the abdominal aorta.BOWEL, MESENTERY: Status post partial colectomy with primary anastomosis. Persistently dilated loops of small bowel proximal to the suture line. Infraumbilical percutaneous catheter with its tip terminating in the site of previously described fluid collection, which is now resolved. There are moderate surrounding inflammatory changes without drainable fluid collection. There are scattered prominent mesenteric lymph nodes, likely reactive. 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: Prominent pelvic lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Resolution of intra-abdominal fluid collection with persistent surrounding inflammatory changes. 2.Postsurgical changes with persistently dilated loops of small bowel proximal to the suture line. |
Generate impression based on findings. | 32 year-old male with possible abdominal abscess below the stoma site ABDOMEN:LUNG BASES: Linear atelectasis at the lung bases.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: Status post colectomy. Postsurgical changes in the abdomen. No evidence of abscess. Small amount of fluid. The right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of abscess or bowel obstruction. Small amount of fluid in the abdomen. |
Generate impression based on findings. | 76-year-old female with history of CLL This study is limited due to lack of IV contrast.CHEST:LUNGS AND PLEURA: Apical fibrosis. Calcified granulomas.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Index right axillary lymph node measures 2.6 x 1.5 cm on image number 24, series number 3, not significantly changed from previous study. Other bilateral axillary adenopathy is also grossly unchanged. Limited visualization of the supraclavicular and neck adenopathy, grossly unchanged.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral mild calyectasis, unchanged.RETROPERITONEUM, LYMPH NODES: Extensive confluent retroperitoneal adenopathy, again noted. Index left para-aortic lymph node measures 3.2 by 2-cm on image number 99, series number 3, not significantly changed from previous study. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic adenopathy. Index left inguinal lymph node measures 1.5 by 1 cm image number 166, series number 3. Other pelvic adenopathy is also unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Limited study due to the provided contrast. No significant change in the size and number of axillary, retroperitoneal and pelvic adenopathy. |
Generate impression based on findings. | Reason: Any evidence of intra or extra hepatic ductal dilation, unable to tolerate IV contrast or MRCP History: S/p idiopathic ALF and bilirubin of 15 with normal liver enzymes. 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: Large right pleural effusion and moderate-sized left pleural effusion.LIVER, BILIARY TRACT: Hypodense lesion in the right lobe of the liver measuring 1.5 x 1.6 cm. due to lack of IV contrast, the lesion cannot be further characterized but has been described on prior ultrasound as a potential hemangioma. No evidence of intrahepatic or extrahepatic biliary ductal dilatation. Status post cholecystectomy. Liver with cirrhotic morphology.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas suggestive of fatty infiltration.ADRENAL GLANDS: Left adrenal lesion measuring 1.4 x 1.3 cm.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered benign appearing lymph nodes.BOWEL, MESENTERY: Fluid around the liver and in the right pericolic gutter likely ascites.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: Moderate amount of pelvic ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Large right pleural effusion and moderate left effusion.2.Hypodense lesion in the right lobe of the liver cannot be further characterized due to lack of IV contrast but is described on prior ultrasound as a possible hemangioma.3.Moderate amount of abdominal and pelvic ascites.4.No evidence of intrahepatic or extrahepatic biliary ductal dilatation. |
Generate impression based on findings. | 72-year-old female. Metastatic breast cancer. There has been interval development of necrosis within many of the metastatic left cervical and parotid lymph nodes. The affected lymph nodes are generally stable in size. For example, a conglomerate of left level 2A lymph nodes measures 15 x 13 mm, previously 14 x 13 mm, but contains extensive areas of central hypoattenuation. A superficial left parotid lymph node now measures 7 x 7 mm, previously 7 x 6 mm, but contains central hypoattenuation. However, there has been interval increase in size of a left axillary lymph node with ill-defined borders, now measures 16 mm in short axis, previously 12 mm. A heterogeneously enhancing left upper chest wall mass is incompletely imaged, but also appears to have enlarged. The aerodigestive tract is patent. The thyroid gland appears unchanged with a possible ill-defined left lobe nodule that measures approximately 15 mm. The major cervical vessels are patent. A right internal jugular venous catheter is in position. There has been interval decrease in size of an enhancing right hypothalamic lesion, which now measures 9 x 8 mm, previously 12 x 11 mm. In addition, the previously demonstrated enhancing lesions within the vermis and right cerebellar hemisphere are not discernable. There are no focal osseous abnormalities. There is a small right maxillary sinus mucus retention cyst. The imaged portions of the lungs are unremarkable. Refer to the separate chest CT for additional details. | 1. Interval development necrosis within the metastatic left intraparotid and left cervical lymphadenopathy without significant interval change in size. However, an left axillary and anterior chest wall mass have increased in size.2. The brain metastasis appear to have decreased in size and conspicuity. |
Generate impression based on findings. | Male; 66 years old. Reason: r/o PE, hx of rheumatoid arthritis History: CP, SOB. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Anterior and basilar predominant subpleural reticular opacities, traction bronchiectasis, and architectural distortion in a honeycombing pattern, appearing similar to the prior CT. These findings are compatible with atypical UIP secondary to rheumatoid arthritis.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Dense coronary artery calcifications. Mildly enlarged mediastinal and hilar lymph nodes, some of which are calcified. Residual thymic tissue in anterior mediastinum. CHEST WALL: Mild multilevel degenerative disease affects the visualized spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Calcification is again noted near the cystic duct. | 1.No evidence of pulmonary embolism.2.Atypical UIP pattern as described above, not significantly changed and compatible with the patient's known history of rheumatoid arthritis. |
Generate impression based on findings. | Reason: PE with hemorrhage. Please evaluate for progression of hemorrhage History: PE LUNGS AND PLEURA: Previously noted focus of ground glass opacity within the central right upper and superior aspect of the right middle lobes has slightly increased (series 80349 image 42). The previously identified focus of concentrated groundglass which abuts the minor fissure, bridging the right upper and middle lobes (series 80349 image 49 and series 5 image 34) has remained stable in appearance. The constellation of findings in the setting of large embolus burden is consistent with pulmonary hemorrhage.There are dependent patchy foci of consolidation in a linear distribution, slightly atypical for infarct, that favor subsegmental atelectasis. However, small peripheral infarcts involving the posterior basal segments of the lower lobes remain in the differential (series 5 image 66). No significant pleural effusion. MEDIASTINUM AND HILA: There are two TPA infusion catheters that traverse the inferior vena cava and enter the right and left pulmonary arteries. The right catheter terminates within a subsegmental lower lobe pulmonary arterial branch (series 5 image 52). The second terminates within a left lower segmental branch (series 5 image 52). Although intravenous contrast was not utilized, the overall caliber of the lower lobe pulmonary arteries (lobar and segmental branches) in the setting of known pulmonary emboli, have not significantly changed in diameter.There is a large amount of thymic tissue given the patient's age interspersed with fat which may represent rebound hyperplasia. No focal nodule is identified. No interval mediastinal or hilar lymphadenopathy. The heart size remains normal. No interval pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. High density within the gallbladder is suggestive of vicarious excretion with residual high density within the collecting system, raising a question of impaired renal function. | 1. Previously noted focus of ground glass opacity within the central right upper and superior aspect of the right middle lobes has slightly increased. The previously identified focus of concentrated groundglass which abuts the minor fissure, bridging the right upper and middle lobeshas remained stable in appearance. The constellation of findings in the setting of large embolus burden is consistent with pulmonary hemorrhage.2. There are two TPA infusion catheters that traverse the inferior vena cava and enter the bilateral pulmonary arteries. The overall caliber of the lower lobe pulmonary arteries in the setting of known pulmonary emboli, have not significantly changed in diameter.3. Dependent patchy foci of consolidation in a linear distribution, slightly atypical for infarct, that favor subsegmental atelectasis.4. High density within the gallbladder is suggestive of vicarious excretion with residual high density within the collecting system, raising a question of impaired renal function. |
Generate impression based on findings. | Reason: s/p Whipple 2 weeks ago now w/ elevated WBC - please eval for abscess History: Elevated WBC ABDOMEN:LUNG BASES: Small right pleural effusion is unchanged.LIVER, BILIARY TRACT: Pneumobilia compatible with postoperative change. Interval removal of intra-abdominal surgical drain, previously terminating in the gallbladder fossa.SPLEEN: Interval decrease in splenic vein narrowing at the portosplenic confluence.PANCREAS: Status post Whipple procedure. The pancreatic tail is unremarkable. There is decreasing non loculated peripancreatic fluid. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Prominent mesenteric and retroperitoneal lymph nodes, likely reactive.BOWEL, MESENTERY: Decreasing colonic wall thickening and mesenteric stranding. No drainable fluid collections in the abdomen or pelvis. No free air or pneumatosis. No evidence of bowel obstruction.BONES, SOFT TISSUES: Body wall anasarca.OTHER: Interval removal of an enteric tube.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.Decreasing intra-abdominal inflammatory changes and non-loculated fluid compatible with postsurgical changes.2.No evidence of obstruction or drainable fluid collections. |
Generate impression based on findings. | Male, 69 years old, history of head and neck squamous cell cancer on chemotherapy. No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact.Mild mucosal irregularity persists at the level of the left tongue base and vallecula. This is unchanged relative to the immediate prior examination. The appearance remains improved relative to the older examination from 07/25/13.No pathologic adenopathy is detected in the neck by size criteria. Cervical vessels are patent with atherosclerotic calcification of the bifurcations. The salivary glands and thyroid are free of focal lesions. Lung apices are clear. Evaluation of the bones in the cervical region is limited by artifact, but no definite suspicious bony lesions are seen. | 1. Stable examination of the neck with no evidence of progressive disease or pathologic adenopathy.2. No intracranial metastatic disease. |
Generate impression based on findings. | Reason: Location of G tube. GI notified not in correct location via KUB after placement History: Location of G tube. GI notified not in correct location via KUB after placement 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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerosis of the abdominal aorta and its branches without aneurysmal dilatation.BOWEL, MESENTERY: No evidence of obstruction, free air, pneumatosis, or free fluid in the abdomen/pelvis.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine.OTHER: Mushroom retained gastrostomy tube in the stomach without evidence of complication.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 significant abnormality noted. |
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